Do you qualify for Medicare if you are not a U.S. Citizen? If you are a non-citizen living in the United States, you may still qualify to enroll in Medicare if you meet certain requirements and are a lawfully present resident. Medicare is the U.S. federal health insurance program for qualified people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease.
When does a non-citizen qualify for Medicare?
Generally, to qualify for Medicare as a non-citizen you must be a lawful resident and meet the 5-year residency rule. The residency rule says you have to resided in the United States for 5 continuous years leading up to when you enroll.
What qualifies as “continuing residence”? The Social Security Administration (SSA) looks at records of entry into the United States compiled by the Department of Homeland Security. Temporary absences do not affect “continuous” residence as long as the individual intends to maintain U.S. residence, but if absences are frequent or of long duration, the agency may inquire in order to determine whether continued U.S. residency was intended. Examples of evidence of intent could include continuing to pay U.S. income taxes, maintaining a house or apartment with the individual’s furnishings and belongings, etc. If an absence is over six months, SSA requires a “strong showing” of intent to retain U.S. residence. If SSA determines that continuous residence has been broken, the new five-year period begins on the date that the individual has returned to the United States.
What about non-citizens married to a U.S. citizen?
If you are a legal permanent residence and you are married to someone with premium-free Part A entitlement, then you will be entitled to Part A after 1 year of marriage, based on your spouse’s work history. The 5-year continuous residency rule will no longer apply.
Part A and the 40 Quarters Rule
Most Medicare beneficiaries qualify for Part A coverage without paying a premium. They qualify based on their work credits (generally 40 quarters, approximately ten years) or on the work credits of their spouse. However, if someone immigrated to the United States later in life they may not have enough work history to qualify for premium-free Part A. Even though you qualify for Medicare after 5 continuous years as a legal permanent resident, you or your spouse need 40 quarters (10 years) of work history to qualify for premium-free Part A. If you meet the 5-year rule, but not the 40-quarter rule, then you can get Part A but you will have to pay a premium.
What if you don’t qualify for premium-free Part A:
If you do not qualify for premium-free Part A, then you may still be able to purchase it for a monthly premium. You’ll pay either $278 or $506 each month for Part A, depending on how long you or your spouse worked and paid Medicare taxes. However, if you are low income and qualify for the Medicare Savings Program then you can get assistance paying for the Part A premium. See our blog on The Ins and Outs of the Medicare Savings Program.
Need more training and resources to increase your Medicare sales? Contact us HERE to learn more about contracting with our team!