Medicare has strict rules about who can enroll, and immigration status is one of them
To get Medicare, you must be a U.S. citizen or a lawful permanent resident (green card holder) who has lived in the United States for at least five consecutive years. If you are not a citizen or lawful permanent resident, you cannot enroll in Medicare, even if you are over 65 or have a may have access to disability.
This is a federal rule set by the Centers for Medicare & Medicaid Services (CMS). It applies to all Medicare programs — Part A (hospital insurance), Part B (medical insurance), Part D (prescription drug coverage), and Medicare Advantage plans. There are no exceptions or workarounds based on how long you have lived here, how much you have paid in taxes, or your health status.
If you are not may be able to access for Medicare because of your immigration status, you may have other options for health coverage. Those options depend on where you live, your age, your income, and whether you may have access to for Medicaid in your state.
Key Takeaways
- Only U.S. citizens and lawful permanent residents who have lived in the country for at least five years can enroll in Medicare.
- Immigration status is checked when you first explore for Medicare, and CMS verifies it through the Department of Homeland Security.
- If you are not may be able to access for Medicare, you may be able to get coverage through your state's Medicaid program, a health insurance marketplace plan, or employer coverage.
- Some states offer limited health programs to certain groups regardless of immigration status, though these are not Medicare.
How Medicare Checks Immigration Status
When you explore for Medicare, the Social Security Administration (SSA) or the Railroad Retirement Board (RRB) will ask you to prove your citizenship or lawful permanent resident status. You will need to provide documents such as a birth certificate, passport, naturalization certificate, or green card.
CMS then verifies your status through the Department of Homeland Security's immigration database. If the verification fails or cannot be completed, your process will be denied. You can appeal the decision, but the appeal process requires you to provide additional proof of your status.
This verification happens whether you explore at a Social Security office, online, or by phone. There is no way around it — it is a required step in the enrollment process.
What Happens If You Are Not a Citizen or Lawful Permanent Resident
If you do not meet Medicare's immigration requirements, you cannot enroll in any part of Medicare. This means you cannot get hospital insurance (Part A) or medical insurance (Part B) through the federal program, even if you are 65 or older or have end-stage renal disease or ALS.
You also cannot enroll in Medicare Advantage plans or prescription drug plans (Part D), because these are Medicare programs and carry the same may be able to access rules.
If you have already been paying Medicare taxes through your job, those payments do not change the rule. You cannot use past tax payments to override the immigration requirement.
Medicaid as an Alternative for Some People
Medicaid is a separate program from Medicare, and it has different rules. Some states cover people regardless of immigration status, while others do not. The rules vary widely by state and by age group.
If you are over 65, blind, or disabled, you may be able to get Medicaid in your state even if you are not a citizen or lawful permanent resident. Some states have programs specifically for older adults or people with disabilities that do not require citizenship. Other states limit coverage to citizens and lawful permanent residents only.
To find out what Medicaid covers in your state, contact your state's Medicaid office or call 211. You can also visit your state health department's website to learn about income limits and what documents you will need to bring.
Health Insurance Marketplace Plans
The health insurance marketplace (also called the ACA marketplace or healthcare.gov) offers plans in every state. To enroll in a marketplace plan, you must be a U.S. citizen, national, or lawful permanent resident. Undocumented immigrants cannot enroll in marketplace plans.
However, some states have created their own health programs outside the federal marketplace that may cover people regardless of immigration status. These programs are not Medicare or marketplace plans — they are state-run programs with their own rules and costs. California, New York, Illinois, and a few other states have programs like this, but they are not available everywhere.
If you live in a state with such a program, your state health department or 211 can tell you whether you are may be able to access and how to sign up.
Employer Health Insurance and Other Coverage
If you work for an employer that offers health insurance, you may be able to enroll in that plan regardless of your immigration status. Employer plans are not subject to the same federal citizenship rules as Medicare and marketplace plans.
Some employers also offer coverage to family members of employees, which may include people who are not citizens or lawful permanent residents. If you have access to employer coverage, that is often the fastest way to get health insurance.
You can also look into community health centers, which provide primary care and preventive services on a sliding fee scale based on income. These centers do not require proof of citizenship or immigration status.
What to Do If You Are Nearing 65
If you are approaching age 65 and are not a citizen or lawful permanent resident, you should start looking into your state's Medicaid program and any state-specific health programs now, rather than waiting until you turn 65. Some states have different rules for people over 65, and enrollment periods may be limited.
Contact your state Medicaid office or call 211 to ask what coverage options are available to you in your state. Bring information about your income, household size, and current health coverage (if any). Having this information ready will speed up the process.
If you are a lawful permanent resident who has not yet lived in the United States for five years, mark your calendar for the date you will reach five years. You can enroll in Medicare during the month you reach that milestone, even if you have not yet turned 65 (if you have a may have access to disability or condition).
Frequently Asked Questions
Can I get Medicare if I have a green card but have not lived here five years?
No. You must be a lawful permanent resident and have lived in the United States for at least five consecutive years. If you have not reached five years yet, you cannot enroll in Medicare. Once you reach five years, you can enroll during your enrollment period.
What if I was born in the U.S. but do not have a birth certificate?
You can still prove citizenship with other documents, such as a passport, naturalization certificate, or even a driver's license from most states. Contact Social Security to ask which documents they will accept. You may need to order a birth certificate from your state's vital records office if other documents are not available.
Can I appeal if Medicare denies me because of immigration status?
Yes, you can appeal. You will need to provide additional proof of your citizenship or lawful permanent resident status. Contact Social Security or the Railroad Retirement Board to ask what documents they need. The appeal process can take several weeks.
Do I have to report my immigration status to get other health coverage?
It depends on the program. Medicaid, marketplace plans, and employer insurance all have different rules. Some state programs do not ask about immigration status at all. Call 211 or your state health department to find out what you need to provide for the programs available in your state.
What if I become a citizen after I turn 65?
Once you become a U.S. citizen, you can enroll in Medicare. You will have a special enrollment period that lasts eight months from the month you become a citizen. Contact Social Security to start the enrollment process.