Are people living in the U.S. who aren’t citizens eligible for Medicare?

Yes. You don’t have to be a U.S. citizen to qualify for Medicare.

The work credits are what matters. You or your spouse must have worked in the United States and paid Medicare payroll taxes for at least 10 years, or you’ll have a five-year waiting period before coverage kicks in and face more than the standard premiums.

These are the rules:

If you or your spouse paid Medicare taxes for at least 40 calendar quarters, not necessarily continuous but for 10 years total, you can enroll in Medicare at age 65 and get premium-free Medicare Part A, which covers a variety of hospital costs. But that’s only if you’re a U.S. citizen or considered “lawfully present.”

For immigration purposes, lawfully present means a person who qualifies as a noncitizen but is permitted to live and work in the U.S., such as a green card holder or someone with temporary protected status.

“Lawfully present individuals with the required work credits have no length-of-residency requirement,” says Tiffany Huyenh-Cho, director of California Medicare and Medicaid Advocacy for Justice in Aging. The national nonprofit advocates for older adults.

If you’ve been married at least one year, you can qualify for Medicare based on your spouse’s work history.

“When a person who is at least age 65 has a spouse who is at least age 62, and has 40 quarters of work credits, the person [who is at least 65] qualifies for premium-free Medicare Part A based on their spouse’s work history,” says Darren Lutz, a Social Security Administration spokesperson. “When this qualification is already met, other factors, such as five years of residency, are not taken into consideration.”

If neither you nor your spouse paid Medicare taxes for 10 years, you must meet additional requirements. If you’re a U.S. citizen and a resident, you can qualify for Medicare at age 65 if you buy into it and pay premiums for both Part A hospitalization and Part B, which covers physician services and other benefits.

If you’re a green card holder, but neither you nor your spouse meets the work requirements, you can enroll in Medicare only if you’ve lived continuously in the U.S. for at least five years and pay premiums for Part A and Part B.

How much do noncitizens pay for Medicare?

The costs are the same for citizens and others who qualify. If you or your spouse hasn’t paid Medicare payroll taxes for 10 years, the following premiums for Medicare Part A and Part B apply in 2024:  

Part A 

• $505 a month, fewer than 30 quarters
• $278 a month, 30 to 39 quarters
• Free, if you or your spouse has worked 40 quarters or more  

Part B

• $174.70 a month, the same as those who’ve paid Medicare payroll taxes for 10 years 
• $69.90 to $419.30 a month additional for high earners  

In what parts of Medicare can people enroll if they’re not citizens?  

You can sign up for parts A, B, C and D, everything that a citizen can. Special rules may kick in if you don’t qualify for premium-free Part A.

If you’re required to pay premiums for Part A — again, if you or your spouse hasn’t paid Medicare payroll taxes for at least 40 quarters — you must also enroll in Part B.

In that case, you can choose to forgo the more expensive Part A coverage altogether and sign up only for Part B. That means you’ll have Medicare coverage for doctor’s services, outpatient care and equipment but not for hospitalization or care at a skilled-nursing center.  

Like other Medicare beneficiaries, you can buy Medicare Part D prescription coverage if you have Part A or Part B or both; however, you must have Part A and Part B to buy a supplemental Medigap policy or a Medicare Advantage plan, also known as Medicare Part C.

Keep in mind

Whether or not you pay Part A premiums, you may qualify for help with Medicare premiums and out-of-pocket costs from a Medicare Savings Program, says Diane Omdahl, author of Medicare for You: A Smart Person’s Guide, and cofounder and president of 65 Incorporated, a Mequon, Wisconsin, company that helps people with Medicare decisions.

Eligibility requirements vary by state but are typically based on income and sometimes assets. Some states have residency requirements, too. Contact your state Medicaid agency for more information.

You may be eligible for help with Part D prescription costs through the Extra Help program. It doesn’t have the same residency requirements as Medicaid and Medicare Savings Programs. For more information and to find Medicare help in your area, contact your local State Health Insurance Assistance Program (SHIP).

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