Green Card Holders and Medicare may be able to access

Green card holders can enroll in Medicare, but not automatically and not on the same timeline as U.S. citizens. You must meet the standard Medicare age and work history requirements — turning 65 and having paid Medicare taxes for at least 10 years (40 quarters) through employment. Your green card status alone does not change these rules, but it does establish you as a lawful permanent resident, which is what Medicare requires to process your enrollment.

The key difference is timing. U.S. citizens can enroll in Medicare during their initial enrollment period starting three months before they turn 65. Green card holders must first establish five years of continuous lawful permanent resident status before they can enroll. This means if you received your green card at age 62, you cannot enroll in Medicare until age 67 — even if you turn 65 before those five years are up.

If you do not meet the work history requirement (10 years of Medicare tax payments), you may still enroll in Medicare Part A at age 65 by paying a monthly premium, provided you have been a lawful permanent resident for five years. This route costs more than the standard program but covers hospital care.

Key Takeaways

  • Green card holders must have been lawful permanent residents for five continuous years before they can enroll in Medicare, even if they meet the age and work history requirements.
  • You still need 10 years of Medicare tax payments (40 quarters) to enroll in Part A without a premium; if you have fewer years, you can pay a monthly premium instead.
  • Your five-year permanent resident clock resets if you leave the United States for more than six months, so document your time in the country carefully.
  • You must enroll during your initial enrollment period (starting three months before you turn 65) or face late penalties on Part B and Part D premiums.

The Five-Year Permanent Resident Rule

Medicare requires that green card holders have been lawful permanent residents for five continuous years before they can enroll. This is a federal rule that applies regardless of your age or work history. The five years must be continuous — meaning you cannot leave the United States for more than six months without resetting the clock.

If you received your green card on January 15, 2020, your five-year mark is January 15, 2025. You can enroll in Medicare starting three months before that date (October 15, 2024), even if you do not turn 65 until later. However, if you travel outside the U.S. for seven months or longer, the five-year clock restarts from the date you return.

Keep records of your green card approval date and any extended trips outside the country. When you contact Social Security to enroll, they will verify your permanent resident status and the length of time you have held it. Bring your green card and your passport showing your travel history.

Work History and Medicare Tax Payments

Medicare Part A (hospital insurance) is free at 65 if you or your spouse paid Medicare taxes for at least 10 years. Green card holders are treated the same as citizens on this point — the IRS counts all quarters of Medicare tax payments, regardless of immigration status at the time you worked.

If you have fewer than 10 years of Medicare tax payments, you have two options. You can pay a monthly premium for Part A (the amount varies yearly and is set by Medicare), or you can continue working and delay enrollment until you reach 10 years of payments. Some people choose to work a few more years specifically to avoid the premium.

To find out how many quarters of Medicare tax you have paid, create an account on ssa.gov and view your earnings record. The record shows each year's wages and the quarters credited. If the number looks wrong, you can request a correction by filing Form SSA-7008 with Social Security.

Enrollment Timing and Late Penalties

Your initial enrollment period for Medicare Part B (medical insurance) and Part D (prescription drug coverage) runs for seven months: three months before the month you turn 65, the month itself, and three months after. If you miss this window, you will pay a permanent penalty on Part B and Part D premiums for as long as you have Medicare.

The Part B penalty is 10 percent of the standard premium for each full year you delayed enrollment. The Part D penalty is 1 percent of the national average premium for each month you were without coverage. These penalties do not go away — they stay on your account even if you enroll years later.

Green card holders sometimes miss the enrollment window because they are waiting for their five-year permanent resident status to be confirmed. If this is your situation, contact Social Security as soon as your five years are complete. Explain the delay, and ask whether you can enroll without penalty. Social Security has limited authority to waive penalties in cases of good cause, but you must request it in writing.

Part A Premium Costs for Those Without 10 Years of Work History

If you have fewer than 10 years of Medicare tax payments, Medicare Part A is not free. The monthly premium depends on how many quarters of coverage you have paid. Those with 30 to 39 quarters pay a reduced premium. Those with fewer than 30 quarters pay the full premium.

The full Part A premium changes each year. In 2024, it was $505 per month for those with fewer than 30 quarters. The reduced premium (for 30 to 39 quarters) was $277 per month. These amounts are set by Medicare and published in January each year. You can find the current rates on Medicare.gov.

You can reduce or eliminate the Part A premium by continuing to work and paying Medicare taxes. Each additional quarter of work adds credit toward the 10-year threshold. Some people choose to work part-time specifically to reach 10 years and avoid the premium.

Documenting Your Green Card Status for Medicare

When you contact Social Security to enroll in Medicare, you will need to prove your lawful permanent resident status. Bring your green card (Permanent Resident Card) and your passport. Social Security will verify your status with U.S. Citizenship and Immigration Services (USCIS) before processing your enrollment.

If your green card has expired, you can still use it as proof of status if you have a valid passport showing your travel history. However, it is easier if your green card is current. If it has been more than six months since your green card expired, renew it before you enroll in Medicare. The renewal process takes several weeks, so start early.

You can enroll in Medicare online at ssa.gov, by phone at 1-800-772-1213, or in person at your local Social Security office. Online enrollment is fastest. You will need your Social Security number, date of birth, and information about your work history. Have your green card and passport ready when you start.

What Happens If You Leave the United States

Once you are enrolled in Medicare, you can use it in the United States and its territories (Puerto Rico, the U.S. Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands). If you travel outside these areas, Medicare does not cover your medical care except in very limited situations.

If you plan to live outside the U.S. for more than six months, you must notify Social Security. Leaving for more than six months can affect your green card status and may trigger a review of your Medicare enrollment. Some people maintain Medicare coverage while living abroad; others drop it to reduce costs. The choice depends on your plans and your health insurance in the other country.

If you are a green card holder and you leave the U.S. for more than six months, your five-year permanent resident clock resets. This means if you had completed your five years and were enrolled in Medicare, you can continue with Medicare. But if you had not yet completed five years, the clock starts over when you return.

Frequently Asked Questions

Can I enroll in Medicare before my five years as a permanent resident are complete?

No. You must wait until you have been a lawful permanent resident for five continuous years, even if you are 65 and have 40 quarters of Medicare tax payments. Contact Social Security three months before your five-year mark to start the enrollment process.

What counts as leaving the United States for the five-year rule?

Any trip outside the U.S. and its territories lasting more than six months resets your five-year clock. Trips of six months or less do not affect it. Keep records of your passport stamps and travel dates to prove your time in the country.

Do I have to pay for Part B if I am a green card holder?

Yes. Part B premiums explore to all Medicare enrollees, including green card holders, regardless of work history. The standard premium in 2024 was $174.70 per month, but it varies by income. Higher earners pay more through an income-related adjustment.

What if I worked in another country before getting my green card?

Work outside the United States does not count toward the 10-year Medicare tax requirement. Only wages earned in the U.S. while paying Medicare taxes count. If you have fewer than 10 years of U.S. work history, you will pay a monthly premium for Part A.

Can I get Medicare if I have a temporary visa instead of a green card?

No. Temporary visa holders (H-1B, L-1, F-1, and others) cannot enroll in Medicare. You must be a lawful permanent resident (green card holder) or a U.S. citizen. Some visa holders can purchase private health insurance or use their employer's plan instead.