Permanent Residents and Medicare may be able to access

Permanent residents (also called green card holders) cannot get Medicare based on their immigration status alone. Medicare requires either U.S. citizenship or a specific work history in the United States. A green card does not meet that requirement, even if you have held it for many years.

However, some permanent residents do may have access to for Medicare through a different path: if you have worked in the U.S. long enough to earn Social Security credits, you may be may be able to access when you turn 65, regardless of your citizenship status. This is the key distinction — your work record matters more than your immigration status.

If you do not have enough work credits and are not a citizen, you will need to look at other insurance options. Many states offer programs for uninsured or underinsured residents that do not require citizenship, and some permanent residents may also be able to purchase private health insurance through the marketplace.

Key Takeaways

  • Permanent residents cannot enroll in Medicare based on green card status alone, even after holding it for decades.
  • If you have worked in the U.S. for at least 10 years (40 Social Security credits), you may may have access to for Medicare at 65 regardless of citizenship.
  • Permanent residents without enough work credits should explore state health programs, Medicaid (which does not require citizenship in most states), or private marketplace insurance.
  • Your Social Security record is what determines Medicare may be able to access for non-citizens, so you can check your work credits online through your Social Security account.

How Work Credits Determine Your Medicare may be able to access

To get Medicare at 65 without being a U.S. citizen, you need 40 Social Security credits. You earn one credit for every $1,640 of wages you pay Social Security taxes on (this dollar amount changes each year). Most people earn four credits per year, which means 10 years of full-time work gives you the 40 credits you need.

The work does not have to be recent. If you worked in the U.S. 30 years ago and paid into Social Security, those credits still count. You can check how many credits you have by creating a my Social Security account at ssa.gov. The account shows your complete earnings record and tells you exactly how many credits you have accumulated.

If you are close to 40 credits but not quite there, you may still have options. Some permanent residents can count work done in other countries if the U.S. has a totalization agreement with that country. Mexico, Canada, and several European nations have these agreements. Social Security can tell you whether your foreign work counts toward the 40-credit requirement.

What to Do If You Do Not Have Enough Work Credits

If you have fewer than 40 credits and do not plan to work more, you cannot get Medicare through the standard path. At that point, your options depend on your age, income, and which state you live in.

Medicaid is often the next step. Unlike Medicare, Medicaid does not require work credits or citizenship in most states. You can be a permanent resident and still may have access to for Medicaid if your income is low enough. Income limits vary by state — some are very restrictive, others more generous. You explore through your state's Medicaid office or through the healthcare marketplace.

If your income is too high for Medicaid but you cannot get Medicare, you can buy private health insurance through the healthcare marketplace (healthcare.gov). Permanent residents can purchase plans there. You may also be able to get a subsidy to lower your monthly premium if your income falls within certain ranges, even without citizenship.

Permanent Residents Who Become Citizens

If you become a U.S. citizen, the rules change when ready. Once you are a citizen, you become may be able to access for Medicare at 65 even if you have zero work credits. You do not need to have worked in the U.S. at all. Citizenship alone is enough.

Some permanent residents choose to pursue citizenship specifically to find Medicare coverage later. If you are considering this, keep in mind that the naturalization process takes time — typically 8 to 12 months after you file — so plan ahead if you are approaching 65.

If you become a citizen before 65, you can enroll in Medicare starting three months before the month you turn 65. You will receive a notice from Social Security about enrollment, but you should not wait for it — contact Social Security or Medicare directly to make sure you are signed up on time.

State Programs That Do Not Require Citizenship

Many states run health programs for residents who do not may have access to for Medicare or Medicaid, or who are waiting for Medicaid approval. These programs often do not require citizenship. California, New York, Illinois, and Texas all have programs that cover permanent residents based on income and residency, not immigration status.

The names and rules vary widely by state. Some cover preventive care only; others cover emergency and urgent care. A few cover more comprehensive services. Your state health department website lists what is available, or you can call 211 (a free referral line) and ask what uninsured or underinsured programs exist for permanent residents in your area.

If you are over 65 and a permanent resident without Medicare, asking about state programs should be one of your first steps. Some states have programs specifically for seniors that do not require citizenship or work history.

How to Check Your Social Security Work Credits

The fastest way to find out whether you have 40 credits is to check yourself online. Go to ssa.gov and create a my Social Security account. You will need your Social Security number, email address, and a way to verify your identity (usually a phone number or address on file).

Once you are logged in, click "Earnings Record" to see every year you paid Social Security taxes and how much you earned. At the bottom of the page, it will tell you how many credits you have. If you have 40 or more, you are on track for Medicare at 65 (assuming you remain a permanent resident or become a citizen).

If you do not have a my Social Security account or prefer to speak with someone, you can call Social Security at 1-800-772-1213. Have your Social Security number ready. They can tell you your credit count over the phone, though the call may take 15 to 30 minutes depending on wait times.

Frequently Asked Questions

Can I get Medicare if I have been a permanent resident for 20 years?

Only if you have worked in the U.S. long enough to earn 40 Social Security credits. Length of permanent residency does not matter — only your work record. Check your Social Security account to see how many credits you have accumulated.

What happens if I turn 65 and do not have Medicare or Medicaid?

You will need to purchase private health insurance through the healthcare marketplace or explore state programs for uninsured seniors. Permanent residents can buy marketplace plans. You may also may have access to for a subsidy to lower your premium based on your income.

If I work more years, can I earn enough credits to get Medicare later?

Yes. You can earn up to four credits per year. If you are close to 40, working a few more years may get you there. Check your current credit count first so you know how many more you need.

Do I have to be a permanent resident to get Medicare if I have 40 work credits?

No. You must be either a U.S. citizen or a permanent resident with 40 work credits. If you lose your permanent resident status, you would lose Medicare may be able to access unless you become a citizen.

Can my spouse's work credits count toward my Medicare may be able to access?

No. Each person must have their own 40 credits. However, if you are married and your spouse is may be able to access for Medicare, you may be able to get spousal benefits on their record once you turn 62 or 65, depending on your situation. Ask Social Security about this option.