Kara Sears
Lawful permanent residents (LPRs) in the US can receive Medicare, but there are several conditions that must be met. Firstly, LPRs must have lived in the US for at least five years before they can enrol in Medicare Part A or B. Secondly, they must be over the age of 65 or have certain qualifying disabilities. Additionally, LPRs need to pay for Medicare Parts B, C, and D, and there may be a late enrolment penalty for Parts A and B if they choose to switch to Medicare from Marketplace coverage. LPRs may also be eligible for other healthcare programs such as Medicaid and the Children's Health Insurance Program (CHIP), but these often have their own set of requirements, including income and residency rules.
| Characteristics | Values |
|---|---|
| Eligibility | Lawful permanent residents are eligible for Medicare if they have worked at least 40 quarters (10 years) in jobs where they or their spouses paid Medicare payroll taxes and are at least 65 years old. |
| Legal immigrants who are 65 or older without this work history can purchase Medicare Part A after residing legally in the U.S. for five years continuously. | |
| Legal immigrants (non-citizen permanent residents) under 65 with disabilities may also qualify for Medicare but must meet eligibility requirements for SSDI (disability benefits). | |
| Lawful permanent residents (LPRs) must have had green card status for at least five years to qualify for Full-Scope Medicaid. | |
| Lawful permanent residents can receive premium tax credits and cost-sharing reductions. | |
| Lawful permanent residents qualify for Medicaid and the Children's Health Insurance Program (CHIP) after a 5-year waiting period. | |
| Lawful permanent residents qualify for the federal program TANF if they have maintained their lawful resident status for 5 years. |
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What You'll Learn
Lawful permanent residents (LPRs) and Medicare Part A
Lawful Permanent Residents (LPRs) are non-citizen U.S. immigrants who are permitted to live and work in the country indefinitely. LPRs are often referred to as "green card holders" due to the documentation they receive to prove their status. While LPRs enjoy many of the same rights as citizens, there are some benefits that are exclusive to citizens, and Medicare Part A is one such benefit that can be challenging for LPRs to access.
Medicare Part A is a federal health insurance program that covers hospital and inpatient stays. Citizens are eligible for premium-free Medicare Part A if they are 65 or older and have worked for at least 40 quarters (10 years) in jobs where they paid Medicare payroll taxes. However, for LPRs to be eligible for Medicare Part A, they must meet additional criteria.
Firstly, LPRs must have five years of continuous residence in the United States immediately prior to Medicare enrollment. This is a standard requirement for many benefits that LPRs may seek to access. Secondly, LPRs must have a sufficient work history in the U.S. This is typically defined as working for at least 40 quarters (10 years) in jobs where they or their spouses paid Medicare payroll taxes. For LPRs under 65, disability benefits may be available through Medicare, but they must first meet the eligibility requirements for SSDI (Social Security Disability Insurance), which are also based on work history and payment of Social Security taxes.
It is important to note that the Social Security Administration (SSA) and the Centers for Medicare and Medicaid Services (CMS) use the term "entitled to Part A benefits" to describe someone who qualifies for premium-free Part A. This can be a point of confusion, as the term "Lawful Permanent Resident" (LPR) is used in most immigration contexts, but the SSA refers to these individuals as "Lawfully Admitted Permanent Residents" (LAPR). As such, LPRs seeking to understand their eligibility for Medicare Part A may encounter challenges due to the complex nature of the enrollment process and varying terminology.
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LPRs, Medicare Part B, C, and D
Lawful Permanent Residents (LPRs) are generally eligible for coverage through Medicaid and the Children's Health Insurance Program (CHIP) if they meet state income and residency rules. LPRs typically have a 5-year waiting period for Medicaid and CHIP coverage, but there are exceptions for certain groups, such as refugees and asylees. During this waiting period, LPRs may qualify for Marketplace coverage and can receive premium tax credits and cost-sharing reductions.
LPRs who are 65 or older and have worked in the U.S. for at least 10 years in jobs where they or their spouses paid Medicare payroll taxes are eligible for premium-free Medicare Part A. Those who do not meet these requirements can still purchase Medicare Part A after residing legally in the U.S. for five years. LPRs under 65 with disabilities may also qualify for Medicare but must meet eligibility requirements for SSDI, including work history and paying Social Security taxes.
Medicare Part B is available to LPRs who meet the eligibility requirements of either having the required work history or residing legally in the U.S. for five years. Most people pay a monthly premium for Part B, which depends on their income level.
Medicare Part C, also known as Medicare Advantage, is an alternative to Parts A and B, offering bundled coverage through private health plans that contract with the federal government. LPRs must first sign up for Part A or Part B before enrolling in Part C. These plans often include Part D, which covers prescription drug costs. To enrol in Part D, LPRs must first have Part A or Part B.
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LPRs and Medicaid
Lawful Permanent Residents (LPRs) are generally eligible for Medicaid coverage if they meet the state income and residency rules. LPRs, also known as green card holders, are considered "qualified non-citizens" and may have to wait five years after obtaining their status before becoming eligible for Medicaid. However, there are exceptions to this waiting period. Refugees, asylees, and LPRs who previously held such statuses are exempt from the five-year wait.
LPRs can also qualify for Marketplace coverage, which may offer lower costs on monthly premiums and additional savings on out-of-pocket expenses based on their income. This coverage does not impact their chances of obtaining a green card or becoming U.S. citizens. Additionally, 35 states, the District of Columbia, the Commonwealth of Northern Mariana Islands, American Samoa, and the U.S. Virgin Islands have waived the five-year waiting period, providing immediate Medicaid coverage to lawfully residing children and/or pregnant individuals.
Medicaid, a joint federal and state program, offers health coverage to a wide range of Americans, including children, pregnant women, parents, seniors, and individuals with disabilities. Eligibility is typically determined by income, with low-income families, qualified pregnant women, and children being mandatory eligibility groups. The Affordable Care Act of 2010 expanded Medicaid to cover nearly all low-income Americans under 65, and most states have opted to extend coverage to this group.
To determine eligibility, the Modified Adjusted Gross Income (MAGI) methodology is used, which considers taxable income and tax filing relationships. Certain groups, such as those with blindness, disabilities, or ages 65 and older, are exempt from the MAGI-based income rules. Additionally, individuals aged 65 and older, or those with blindness or disabilities, have their eligibility determined using the income methodologies of the SSI program.
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LPRs and income requirements
Lawful Permanent Residents (LPRs) are generally eligible for coverage through Medicaid and the Children's Health Insurance Program (CHIP) if they meet state income and residency rules. LPRs, also known as green card holders, usually have a five-year waiting period for Medicaid and CHIP coverage, starting from when they obtain "qualified" immigration status. However, there are exceptions to this waiting period, such as for refugees, asylees, or LPRs who previously held refugee or asylee status. During this waiting period, LPRs may opt for coverage through the Marketplace, which offers lower costs on monthly premiums and extra savings on out-of-pocket expenses based on income.
LPRs who have maintained their status for five years are also eligible for certain federal programs, such as TANF, which provides cash assistance to low-income families, and SNAP, which assists with food purchases. To qualify for Full-Scope Medicaid, most states require LPRs to have held their green card status for at least five years, although a few states also mandate 40 quarters of work before granting these benefits. Similarly, to be eligible for SSI, a federal program that provides financial assistance to low-income seniors, disabled children, and adults, LPRs must reside in the U.S. for at least five years and accumulate 40 quarters of work.
LPRs who are 65 or older and have not worked in the U.S. for a sufficient period may not qualify for premium-free Medicare Part A. However, they can purchase Medicare Part A after legally residing in the country for five consecutive years. LPRs under 65 with disabilities may also be eligible for Medicare but must meet the eligibility requirements for SSDI (disability benefits), including work history and payment of Social Security taxes.
It is important to note that eligibility for certain programs, such as savings on Marketplace health insurance, Medicaid, and CHIP coverage, is determined by federal poverty levels issued annually by the Department of Health and Human Services (HHS). These levels serve as a measure of income to assess an individual's qualification for specific programs and benefits.
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LPRs and Medicare: work history
Lawful Permanent Residents (LPRs) are generally eligible for Medicare if they have worked in the US for a long enough period. This usually means having worked at least 40 quarters (10 years) in jobs where they or their spouses paid Medicare payroll taxes.
LPRs who have been in the United States for five years are normally eligible to receive Medicare. This is a requirement for Full-Scope Medicaid, which is a health coverage program for low-income individuals and families. LPRs who do not have this work history can purchase Medicare Part A after residing legally in the US for five years.
The eligibility criteria for LPRs to receive Medicare also include having a Social Security number that was issued on or after January 1, 2004, and which was valid for work. Alternatively, the work for which the LPR is seeking credit must have been performed while the person was temporarily in the United States with an immigration status as a businessperson or crewperson.
It is important to note that the eligibility requirements for Medicare can be complex and confusing, especially for older immigrants. There are also different types of Medicare, including Part A, which covers major procedures such as hospitalizations or surgeries, and Part B, which covers outpatient benefits such as doctor's office visits and lab work. LPRs need to pay for Medicare Parts B, C, and D.
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Frequently asked questions
Lawful permanent residents who don't meet the 5-year requirement can still qualify for Emergency Medicaid, assuming they meet the general, non-immigration-related eligibility requirements. They may also qualify for Marketplace coverage and may even be eligible for lower costs on monthly premiums and extra savings on out-of-pocket costs based on their income.
Legal immigrants (non-citizen permanent residents) under 65 with disabilities may qualify for Medicare. However, they must first meet the same eligibility requirements for SSDI (disability benefits) that citizens do.
There are several different types of Medicare:
- Part A, which covers major procedures such as hospitalizations or surgeries
- Part B, which covers outpatient benefits such as doctor's office visits, lab work, and X-rays
- Part C, which combines components of Part A and B and adds coverage for vision, dental, and more
- Part D, which must be paid for
Enrolling in Medicare and accessing its benefits can be complex and confusing, especially for older immigrants. Some good sources of information include www.ssa.gov and www.medicare.gov. The Social Security Administration also has a brochure about Medicare in general, and Medicare.gov has a brochure specifically for enrolling in Medicare Part A and Part B. Medicare.gov also provides an online calculator to help determine your eligibility and premium amount.
