The U.S. government only wants to fund Medicare for people who live in the country. Unfortunately, not everyone who lives here will qualify. It depends how long you live in the country and whether or not you (or your spouse) paid taxes into the system. You need to be a U.S. citizen, a permanent legal resident, or a qualifying legal immigrant.

Eligibility Based on Residency and Taxes

You must meet one of the following requirements or your Medicare journey ends here.

1 — You are a U.S. citizen.

Being a U.S. citizen satisfies the first hurdle for Medicare eligibility.

People born in the U.S. are citizens as are children born to U.S. citizens, even if their parents were not in the country at the time of their birth. Any permanent legal resident under 18 whose two parents became naturalized citizens automatically becomes a U.S. citizen too. Finally, any child adopted by a U.S. citizen gets citizenship status.

People from other countries can also become naturalized citizens. This can occur when someone lives in the country legally for five years, they marry a U.S. citizen who lives in the United States, they marry a U.S. citizen who is a government employee living abroad, or they served in the U.S. military. The application process for naturalization varies based on your circumstances, so it is important to check with the U.S. Citizenship and Immigration Services (USCIS) for details.

2 — You are a permanent legal resident (i.e., you have a Green Card).

There are two ways to qualify for Medicare as a permanent legal resident.

• You have a Green Card and you lived in the U.S. for five consecutive years right before you apply for Medicare.
• You are a permanent legal resident, you have been married to a U.S. citizen or another Green Card holder for at last one year, AND your spouse has paid at least 40 quarters (10 years) in Medicare payroll taxes.

To qualify for a Green Card, you need to have certain family relationships with U.S. citizens, meet certain employment requirements, be a refugee or seeking asylum, be a victim of abuse/crime/human trafficking, be approved for a Diversity visa, or be considered a “special immigrant” in other ways. Again, the application process varies based on your circumstances, so it is important to check with USCIS for details about Green Card eligibility.

3 — You are a legal immigrant.

Unfortunately, not all immigrants will be eligible Medicare. First, they must be “documented”, also referred to as being a legal alien. That means 1) they entered the country with a valid visa or other immigrant documentation, and 2) they went through the proper channels. Undocumented immigrants are those who do not have a valid visa, whose temporary visa has expired, who violated the terms of their entry into the country, or who entered the U.S. without inspection.

Aside from having an approved visa, legal immigrant status can be given for a number of reasons ranging from asylum and refugee status to victims of abuse, trafficking, or violence. This is not an all-inclusive list. Qualified alien status can get complicated so you will want to reach out to USCIS for details.

To qualify for Medicare, they must qualify for Social Security retirement benefits, Social Security Disability Insurance, or Railroad Retirement Board benefits. This means they paid a qualifying amount of Medicare and Social Security taxes.

 

8 U.S. Code § 1641 – Definitions (Qualified Alien). (2020). LII / Legal Information Institute. https://www.law.cornell.edu/uscode/text/8/1641

10 Steps to Naturalization: Understanding the Process of Becoming a U.S. Citizen. (2022, May). USCIS. https://www.uscis.gov/sites/default/files/document/brochures/M-1051.pdf

Green Card Eligibility Categories. (2022). USCIS. https://www.uscis.gov/green-card/green-card-eligibility-categories

Learn About Citizenship. (2022). USCIS. https://www.uscis.gov/citizenship/learn-about-citizenship

Understanding SSI – SSI Eligibility. (2022). SSA.gov. https://www.ssa.gov/ssi/text-eligibility-ussi.htm