What are the Medicare eligibilty regulations for a green card holder?
June 12, 2020 3:34 PM   Subscribe

Bit of a complicated situation (isn't it always with health insurance and the US): Can someone point me to the regulations around how long before a green card holder is eligible for Medicare? Trying to work out whether they would need to wait 5 years or not. Snowflake details inside...

I'm trying to help find the right regulations to reference when calling Medicare to discuss eligibility for a green card holder. The person in question is currently:
a) Over 65
b) Married to a US citizen for 20+ years (and has adult children who are US citizens if relevant)
c) applied for a green card, while living outside the US (so a pending IR-1 Green Card). That application is pending, with a tentative date of June 2021.

Note: The U.S. citizen spouse meets the 40 quarters eligibility requirement and is enrolled in Medicare already (both Part A & Part B)

We tried the general helpline for Medicare and the representative suggested that it would take 5 years before the green card holder would be eligible for Medicare benefits but wasn't certain.
When researching, information on sites like the AARP suggest that the green card holder would be immediately eligible, so trying to find the relevant regulations or someplace to point to on Medicare's website. So far no luck through googling terms like qualified alien, medicare eligibility, etc., so hoping someone knows the right place to look or better search terms :)
posted by thefuzzypanda to Law & Government (3 answers total)
 
Medicare Rights offers a National Helpline at 1-800-333-4114 to answer questions from people with Medicare, their family members and friends, (via MeFi Wiki ThereIsHelp, Help with Health Insurance section), and they spoke to me about eligibility questions.
posted by katra at 3:41 PM on June 12, 2020


I believe that is true, but I can't completely remember off the top of my head. This chart indicates the same -- Medicare Part A requires "qualified immigrant" status, which is basically LPR and a few other categories like refugee/asylee -- the full definition is on page 4 of the .pdf linked from that page.

I would search for "SHIP counselor + [your state]" just to double-check. They're typically nonprofit employees whose agencies have state contracts to help people answer questions like this! (I used to be one and I'm sure I still have my huge eligibility binder somewhere, but I don't know where.)

But you could call Medicare as well. It's just hit or miss as to how long you'll be on hold.
posted by tivalasvegas at 4:02 PM on June 12, 2020


In general it's five years, but age may play a rule in this, but my quick Google says no, it doesn't change it . In addition it states that to get medicare it looks like a LPR cannot be eligible for social security payments as well. These are complicated systems, with incredibly complicated rules please reach out as suggested above. For example, having ESRD and requiring dialysis throws a ton of rules out the window.

Depending on income, there is also medicaid to coincider which can be a little different depending on state. Many states have a five year waiting period as well. Medicare does NOT pay for long term care, that is medicaids role.

He may need to look into purchasing his own healthcare until he qualifies. In addition some states have hospitals who have programs designed for individuals who don't qualify for insurance to get basic medical care at low cost within their hospital system. These systems aren't perfect, but usually include access to a primary care doctor, some medications and fee waving for hospital stays within that hospital network. I know about a program in Chicago, if you are interested in learning more pm me.
posted by AlexiaSky at 11:01 PM on June 12, 2020


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