Medicare Enrollment Ends December 7: What Changes for 2027, Plus the Part A Bill Immigrants Do Not Expect

By Max Stephani

If you have Medicare, December 7, 2026 is the date you need to know.

Medicare’s annual Open Enrollment period runs from October 15 through December 7, 2026, and changes made during that window take effect January 1, 2027. This is when you can change Medicare Advantage or Part D coverage for the coming year.

But immigrants approaching Medicare age have another issue to think about.

A green card holder who spent most of their working life outside the United States may not have enough U.S. work credits for free Medicare Part A. Instead, they may have to pay hundreds of dollars every month just for hospital coverage.

In 2026, that means $311 or $565 per month, depending on the person’s work history. And if someone who has to buy Part A waits too long to enroll, the premium can increase by another 10% for a period of time.

The rules are not the same for every immigrant. Your immigration status, U.S. work history, age, and previous health coverage can all matter.

Here is what changes for 2027 and what immigrants approaching Medicare need to watch.

December 7 is the big deadline for 2027 coverage

Medicare’s Annual Enrollment Period runs from:

October 15, 2026 → December 7, 2026

During this period, people with Medicare can:

• Join, switch, or drop a Medicare Advantage plan
• Switch between Medicare Advantage and Original Medicare
• Join, switch, or drop a Medicare Part D prescription drug plan

Changes made during this period generally take effect January 1, 2027.

But missing December 7 does not necessarily mean you are stuck until the end of 2027.

If you are already enrolled in Medicare Advantage, you have another opportunity from January 1 through March 31, 2027. During that Medicare Advantage Open Enrollment Period, you can switch to another Medicare Advantage plan or return to Original Medicare and, if needed, join a separate Part D plan.

There are also Special Enrollment Periods for certain life events, such as losing qualifying coverage or moving.

The December deadline is still important because it is the main opportunity to choose your coverage for the new year.

2027 brings a bigger Part D deductible and higher drug-cost ceiling

One of the biggest changes for everyone with Medicare prescription drug coverage is the Part D cost structure.

For 2027:

The $700 figure is the maximum standard Part D deductible. Individual plans can charge less, including a $0 deductible.

The annual out-of-pocket threshold for covered Part D drugs rises from $2,100 to $2,400 in 2027. Once you reach that threshold, covered Part D drugs are subject to the catastrophic-coverage rules and your out-of-pocket cost for those covered drugs falls to $0 for the rest of the year.

The $41.33 national base beneficiary premium is also important because it is used to calculate Part D late-enrollment penalties. CMS announced the figure in July 2026.

There is another change worth knowing about: CMS is ending the Part D Premium Stabilization Demonstration after 2026. The voluntary program was introduced in 2025 to limit volatility in standalone Part D premiums. CMS says plans will return to the traditional market structure for 2027.

That does not mean every Part D premium will automatically rise. It means you should not assume that the plan you had in 2026 will have the same premium, deductible, formulary, or pharmacy network in 2027.

Check the actual 2027 plan before letting your current coverage roll over.

Part B is another cost to watch

The standard Medicare Part B premium for 2026 is $202.90 per month, with a $283 annual deductible. Higher-income beneficiaries can pay more through the Income-Related Monthly Adjustment Amount, or IRMAA.

The 2027 Part B premium had not yet been announced as of September 21, 2026.

That number normally becomes available later in the year, so do not treat the 2026 figure as your 2027 bill.

And there is an important distinction here: changing your Medicare Advantage or Part D plan during Open Enrollment does not eliminate your underlying Part B premium.

The immigrant-specific problem: Medicare Part A is not automatically free

This is where a lot of people who immigrated later in life get caught off guard.

Most people with enough U.S. work history receive premium-free Part A, because they or their spouse paid Medicare taxes for the required period.

The usual benchmark is 40 quarters of Medicare-covered work, roughly 10 years.

But work performed outside the United States generally does not create those U.S. Medicare work credits.

So imagine someone who moves to the United States at 55, gets a green card, works for several years, and reaches 65 with only a handful of U.S. quarters.

They can still potentially qualify for Medicare, but they may not qualify for premium-free Part A.

In 2026, the Part A premiums are:

• $311 per month with 30 to 39 quarters of qualifying work
• $565 per month with fewer than 30 quarters

Those are the 2026 amounts. The 2027 Part A premiums had not yet been announced as of September 21, 2026.

And there is an important detail: if you are buying Part A rather than getting it premium-free, you generally also have to enroll in Part B and pay the Part B premium.

So someone without enough U.S. work history could potentially face both bills.

At 2026 rates, that could mean:

$565 Part A + $202.90 Part B = $767.90 per month

before considering Part D, Medicare Advantage, Medigap, or any income-related adjustment.

That is why the phrase “Medicare is free after 65” can be dangerously incomplete for people who immigrated later in life.

There is also a five-year residency rule

Having a green card does not automatically mean you can immediately buy into Medicare.

For people who are not entitled to premium-free Part A and are seeking Medicare based on age, CMS says a lawful permanent resident generally must have lived in the United States for five continuous years immediately before applying. The person must also meet the other Medicare eligibility requirements.

That creates a situation that can surprise newer immigrants.

Someone could be:

• 65 or older
• a green card holder
• living legally in the United States
• without enough U.S. work credits

and still have to satisfy the five-year residence requirement before buying Medicare coverage.

This is particularly important for people who receive a green card later in life.

Waiting too long can create permanent penalties

The other expensive mistake is simply waiting.

Part B

The Part B late-enrollment penalty is generally 10% of the standard Part B premium for every full 12-month period that you could have had Part B but did not enroll.

The penalty generally continues for as long as you have Part B.

For example, if someone went two full years without Part B and did not qualify for a Special Enrollment Period, the penalty would be 20%.

Using the 2026 standard Part B premium of $202.90, that would add about $40.58 per month.

And because the penalty is tied to the Part B premium, the dollar amount can change when the standard premium changes.

Part D

Part D works differently.

The penalty is generally:

1% × the national base beneficiary premium × each full month without Part D or other creditable drug coverage

For 2026, the base beneficiary premium is $38.99. For 2027, it is $41.33.

So someone who went 14 full months without Part D or creditable prescription drug coverage would face a penalty based on 14% of the applicable base premium.

The penalty generally continues for as long as the person has Medicare drug coverage.

However, simply having another health insurance plan does not automatically protect you. The prescription coverage must generally qualify as creditable drug coverage.

Employer or union drug coverage can qualify, but you should verify this with the plan rather than assume it does.

Part A

If you have to buy Part A and delay enrollment, the rules are different again.

The Part A late-enrollment penalty can increase your monthly premium by 10%, and you generally pay that higher premium for twice the number of years you delayed.

For example, a two-year delay can result in the higher premium for four years.

That is very different from the Part B and Part D penalties, which generally continue for as long as you maintain that coverage.

Your first Medicare enrollment window is not the same as Open Enrollment

This distinction matters.

The Initial Enrollment Period around age 65 is generally seven months long:

• Three months before your 65th birthday month
• Your birthday month
• Three months afterward

The October 15 to December 7 period is a different enrollment window. It is primarily for changing Medicare Advantage and Part D coverage for the following year.

If you are approaching 65 for the first time, do not wait until October to start figuring out Medicare.

Your initial enrollment decisions can affect premiums, coverage, and potential late penalties for years.

And if you have employer coverage, check whether it qualifies you for a Special Enrollment Period before deciding to delay Part B. Medicare specifically warns that the rules depend on the type of coverage you have.

A major 2027 change for some immigrants: Medicare eligibility itself is changing

There is another change that is especially important for immigrants.

Section 71201 of the Working Families Tax Cut legislation, Public Law 119-21, limits Medicare eligibility to four immigration-status categories:

1. U.S. citizens and nationals
2. Lawful permanent residents
3. Cuban and Haitian entrants
4. Certain individuals lawfully residing in the United States under a Compact of Free Association

CMS is implementing the change for 2027.

That means green card holders remain within the eligible group.

But several other immigration categories that were previously relevant to Medicare eligibility are not included in the new four-category list.

This includes people who are in the United States as refugees, asylees, or people with Temporary Protected Status (TPS).

CMS’s 2027 implementation materials say the agency is establishing procedures for identifying people who become ineligible, terminating coverage, providing appeal rights, and allowing people to enroll again if they later regain eligibility.

This is a significant change, and anyone in one of these immigration categories should not assume that an existing Medicare card means coverage will simply continue unchanged into 2027.

What immigrants should check before December 7

If you are a green card holder or another immigrant approaching or already receiving Medicare, do not look only at the monthly plan premium.

Check these items:

1. Your Medicare work credits

Find out whether you qualify for premium-free Part A through your own work history or a spouse’s work history.

2. Your Part A premium

If you have fewer than 40 quarters, find out whether you would pay the reduced or full premium.

3. Your five-year residency history

If you are a permanent resident without enough work credits, confirm that you satisfy the five-year continuous U.S. residence requirement before applying.

4. Your Part B penalty risk

If you delayed Part B, determine whether you had a qualifying Special Enrollment Period.

5. Your Part D coverage

Check whether you have creditable prescription drug coverage. Do not assume that any private health insurance automatically counts.

6. Your 2027 drug plan

Compare the actual 2027 premium, deductible, covered drugs, pharmacies, and other costs rather than automatically keeping the 2026 plan.

7. Your immigration category

If you are not a U.S. citizen or green card holder, check whether the 2027 eligibility changes affect you.

The 2026 to 2027 Medicare numbers to know

The 2027 Part D figures have been finalized by CMS. The 2027 Part B and Part A premium figures were not yet available as of September 21, 2026.

Where to get help

For plan comparisons, use Medicare’s Plan Compare tool at Medicare.gov.

You can also call 1-800-MEDICARE (1-800-633-4227).

For free, personalized counseling, the State Health Insurance Assistance Program (SHIP) provides Medicare counseling in every state.

If you need to enroll in Part A or Part B, enrollment is handled through the Social Security Administration.

The important point for immigrants is simple: Medicare is not one-size-fits-all.

A person who worked in the United States for 40 quarters can have a very different Part A bill from someone who arrived at 60 and spent most of their career abroad. And someone with a green card can face a different eligibility situation in 2027 from someone with another immigration status.

If you are approaching 65, do not wait until December 7 to discover what your Medicare actually costs.

Sources: Medicare.gov (enrollment window, Part D costs, avoiding late penalties); CMS.gov (2026 Part A and B premiums, 2027 Part C and D announcement, CY2027 eligibility groups, five-year residence rule); SSA Medicare enrollment.