Medicare 2026

Medicare for Older Green Card Holders: The 5-Year Rule and Buying Part A

If you have a green card and you're approaching 65 — or already past it — Medicare's rules may feel like a maze. A federal law enacted on July 4, 2025 narrowed who can have Medicare at all, but green card holders are one of the groups that still qualify. What usually trips people up is a separate, older rule: the 5-year continuous-residence requirement that applies when you have to buy Part A or sign up for Part B because you don't have enough U.S. work history. Here's how the pieces fit together.

Who can have Medicare now

Under Public Law 119-21 (section 71201), enacted July 4, 2025, a person can be entitled to or enrolled in Medicare only if they are a U.S. citizen or U.S. national, a lawful permanent resident (green card holder), a Cuban-Haitian entrant, or someone lawfully living in the U.S. under a Compact of Free Association (COFA). The 2027 Medicare & You handbook confirms this applies to Part A, Part B, and joining a Medicare health or drug plan.

Before this law, eligibility reached a broader "lawfully present" group — including refugees, people granted asylum, and certain parolees. People in those categories who do not have a green card can no longer newly qualify. Those who were already entitled or enrolled on July 4, 2025 but who fall outside the four listed groups lose eligibility 18 months later; CMS's 2027 physician fee schedule final rule terminates that coverage effective February 1, 2027.

If someone in that situation later gets a green card (or otherwise joins one of the four groups) and meets Medicare's other requirements, CMS created a special enrollment period in the same rule: it starts the month the person contacts the Social Security Administration (SSA) and shows they qualify, and it ends the last day of the 12th month after that. Up to 6 months of retroactive coverage may be chosen, but never before the month the person first met all Medicare eligibility requirements.

Important: CMS has said the 2025 law did not eliminate the 5-year continuous-residence requirement for green card holders who buy Part A or enroll in Part B. If you meet that rule and Medicare's other requirements, you keep your Medicare.

Premium-free Part A vs. buying Part A

Most people don't pay a Part A premium. CMS says about 99% of beneficiaries pay nothing for Part A because they (or a spouse) have at least 40 quarters — roughly 10 years — of Medicare-covered work. If you have that history, you can get Part A premium-free when you turn 65, regardless of how long you've lived in the U.S. as a green card holder.

If you don't have enough work quarters, you can still get Part A — but you have to buy it. A person 65 or older who does not qualify for premium-free Part A can buy Part A, or enroll in Part B, only if they live in the U.S. and are either a U.S. citizen or a green card holder who has lived in the U.S. continuously for the 5 years immediately before the month they apply (for premium Part A, before the month they meet all the other requirements).

For 2026, buying Part A costs $311 a month if you (or your spouse) had at least 30 quarters of coverage, and $565 a month with fewer than 30 quarters. A key rule: to buy Part A, you must also have — or sign up for — Part B. If Part B ends, your premium Part A ends too.

When your enrollment window opens

If you turn 65 and already meet the citizenship or 5-year residency requirement, your Initial Enrollment Period is the usual 7 months around your 65th birthday month.

If you don't meet it at 65 — for example, you got your green card later, or you haven't yet lived in the U.S. continuously for 5 years — your first month of eligibility is the later month when you do meet it. Your 7-month Initial Enrollment Period then runs from 3 months before that month to 3 months after it.

Missing that window can be costly. The Part A premium (for people who buy it) may go up 10%, charged for twice the number of years you could have had it but didn't sign up. The Part B premium generally goes up 10% for each full 12-month period you could have had Part B and didn't — usually for as long as you have Part B.

A note on 2027 figures and Part D

Some national 2027 numbers are set: the Part D out-of-pocket cap is $2,400 (up from $2,100 in 2026), the most any Part D plan may charge as a deductible is $700, and the Part D base beneficiary premium — used in calculating the late-enrollment penalty — is $41.33. Annual Enrollment runs October 15 – December 7, 2026 for coverage starting January 1, 2027. Social Security announced a 3.6% COLA for benefits payable beginning January 2027.

The 2027 Part B standard premium and deductible, and the 2027 IRMAA income brackets, had not yet been announced at the time of writing. CMS typically releases those figures in the fall. Please check Medicare.gov for the current numbers before making decisions.

Original Medicare + Medigap, or Medicare Advantage?

Once you have Part A and Part B, you choose how to receive your coverage. Original Medicare lets you use any provider that accepts Medicare nationwide, and many people pair it with a stand-alone Part D drug plan and, if eligible, a Medigap policy to help with out-of-pocket costs; Medigap rules and pricing vary, and your strongest guaranteed-issue rights are time-limited. Medicare Advantage plans bundle Part A, Part B, and usually Part D, often with extra benefits and an annual out-of-pocket maximum, but they use provider networks and may require referrals or prior authorization. Neither is "better" — the right fit depends on your doctors, your medications, your travel patterns, and your budget.

If you have Medicaid or qualify for Extra Help, since 2025 you have a monthly Special Enrollment Period to move to Original Medicare with a stand-alone Part D plan, or to switch stand-alone Part D plans. Full-benefit dual-eligible individuals can also join an integrated Dual Eligible Special Needs Plan (D-SNP) in any month.

Where to go next

For personalized answers, current premiums, and to start or check an application, visit Medicare.gov or call 1-800-MEDICARE (TTY 1-877-486-2048), 24 hours a day, 7 days a week. This article is educational only and is published by an independent, privately owned site that is not affiliated with the federal government or any government agency.