Qualify for Medicare as a U.S. Citizenship or Permanent Legal Resident

Medicare provides health care to millions of people, 64.5 million in 2022. Many are still left uninsured. It is important to know when and if you are eligible to take advantage of the program's many benefits. While Medicare.gov offers an eligibility calculator, it can still be confusing. Understanding exactly what those requirements are will give you a better understanding of the Medicare application process.

Living in America

Medicare is health care partially funded by tax dollars. With federal money on the line, it is not surprising the government wants to keep tight reins on these services. Specifically, it wants to make sure that you are a citizen or permanent legal resident of the United States.

Simply put, if you are not a U.S. citizen, you need a Green Card or you need to be a documented legal immigrant who has paid a qualifying amount in Medicare and Social Security taxes.

You are not eligible for Medicare if:

• You are in the United States on a visa.
• You are married to a U.S. citizen or permanent legal resident, but you are not one yourself.

While marriage in some cases could make you eligible for free Part A premiums, you first have to meet citizenship and/or legal residency requirements before you would be considered for Medicare coverage at all.

Legal Residency in the United States

The legal residency requirement for Medicare is layered. Not only must you establish permanent residency in the United States, but you must also have maintained that residency for at least five years.

As a Green Card holder, timing also matters. Even if you have exceeded five years as a permanent resident, you cannot apply for Medicare unless you lived in the United States during the five consecutive years immediately before you file an application.

For example, Maria has had a U.S. Green Card for six years and she will turn 65 years old in 2022. However, she lived outside of the country for the bulk of 2021. Unfortunately, she would not be eligible to apply for Medicare in 2022. She would have to live in the United States for five more continuous years before she would qualify for coverage.

Getting a Green Card

You can establish legal residency in one of the following ways, but do not expect it to be easy or quick. The process can take anywhere from months to years before you actually get a Green Card. All applications must ultimately be approved by U.S. Citizenship and Immigration Services (USCIS) under the Department of Homeland Security. However, immigration remains a hot-button issue. Be sure to check in with the USCIS to review their current processes.

As of 2023, you are eligible for a Green Card: 

• Through asylum or refugee status: If the U.S. government has granted you asylum, you may be eligible for permanent residency after one year of your entry into the United States. This remains the case only so long as your asylum or refugee status has not been terminated.
• Through the Diversity Immigrant Visa Program: If you reside in a country that has low rates of immigration into the United States, you can apply for an annual lottery for a Visa. As many as 50,000 immigrants may win a Visa through the DV program.
• Through your employer: An employer can sponsor you through a labor petition. Your employer must prove to the government that there is not a U.S. citizen or legal resident otherwise qualified and willing to perform in the position you are being offered.
• Through entrepreneurship: If you invest dollars into an American company, you, your spouse, and your children may be considered for permanent residency. This will require a minimum $500,000 investment in an area of the country where there is a high unemployment rate or high need, i.e., rural areas. Otherwise, a minimum $1,000,000 investment will be necessary. You must also assure that your investment supports at least ten full-time permanent jobs for qualified U.S. workers.
• Through a family member: If your family member is a U.S. citizen or legal permanent resident, they can apply to sponsor you for legal residency, i.e., a Green Card. U.S. citizens over 21 years of age can sponsor their spouses, parents, children, siblings, fiancees, and fiancee's children. Permanent legal residents are limited to sponsoring their spouses and children. By definition, children are unmarried and under 21 years of age.
• Through your talents: If you are a skilled worker or professional who provides services that are considered to be of "extraordinary ability", you may apply directly to the government for legal residency. Interestingly, burlesque dancer Bettina May was granted one of these rare Green Cards in 2012. You just have to prove that you are the best in your field.

Exceptions to the Rule

As with most things, there is always an exception. It is possible, though less common, to become eligible for Medicare without being a U.S. citizen or permanent legal resident.

This would be the case if you qualify for Social Security retirement benefits, Social Security Disability Insurance, or Railroad Retirement Board benefits. You need to be lawfully in the United States to qualify for those programs but not necessarily a permanent legal resident. Also, you would need to meet all additional eligibility requirements for those programs before you would be considered for Medicare.

Summary

Once you have established U.S. citizenship or legal residency, you are on the path to securing health care through Medicare. Next, you will have to demonstrate medical need based on your age (65 years and older) or based on a long-term disability. Understanding these eligibility requirements will help you get the care you need.