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This guide is for information only and is intended for foreigners living in the US, not Americans retiring abroad. Medicare, immigration rules, state help programs, premiums, and enrollment windows can change, so confirm your situation with the Social Security Administration (SSA), Medicare, the State Health Insurance Assistance Program (SHIP), your state Medicaid office, or a qualified immigration professional.
Key takeaways
- If you’re age 65+ and you or a qualifying spouse have enough Medicare-taxed work credits, you may qualify for premium-free Part A and then Part B.
- If you’re an age 65+ green card holder without enough credits, you may be able to buy Part A and enroll in Part B after 5 continuous years of US residence before filing.
- Disability-based Medicare is available for certain people under 65 who receive Social Security Disability Insurance (SSDI), or who qualify through amyotrophic lateral sclerosis (ALS) or end-stage renal disease (ESRD).
- If you travel frequently or split your time between countries, you may be able to keep Medicare if you remain eligible, but overseas coverage is limited.
- If you don’t have Medicare, you may need suitable private or international cover – compare international plans such as Cigna Global with Affordable Care Act (ACA) Marketplace options.
Wise for managing healthcare payments in the US
- Hold USD for premiums and healthcare bills
- Convert supported currencies when funds arrive from abroad
- Wise doesn’t affect Medicare eligibility, coverage, or pricing
Who can get Medicare in the US as a foreign resident?
Not every foreigner in the US can get Medicare. Under current federal rules, your immigration category, age, disability status, work history, and, in some cases, your residence history all matter.
If you are 65 or older
There are 2 main age-based paths. If you or an eligible spouse has enough Medicare-taxed work credits, you may qualify for premium-free Part A. If not, some green card holders can still buy Part A and enroll in Part B, but this may be subject to a 5-year waiting period.
A common question is whether Medicare starts automatically at 65 for immigrants. It often doesn’t, so check your record with the social security system and public benefits in the US and with SSA before your enrollment window closes.
If you are under 65 and disabled
Some younger people can get Medicare after qualifying for Social Security Disability Insurance (SSDI), which is monthly disability pay based on work history, or through special rules for amyotrophic lateral sclerosis (ALS) and end-stage renal disease (ESRD).
The Social Security Administration decides disability-based entitlement. That means a serious diagnosis alone doesn’t automatically open Medicare.
How the 5-year permanent residence rule works
For many immigrants, this is the most misunderstood rule. The 5-year test mainly matters when a green card holder is 65 or older, doesn’t have premium-free Part A, and wants to buy Part A or enroll in Part B.
A lawful permanent resident, also called a green card holder, must usually show 5 continuous years of US residence immediately before filing. That clock can start when you came to make the US your home, not necessarily on the day you received the green card. Long trips abroad can create problems if SSA decides you stopped maintaining US residence.
This is different from the Medicaid 5-year waiting period, which follows separate federal and state rules. One thing worth knowing is that a spouse’s work record can sometimes matter more than the wait itself because it may open a premium-free Part A path.
If you spend long stretches outside the US while waiting to qualify, keep proof that your main home stayed in the US, such as tax returns, lease or mortgage records, and travel history.
Evidence that often helps includes:
- Green card and other immigration papers
- Address history, lease, or mortgage records
- US tax returns or wage records
- Travel history and passport entry records
- Marriage and spouse work records, if you may qualify through a spouse
Medicare parts explained: A, B, C, and D
Once you’re eligible, Medicare is split into 4 parts. Original Medicare means Part A and Part B together. Part C, also called Medicare Advantage, is a private alternative to Original Medicare, and Part D covers prescription drugs.
What Part A and Part B cover
Part A is hospital insurance. It mainly covers inpatient hospital stays, skilled nursing facility care, hospice, and some home health care. Part B is medical insurance, which covers doctor visits, outpatient care, preventive services, durable medical equipment, and many routine medical needs.
Original Medicare doesn’t cover everything. Routine dental care, most routine vision care, hearing aids, and long-term custodial care are common gaps.
How Part C and Part D fit in
Part C, or Medicare Advantage, is offered by private insurers and usually requires both Part A and Part B first. Part D helps pay for prescription drugs, either through a stand-alone drug plan or through many Medicare Advantage plans.
The following table summarizes the main role of each Medicare part and an important point to watch.
| Part | Main role | Usually needed first | Main catch |
|---|---|---|---|
| A | Hospital care | Age, disability, or ESRD route, plus eligible status | Work history affects whether Part A is free or sold with a premium |
| B | Outpatient and doctor care | Sometimes bought with or without premium Part A | Late enrollment can raise your monthly cost for life |
| C | Private alternative to Original Medicare | Usually Parts A and B | Networks, prior approval rules, and extras vary by plan |
| D | Prescription drugs | Part A or Part B | Going 63 days or more without creditable drug cover can trigger a lasting penalty |
Understanding Medicare costs: premiums, late penalties, and financial help
Medicare isn’t free for everyone, and the amount you pay can vary widely from one person to another. Your costs depend mainly on your work history in the US, when you enroll, and which parts of Medicare you choose.
Monthly premiums
Most people pay a monthly premium for at least part of their Medicare coverage. The table below shows the 2026 monthly premium amounts or ranges stated in the source article.
| Part | Monthly cost |
|---|---|
| A | Free if you or a qualifying spouse paid Medicare taxes long enough. Otherwise $311 or $565, depending on work history |
| B | From $202.90 (standard premium) |
| C | Varies by plan |
| D | Varies by plan |
Late enrollment penalties
If you miss your first enrollment window, Medicare can add a penalty to your premium, sometimes for as long as you have coverage:
- Part A: if you delay buying Part A, your premium may rise by 10% for twice the number of years you delayed.
- Part B: your premium can rise by 10% for each full 12 months you waited, usually for as long as you keep Part B.
- Part D: a separate penalty applies if you go 63 days or more without creditable drug coverage.
Help with Medicare costs
If you have a limited income, you may not have to pay the full amount on your own. Several federal and state programs can cover part of your premiums or other Medicare costs:
- Medicare Savings Programs (MSPs): state-run help with Part A and Part B costs
- Qualified Medicare Beneficiary (QMB): covers premiums and cost sharing
- Extra Help: lowers Part D premiums and drug costs
- State Medicaid: separate from Medicare, with rules that vary by state
Many foreign residents rely on income or savings from their home country to pay for life in the US, including healthcare. If money for premiums or other bills arrives from abroad, you might benefit from a Wise account to receive funds, hold USD, and manage payment timing. Wise accounts allow you to hold 40+ currencies, including USD, and access mid-market exchange rates when you need to convert from one currency to another.
How to apply and avoid common mistakes
Check your status and work history first. If you’re unsure whether your own or your spouse’s record helps, review your pensions in the US and ask SSA to confirm your Medicare path.
Confirm your enrollment window. The risk here is assuming you can sign up any time without consequences, especially for Part B.
Gather documents early. You may need identity documents, immigration records, work or tax records, address history, and marriage records if you’re using a spouse’s record.
Apply through SSA for Part A and Part B. If language is a barrier, SSA offers free interpreter services by phone and in local offices.
Once eligible, compare drug and health plan options. Common mistakes include confusing Medicare with Medicaid, missing Part B deadlines, and assuming time abroad pauses penalties automatically.
What to do if you are not eligible yet
If Medicare isn’t available to you now, your bridge option may be employer coverage, health insurance in the US through the ACA Marketplace, Medicaid if your state rules fit your status and income, or a private plan.
This is where the differences matter. Medicare is federal retirement and disability health insurance. Medicaid is a state and federal program for eligible people with low income. The Affordable Care Act (ACA) Marketplace is the government system for comparing private plans. Lawfully present immigrants should check current HealthCare.gov guidance because subsidy rules are subject to change and review.
If you need private or international cover during that gap, an expat-focused plan is worth comparing with local US plans, especially if you live across borders.
When to consider an alternative to Medicare
If you can’t get Medicare yet, or your cover leaves gaps, an international health plan such as Cigna Global® may be worth considering.
It can help in 4 main cases:
- Cover in the US and abroad: Medicare doesn’t cover routine care outside the US, but an international plan can provide international cover, which may help if you travel often or live between countries.
- A bridge while you wait: it can help avoid a gap in cover while you build your 5 years of residence or wait for your Medicare start date.
- Flexible options: plans are usually built around hospital care, with options such as doctor visits, specialists, prescription drugs, or maternity care.
- Private networks: depending on the plan, you may be able to see doctors in the US and abroad without the tighter network rules of some Medicare Advantage plans.
Cover levels, exclusions, and prices vary by plan, so check what is included before you buy, especially for pre-existing conditions and cover in the US.
FAQ
Frequently asked questions about Medicare for foreigners
Can green card holders get Medicare before five years? 
Sometimes. A green card holder may qualify earlier through their own or a spouse’s work record for premium-free Part A, or through disability. If they need to buy into Medicare based on age, the 5-year continuous residence rule usually matters.
Can a spouse’s work record help a foreign resident qualify?
Yes, in some cases. A spouse’s work history can help a person qualify for premium-free Part A, but it doesn’t apply automatically, so ask SSA to check your situation.
Can foreigners on temporary visas get Medicare?
Under the rules described in the source article, temporary visa holders are usually not eligible for Medicare, even if they are lawfully present in the US. They may need employer coverage, Marketplace coverage, or private insurance instead.
Can you keep Medicare if you spend long periods abroad?
Often, yes, if you stay enrolled and keep paying required premiums. But keeping Medicare isn’t the same as having useful cover abroad because overseas care is usually not covered except in narrow cases.
Does Medicare cover you outside the US?
Medicare only covers care abroad in narrow cases, such as certain emergencies near the US border or on a ship near a US port. Some Medigap and Medicare Advantage plans add limited emergency travel cover, but this isn’t full international health insurance.
What happens if you miss Part B when you first qualify?
You may face a late enrollment penalty and may have to wait for the next enrollment period unless you qualify for a Special Enrollment Period. That can mean delayed access and a higher monthly Part B cost for as long as you keep the coverage.
What are your options if you do not qualify for Medicare?
You can still get health cover through other routes, including the ACA Marketplace or Medicaid if you meet the relevant rules. If you live or travel across borders, an international health plan such as Cigna Global® may also be an option.
Sources
Expatica’s experts are all about providing the most up to date and accurate information. All guides are fact checked, and whenever we use external sources (like government websites or research papers) we’ll make a note of them here so you can check them out too.
- Plan basics, plan comparison, and travel rules, Medicare.gov
- Original Medicare Part A and Part B eligibility and enrollment rules, Centers for Medicare and Medicaid Services
- Marketplace coverage guidance for lawfully present immigrants, HealthCare.gov
- State contacts for Medicaid and CHIP help, Medicaid.gov
- Free state-based Medicare counseling, SHIP
- 2026 Part A and Part B premiums and deductibles, Centers for Medicare and Medicaid Services
- Medicare coverage when traveling outside the US, Medicare.gov
- Medicare Savings Programs and cost help, Medicare.gov
- Extra Help and prescription drug cost assistance, Medicare.gov
- Free interpreter services, Social Security Administration
- Medicare enrollment background for immigrants, KFF
- Immigrant-specific Medicare guidance and the 5-year residence rule, Justice in Aging
- About State Health Insurance Assistance Programs, SHIP TA Center
