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Medicare for seniors who are new to the US

Whether elderly parents new to the US can get Medicare, why most must wait 5 years of residence, and what to use while waiting.

Last updated: September 18, 2026Last reviewed: September 18, 2026About 9 min read

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Medicare is the federal health insurance program for people 65 and older. Many families sponsor their parents to the US and then meet an unwelcome surprise: turning 65 does not automatically bring Medicare, and most new immigrants need a green card plus 5 continuous years of US residence before they are even allowed to buy in. This guide covers who qualifies for what, the real 2026 prices, and what to use during the waiting years.

The parts of Medicare

  • Part A covers hospital stays.
  • Part B covers doctors, outpatient care, and tests.
  • Part D covers prescription drugs, bought through private insurers.
  • Medicare Advantage (Part C) is a way to receive Part A and Part B through a private insurer.

For newly immigrated families, the money question sits in Part A. The CMS 2026 fee announcement states that about 99% of Medicare beneficiaries pay no Part A premium, because they have at least 40 quarters of Medicare-taxed employment, roughly 10 years of work in the US. Medicare's costs page adds that your own quarters or a spouse's both count. If you or your spouse are still working with Medicare tax withheld on each pay stub, those quarters keep building year by year. Newly arrived parents do not have those years, so their path differs from an American retiree's in both ways that matter: whether they can enroll at all, and what it costs when they can.

The 5-year rule: count it right, and do not donate years

The CMS enrollment rules are explicit: a person without the 40 quarters may only buy Part A or Part B if they are a US citizen, or "an alien who has been lawfully admitted for permanent residence and has been residing in the United States for 5 continuous years prior to the month of filing an application for Medicare."

Notice that the rule demands two things, not one: a green card at the time of filing, and 5 continuous years of residence. For parents who arrived on an immigrant visa and stayed, the two marks nearly coincide and the count runs from arrival. But for someone who lived in the US for a while before the green card was granted, the Social Security program manual (POMS) says plainly that the 5 years of continuous residence "may begin prior to the date that the lawful admission for permanent residence is granted." Do not subtract those earlier years yourself and wait longer than the law asks: when the time comes, report the full period of US residence and let Social Security set the date.

What to use before qualifying

These waiting years worry families the most, because these are heavy doctor-visit ages. The current official pages describe these routes:

The ACA Marketplace. HealthCare.gov states that lawfully present immigrants can get Marketplace coverage and may qualify for lower monthly costs based on income. The premium tax credit is currently described for household incomes between 100% and 400% of the federal poverty level. If your family's income sits below that band, do not rule yourselves out and walk away: apply and let the system decide based on your actual immigration status and state, and also ask your state Medicaid office. For seniors who cannot yet buy Medicare, the Marketplace is usually the main road. Enrollment windows and the application itself are covered in enrolling in health insurance.

Medicaid, at very low incomes. Green card holders generally face a 5-year waiting period before full Medicaid, and each state applies its own rules. HealthCare.gov currently lists refugees and asylees as exempt from the wait, but read the next paragraph: a new law is about to narrow exactly that group. Emergency care is treated differently: Medicaid may pay for treatment of an emergency medical condition if the person meets the state's other criteria, even when their immigration status does not qualify them for regular Medicaid.

A change that takes effect October 1, 2026. A CMS letter to state health officials (SHO 26-001) explains that from that date, a new federal law narrows the groups eligible for federally funded, non-emergency Medicaid to US citizens and US nationals, lawful permanent residents, Cuban and Haitian entrants, and COFA migrants. Green card holders remain on the eligible list. Refugees and asylees who have not yet become permanent residents are no longer on it, which means the waiting-period exemption above holds only through the end of this September for non-emergency Medicaid. This guide reflects the rules as of September 18, 2026; confirm the details with your state Medicaid office when applying.

Once eligible: what buying in costs in 2026

These are the official 2026 figures from the CMS premium announcement. They change every year.

  • Part A: free with 40 quarters of Medicare-taxed work. With at least 30 quarters, yours or a spouse's, the buy-in price is $311 a month. With fewer than 30 quarters, the situation of most newly arrived parents, it is $565 a month.
  • Part B: the standard premium is $202.90 a month, more at higher incomes. The 2026 Part B deductible is $283 for the year.

Together, a person with no US work history buying both parts pays about $768 a month at 2026 rates, before Part D. That is why the low-income programs below matter: they exist to pay these amounts for people who cannot.

Where and when to enroll, and the penalties

A Medicare application is filed with Social Security. The CMS enrollment page says a person not yet receiving monthly Social Security benefits "must file an application for Medicare by contacting the Social Security Administration", phone 1-800-772-1213. How to find your local Social Security office is covered in applying for an SSN or ITIN.

The two enrollment windows on the CMS page:

  • Initial Enrollment Period: 7 months long, from 3 months before the month of the 65th birthday, through the birthday month, to 3 months after.
  • General Enrollment Period: January 1 to March 31 each year, with coverage starting the month after you sign up.

Sponsored parents usually qualify only well past 65, meaning the 7-month birthday window came and went while they were not yet allowed to file. The CMS page names no separate enrollment window for this late-eligibility case. So in the very month both conditions are met, contact Social Security, ask which window applies to you, whether any penalty applies and from what date, and get the answer in writing.

Late enrollment carries penalties, and the arithmetic deserves one careful read:

  • Part B: the premium goes up 10% for each full 12-month period you could have had Part B but did not sign up. Medicare.gov notes that penalties of this kind are usually charged for as long as you keep that coverage, for most people a lifetime.
  • Purchased Part A: the premium rises by up to 10%, paid for twice the number of years enrollment was delayed.
  • Part D (drugs): has its own separate late penalty, described on the same avoid-penalties page.

Note how the rule is worded: the penalty counts time you could have signed up and did not. Whether your family's pre-eligibility years count is exactly one of the written questions above.

If income is low: programs that pay these bills

Medicare.gov describes the Medicare Savings Programs, run by each state, which pay Medicare costs for people with limited income and resources:

  • QMB pays Part A premiums for those without premium-free Part A, Part B premiums, and also deductibles, coinsurance, and copayments.
  • SLMB and QI pay the Part B premium and require you to have both Part A and Part B; QI requires reapplying every year. For someone who must buy Part A, QMB is the only one of the three that pays that bill.

Apply through your state Medicaid office. Anyone in one of these programs also automatically gets Extra Help, which lowers Part D drug costs. Your state's SHIP program offers one-on-one Medicare counseling.

What Medicare does not pay for

Two items every family should plan around, because Medicare's own pages say plainly they are not covered:

What to do next

  • Work out the date your parents meet both conditions: holding a green card, and 5 continuous years of US residence. Remember that time lived in the US before the green card can count, so do not guess the mark later than it is.
  • Before that mark: enroll them in a Marketplace plan for the waiting years, see enrolling in health insurance.
  • At the mark, or approaching a 65th birthday: contact Social Security (1-800-772-1213) and ask which enrollment window applies; if eligibility came after 65, ask in the very month it arrives, not later.
  • On a low income: ask the state Medicaid office about QMB and SLMB before paying full price, and ask SHIP for help comparing the options.
  • Once they are enrolled, there is a window each year to change plans, October 15 to December 7: see Medicare Open Enrollment.

Common questions

My parents are over 65 and recently immigrated through family sponsorship. Can they enroll in Medicare?

Usually not yet. A person without roughly 10 years of Medicare-taxed work in the US can only buy Medicare if they are a US citizen, or a lawful permanent resident who has resided in the US for 5 continuous years. Parents who arrived a couple of years ago have not reached that mark. While waiting, lawfully present immigrants can buy a Marketplace plan and may qualify for income-based savings.

Is Medicare free?

Part A is premium-free for people who paid Medicare taxes for about 10 years of work in the US, which covers most American retirees. New immigrants do not have those years, so they pay for both Part A and Part B if they buy in. In 2026, Part A costs 311 or 565 dollars a month depending on quarters of work, and the standard Part B premium is 202.90 dollars a month.

Is there a penalty for enrolling late?

Yes, and it is measured against the time you could have signed up but did not. Part B adds 10% for each full 12-month period of delay, and for most people that surcharge lasts as long as they keep Part B. For purchased Part A, the premium goes up by as much as 10% and the higher rate is paid for twice the number of years enrollment was delayed. The Part D drug benefit has its own separate late penalty. Plan the enrollment calendar before the 65th birthday.

My parents finally qualify to buy Medicare, but it is expensive. Can they stay on a subsidized ACA plan instead?

HealthCare.gov's Medicare-and-the-Marketplace page states two things. First, once someone has premium-free Part A or a Medicare Advantage plan, they no longer qualify for Marketplace savings, and it is against the law for anyone who knows they have Medicare to sell them a Marketplace plan. Second, for people paying a premium for Part A, the page says they can drop Part A and Part B and get a Marketplace plan instead. Before choosing that road, read the late-penalty section in this guide and talk it through with your state's SHIP program.

I sponsored my parents. If they use Medicaid, will the state bill me?

For Medicaid and CHIP, the rules do address this. A CMS letter to state agencies says states count a sponsor's income when deciding eligibility, and a sponsor who signed the Form I-864 Affidavit of Support can be required to repay the state for the cost of most benefits provided to the person they sponsored. For Medicare itself, the official pages this guide relies on say nothing about billing sponsors.

Sources / Nguồn

Official US government pages. If anything here disagrees with the official page, trust the official page.

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