Medicare can be confusing for anyone. It is easy to misunderstand Medicare eligibility or the best time to enroll in the various parts of Medicare. The factors around Medicare eligibility and enrollment choices can be even more complicated for older people who were born outside the U.S. Immigrants may not have as much work history in the U.S., may have a variety of immigration statuses, or may have limited English proficiency—all making a potentially confusing process even more difficult.
Non-citizens and Medicare eligibility
If you qualify for Social Security Retirement Benefits, Social Security Disability Insurance, or Railroad Retirement Benefits, you are eligible for Medicare. In other words, if you qualify for premium-free Part A, you are Medicare-eligible regardless of your immigration status and residency. To be eligible for retirement benefits and premium-free Part A at age 65, you must have worked at least 40 calendar quarters, or 10 years, in the U.S. and paid Social Security tax; these are known as work history credits. To qualify for premium-free Part A before age 65, you must meet pro-rated work history requirements that are based on the age you became disabled and when the work was performed. If you don’t have enough work history, you may still be eligible based on your spouse’s work history. If you aren’t sure how many quarters of work history you or your spouse has, you can contact Social Security to ask. You can also make an online account at SSA.gov to check your number of work quarters online.
Legal permanent residents (LPRs) are non-citizens who are allowed to live in the U.S. indefinitely. A person who has the immigration status of LPR is sometimes referred to as a “green card holder.” If you are an LPR who doesn’t qualify for the federal benefits just described, you can be eligible for Medicare if you have lived in the U.S. continuously for five years before enrolling in Medicare. The five years begins the day you arrive in the U.S. with the intention of establishing a home, not just for a visit. You can keep your LPR status even if you leave the U.S. temporarily, meaning for no more than six months. These short visits out of the country shouldn’t be considered a break in your period of residence in the U.S. for the five-year residency requirement.
To qualify for premium-free Part A, you must be considered “fully insured” by the Social Security Administration. This means that at age 65 you, or in some situations your spouse, must have worked at least 40 calendar quarters (or 10 years) in a job where Social Security taxes were paid. For people under 65, the number of calendar quarters of Social Security credit needed varies based on the age of onset of disability and when those work quarters occurred. Most people who are considered fully insured also qualify for Social Security retirement or Railroad Retirement Benefits.
To discuss your Medicare enrollment options, or to ask any questions regarding your specific situation, please contact the State of Alaska Medicare Information Office at 800-478-6065 or 907-269-3680; our office is also known as the State Health Insurance Assistance Program (SHIP), the Senior Medicare Patrol (SMP), and the Medicare Improvements for Patients and Providers Act (MIPPA) program. If you are part of an agency or organization that assists Seniors with medical resources, consider networking with the Medicare Information Office. Call us to inquire about our new Ambassador program.
Sean McPhilamy is a volunteer and Certified Medicare Counselor for the Alaska Medicare Information Office.
