Yes, green card holders (lawful permanent residents) are eligible for Medicare, but the path to coverage depends on how long you’ve lived in the U.S. and how much you or your spouse have worked and paid into the system. The two key factors are five years of continuous U.S. residency and at least 40 quarters (10 years) of work history paying Medicare taxes.
The Five-Year Residency Requirement
To qualify for Medicare as a green card holder, you must have been a lawful permanent resident for at least five continuous years. This is the same five-year waiting period that applies to most federal benefit programs for immigrants. The clock starts from the date you received your green card, not the date you first entered the country on another visa.
There is one notable exception: if you originally entered the U.S. as a refugee or asylee and later adjusted to permanent resident status, the five-year waiting period does not apply to you. Your eligibility clock effectively started when you first received refugee or asylee status.
How Work Credits Determine What You Pay
Meeting the residency requirement gets you in the door, but your work history determines whether Medicare Part A (hospital insurance) is free or costs a monthly premium. You earn work credits, called quarters of coverage, by working and paying Medicare payroll taxes through FICA deductions on your paycheck. You can earn up to four credits per year.
If you or your spouse have accumulated 40 or more quarters of coverage (roughly 10 years of work), you qualify for premium-free Part A. This is the same threshold that applies to U.S. citizens. The work doesn’t have to be continuous, and credits earned over your entire career count, so years of part-time or intermittent employment still add up.
If you haven’t reached 40 quarters, you can still enroll in Part A, but you’ll pay a monthly premium. The cost breaks into two tiers: if you or your spouse worked 30 to 39 quarters, the premium is $311 per month. With fewer than 30 quarters, it jumps to $565 per month. These are significant costs, so it’s worth checking your work credit total through the Social Security Administration before you turn 65.
Qualifying Through a Spouse’s Work Record
You don’t necessarily need your own work history. If your spouse has earned 40 or more quarters of coverage, you can qualify for premium-free Part A based on their record. This applies whether your spouse is a U.S. citizen or another green card holder, as long as they meet the work credit threshold. You do need to be at least 65 and married (or, in some cases, divorced after at least 10 years of marriage).
Some government employees pay only the Medicare portion of payroll taxes rather than the full FICA tax. Those credits count toward Part A eligibility but cannot be used to qualify for monthly Social Security retirement benefits.
Part B, Part D, and Medicare Advantage
Medicare Part B (which covers doctor visits, outpatient care, and preventive services) works differently from Part A. There’s no work credit requirement for Part B. If you meet the age and residency requirements, you’re eligible. However, Part B is never free. Everyone who enrolls pays a monthly premium, which is income-based and starts at around $185 per month for most people.
Part D (prescription drug coverage) and Medicare Advantage plans (Part C) follow the same basic eligibility rules. Once you qualify for Parts A and B, you can enroll in these additional plans through private insurers that contract with Medicare. Part D premiums vary by plan, and Medicare Advantage plans sometimes bundle drug coverage with hospital and medical insurance at competitive rates.
When to Enroll
Your initial enrollment period is the seven-month window surrounding your 65th birthday: the three months before, the month of, and the three months after. This timeline applies to green card holders the same way it applies to citizens, assuming you’ve already met the five-year residency requirement.
If you turn 65 before completing five years of permanent residency, the timing gets trickier. You won’t be automatically enrolled, and you’ll need to sign up during a general enrollment period (January 1 through March 31 each year) once you do meet the residency threshold. Delaying enrollment beyond your initial window can result in late enrollment penalties, which permanently increase your Part B and Part D premiums, so planning ahead matters.
Help Paying for Medicare Premiums
If your income is limited, you may qualify for a Medicare Savings Program that helps cover premiums, deductibles, and copays. These are state-administered programs with federal guidelines, and green card holders who meet the five-year residency requirement are generally eligible. The 2026 income and resource limits for the main programs are:
- Qualified Medicare Beneficiary (QMB): Covers Part A and Part B premiums plus cost-sharing. Income limit of $1,350/month for individuals or $1,824 for married couples, with resources under $9,950 (individual) or $14,910 (couple).
- Specified Low-Income Medicare Beneficiary (SLMB): Covers Part B premiums. Income limit of $1,616/month for individuals or $2,184 for couples, same resource limits as QMB.
- Qualifying Individual (QI): Also covers Part B premiums at a slightly higher income cutoff of $1,816/month for individuals or $2,455 for couples.
These limits are slightly higher in Alaska and Hawaii, and some states set their own thresholds above the federal minimums. If your income is close to the limit, it’s worth applying through your state Medicaid office, since eligibility rules vary.
Green Card Holders Without Enough Work Credits
If you’re approaching 65 without 40 quarters of work history and can’t qualify through a spouse, you still have options, though none are free. You can purchase Part A at the reduced or full premium ($311 or $565 per month) and enroll in Part B at the standard premium. Combined, this could mean paying $750 or more per month before any supplemental coverage.
For some green card holders, continuing to work past 65 to accumulate additional quarters may be worthwhile, especially if you’re close to the 30- or 40-quarter thresholds. Each quarter you add either lowers your Part A premium or eliminates it entirely. In the meantime, you can still enroll in Part A and Part B while you keep working, and your premium will automatically drop once you cross into the next tier.