Short answer: Yes. Someone over 65 who never worked in the United States can almost always get coverage, but usually not for free. There are three realistic paths: buy into Medicare (if they are a citizen or a green card holder with five years of continuous residence), enroll in an ACA Marketplace plan (often with subsidies, because people who have to pay for Part A still qualify for them), or qualify for Medicaid or a Medicare Savings Program that pays the Medicare premiums for them. Which one is cheapest depends almost entirely on income and immigration status.
This is one of the most common questions we get from adult children helping an immigrant parent, from people who spent their careers abroad, and from spouses who never worked outside the home. Below is the full picture, with 2026 numbers.
Why this happens: Part A is earned, not given
Most Americans get Medicare Part A (hospital insurance) with no premium at 65. That is not a birthday benefit. It is a benefit you buy in advance through payroll taxes. You need 40 quarters of coverage (about 10 years of Medicare-taxed work) to get Part A at no cost.
Someone who never worked in the U.S. has zero quarters. That does not lock them out of Medicare, but it does mean Part A carries a premium, and it is a large one.
| Quarters of Medicare-taxed work | 2026 Part A premium | Per year |
|---|---|---|
| 40 or more | $0 | $0 |
| 30 to 39 | $311/month | $3,732 |
| Fewer than 30 (including zero) | $565/month | $6,780 |
Part B (doctors and outpatient care) is never free for anyone. The standard 2026 premium is $202.90/month, more if income is high enough to trigger IRMAA.
First, make sure they really have no work record
Before paying $565 a month, rule out the four ways people qualify for premium-free Part A without ever having worked themselves. This is the single most valuable thing to check, and it is the step most families skip.
1. A current spouse's work record
If the spouse has 40 quarters and is at least 62, and the couple has been married at least one year, the non-working spouse gets premium-free Part A at 65. The spouse does not have to be retired or drawing benefits, and does not have to be enrolled in Medicare yet. They only have to be 62 with 40 quarters.
2. A former spouse's work record
If the marriage lasted 10 years or more, the person is now unmarried, and the ex-spouse has 40 quarters and is 62 or older, they can qualify on the ex-spouse's record. The ex-spouse does not need to consent and is not notified in a way that affects their own benefits.
3. A deceased spouse's work record
A widow or widower who was married at least nine months before the spouse died can qualify on that record, provided the deceased spouse had 40 quarters.
4. Partial credits that put them over 30
Even a few years of U.S. work matters. Thirty quarters (seven and a half years) drops the Part A premium from $565 to $311, a savings of $3,048 a year. Self-employment income, farm work, and household work can all generate quarters if taxes were paid. Pull the earnings record at ssa.gov/myaccount rather than relying on memory.
A warning about totalization agreements
The U.S. has Social Security totalization agreements with about 30 countries, and foreign work credits can be combined with U.S. credits to qualify for a Social Security retirement check. They do not count toward premium-free Part A. This trips people up constantly: a person can draw a small Social Security benefit through totalization and still owe the full $565 Part A premium, because Part A requires 40 U.S. quarters. Getting a Social Security payment is not proof of premium-free Medicare.
Option 1: Buy into Medicare
Who is allowed to buy in
To purchase Medicare without the work history, a person must be 65 or older and one of the following:
- A U.S. citizen, or
- A lawfully admitted permanent resident (green card holder) who has lived in the U.S. continuously for the five years immediately before applying.
The five-year clock is a hard requirement, and it is continuous residence, not five years since the green card was issued at some point in the past. A green card holder who arrived 18 months ago has to wait.
Important 2025 change: a law enacted in July 2025 narrowed Medicare eligibility to U.S. citizens, green card holders, Cuban and Haitian entrants, and people residing under the Compacts of Free Association. Lawfully present immigrants in other categories, including refugees, asylees, and people with Temporary Protected Status, are no longer eligible to enroll, and those already enrolled lose coverage no later than January 2027. If your family member is in one of those categories, do not assume an old answer from a few years ago still applies.
The rules that surprise people
- You cannot buy Part A without also taking Part B. They come as a package for buy-in enrollees.
- You can, however, take Part B alone and skip Part A. That gives you doctor and outpatient coverage for $202.90 instead of $767.90, but leaves hospital stays uncovered, and it blocks you from Medigap and from Medicare Advantage, both of which require Parts A and B.
- Enrollment is manual. Nobody is auto-enrolled in premium Part A. There is no card in the mail. Someone has to file an application with Social Security.
- Medigap and Medicare Advantage are available once you have both A and B, on the same terms as anyone else, including the six-month Medigap open enrollment window with no medical underwriting.
What it actually costs in 2026
| Piece | Zero quarters | 30 to 39 quarters |
|---|---|---|
| Part A premium | $565.00 | $311.00 |
| Part B premium (standard) | $202.90 | $202.90 |
| Subtotal, monthly | $767.90 | $513.90 |
| Subtotal, annual | $9,214.80 | $6,166.80 |
| Part D drug plan (varies) | plus roughly $20 to $60 | plus roughly $20 to $60 |
| Medigap Plan G (varies by age, state, carrier) | plus roughly $140 to $300 | plus roughly $140 to $300 |
And that is before cost sharing. In 2026 the Part A hospital deductible is $1,736 per benefit period, days 61 through 90 cost $434/day, lifetime reserve days cost $868/day, skilled nursing days 21 through 100 cost $217/day, and the Part B deductible is $283 with 20% coinsurance after that.
Realistically, a buy-in enrollee with a drug plan and a Medigap policy is looking at $930 to $1,100 a month. For many families that is more than a subsidized Marketplace plan, which is why the next section matters so much.
When you can enroll, and the penalties for waiting
- Initial Enrollment Period: the seven months around the 65th birthday (three months before, the birth month, three months after). For a green card holder who has not yet hit five years of residence, the window opens when the five years are complete.
- General Enrollment Period: January 1 through March 31 every year. Coverage starts the first of the month after you sign up.
- Part A late penalty: 10% added to the premium, paid for twice the number of years you delayed. Two years late means four years at $621.50 instead of $565.
- Part B late penalty: 10% for each full 12 months you delayed, and unlike the Part A penalty, it lasts for life. Five years late is a permanent 50% surcharge, about $101 a month on top of the standard premium in 2026.
The Part B penalty is the expensive mistake here. Someone who moves to the U.S. at 68, waits until 75 to enroll, and then needs coverage will pay that surcharge forever. Read our full breakdown in Medicare Late Enrollment Penalties (2026).
Option 2: An ACA Marketplace plan, often with subsidies
This is the part almost everyone misses, and for middle-income households it is usually the better answer.
Being eligible for premium-free Part A ends your eligibility for Marketplace premium tax credits. But someone who would have to pay for Part A is in a different bucket. In CMS's own words to Marketplace assisters: consumers who are eligible to enroll in premium Part A remain eligible for financial assistance through the Marketplace, unless and until they actually sign up for Medicare and can start using it.
In plain English: a 67-year-old with no work history can buy a subsidized Marketplace plan, at any age, with no Medicare involved at all. There is no age cap on the Marketplace. Turning 65 does not push you off it if you were never entitled to free Part A.
Who can use the Marketplace
- You must be lawfully present, which is a broader list than Medicare uses and includes green card holders, refugees, asylees, TPS holders, and many valid non-immigrant visa categories.
- You must live in the state where you apply and not be incarcerated.
- Undocumented immigrants cannot buy Marketplace coverage, subsidized or not. See the last section for what is left.
What the subsidy is worth in 2026
The enhanced subsidies from 2021 through 2025 expired on December 31, 2025, and the original ACA formula is back. That means the 400% federal poverty level cliff has returned: for 2026 coverage, premium tax credits stop completely above $62,600 for a single person and $128,600 for a family of four in the continental U.S.
Why this matters so much at this age: Marketplace premiums are age-rated, and a 64-year-old pays three times what a 21-year-old pays. Below the cliff, the subsidy absorbs that and caps the premium as a percentage of income. One dollar above it, the full age-rated premium lands on the household. For a couple in their late 60s, the difference across that line can be well over $20,000 a year.
When you can enroll
Open Enrollment runs from November 1 through January 15 in most states. Outside of that you need a Special Enrollment Period. The one that applies most often in this situation is loss of other coverage, which includes losing Medicaid. That gives 60 days from the loss to pick a plan, and it is exactly the lifeline for a family whose parent was just denied at Medicaid renewal. Moving to a new state or a permanent move to the U.S. can also open a Special Enrollment Period.
One more 2025 law change to plan around
The same July 2025 law narrows Marketplace subsidies too, on a delayed schedule:
- Starting with tax years after December 31, 2025: lawfully present immigrants with income below 100% of the federal poverty level no longer qualify for premium tax credits. This group used to be covered by a special rule precisely because the five-year Medicaid bar shut them out. That bridge is gone.
- Starting with tax years after December 31, 2026: premium tax credits are limited to green card holders, Cuban and Haitian entrants, and COFA migrants. Refugees, asylees, TPS holders, and most other lawfully present categories lose subsidy eligibility for 2027.
If a family member is in one of those categories, 2026 may be the last year the math works the way it does today. That is a reason to plan now rather than next fall.
Option 3: Medicaid and Medicare Savings Programs
Medicaid and the five-year bar
Medicaid for adults 65 and over is income and asset tested, and most lawfully present immigrants face a five-year waiting period from the date they got qualified immigration status before they can enroll in full Medicaid. Refugees, asylees, and certain other humanitarian categories are exempt from that bar. Undocumented immigrants are not eligible at all, except for Emergency Medicaid, which covers emergency treatment including labor and delivery and emergency dialysis, and which does not require satisfying the five-year bar.
Denial at renewal, which is how many families discover this problem, is often about paperwork or a change in reported income rather than a true loss of eligibility. It is always worth asking the state agency for the specific reason in writing and filing an appeal within the deadline, while simultaneously lining up Marketplace coverage so there is no gap.
Medicare Savings Programs can pay the entire buy-in premium
This is the best-kept secret in this whole topic. The Qualified Medicare Beneficiary (QMB) program, run by state Medicaid agencies, pays the Part A premium, the Part B premium, and Medicare deductibles, coinsurance, and copays. A QMB enrollee with zero work quarters pays $0 for coverage that would otherwise cost more than $9,200 a year, and providers are prohibited from billing them for Medicare-covered services.
Rough 2026 limits, which vary by state and are higher in Alaska and Hawaii:
| Individual | Couple | |
|---|---|---|
| Monthly income (QMB) | about $1,350 | about $1,824 |
| Countable assets | about $9,950 | about $14,910 |
A dozen states ignore assets entirely for QMB, and several use more generous income limits, so never rule someone out based on the federal figures alone.
The chicken-and-egg problem, and how to solve it
QMB requires you to be entitled to Part A, but nobody with QMB-level income can afford a $565 premium to become entitled. Social Security and CMS solved this with the conditional Part A application: you apply for premium Part A on the condition that you will only be enrolled if the state approves you for QMB. You file the conditional application with Social Security, then apply for QMB with the state Medicaid agency, and the state buys the Part A in.
Two practical notes. In most states (the "Part A buy-in" states) you can do this any time of year. In roughly 14 "group payer" states, the conditional enrollment can only be done in the first three months of the year, which lines up with the General Enrollment Period. And because Medicare Savings Programs are administered through Medicaid, the same immigration status rules and five-year bar apply.
Option 4: Everything else, and what does not work
Worth checking
- A working family member's employer plan. Most group plans let you add a spouse at any age, and some allow a dependent parent. If an adult child's employer permits it, this is often the cleanest answer and there is no Medicare interaction to worry about if the parent is not Medicare-entitled.
- A retiree plan or COBRA from a job worked abroad for a U.S. employer, if one exists.
- Visitor and travel medical insurance for a parent in the U.S. on a B-2 visitor visa. This is not real health insurance and it excludes pre-existing conditions, but it is designed for exactly that situation and it is far better than nothing for an accident or a new acute illness. It is not a substitute for coverage for someone who lives here.
- Community health centers (FQHCs) charge on a sliding scale based on income and see patients regardless of immigration status. Hospital charity care is also mandatory for nonprofit hospitals, and the income thresholds are more generous than most people expect. Ask for the financial assistance policy by name.
- State-funded programs. A handful of states cover older adults regardless of immigration status with state dollars. These programs are contracting rather than expanding: Illinois paused new enrollment in its seniors program in November 2023 and ended the 42-to-64 program in June 2025, and California closed new adult enrollment in January 2026. Existing enrollees in both states generally keep coverage. Check your state's current rules, not last year's article.
What does not work
- Short-term medical plans. Most carriers will not issue to applicants 65 and over, federal rules now limit these plans to a few months, and they exclude pre-existing conditions entirely. Not a solution for someone who needs ongoing care.
- Health care sharing ministries. Not insurance, not regulated as insurance, no guaranteed payment, and typically restrictive for older applicants and pre-existing conditions.
- Waiting and hoping. Every year of delay after eligibility begins adds to a Part B penalty that never goes away.
The public charge question
Many families hesitate to enroll a parent in anything because of immigration consequences. Be careful here, because the rules just changed. A new DHS public charge rule took effect September 18, 2026, replacing the 2022 rule, and it allows adjudicators to consider a much broader set of means-tested benefits, including Medicaid, when deciding green card applications filed on or after that date. It can also consider benefits received by family members.
Public charge does not apply to everyone. It generally does not apply to U.S. citizens, to most green card holders renewing a card or applying for citizenship, or to refugees, asylees, and certain humanitarian categories. Medicare is an insurance program you pay premiums for rather than a means-tested benefit, and premium tax credits have historically not been treated as a public charge factor, but the new rule is broad and very new.
Do not guess on this. If anyone in the household has a pending or planned immigration application, talk to an immigration attorney or an accredited representative before enrolling in Medicaid or a Medicare Savings Program. We can tell you what the coverage options cost; we cannot give immigration advice, and the stakes are too high for an educated guess.
Putting it together: which path fits
| Situation | Usually the best path |
|---|---|
| Spouse, ex-spouse, or late spouse has 40 quarters | Premium-free Part A on their record. Apply with Social Security. |
| Citizen or green card holder, low income and few assets | Conditional Part A application plus QMB. Coverage at no cost. |
| Lawfully present, income between about 100% and 400% of poverty | Subsidized Marketplace plan. Usually far cheaper than buying Medicare. |
| Green card holder, high income, five years of residence met | Buy into Medicare with a Part D plan and Medigap. The subsidy cliff makes the Marketplace expensive above 400% of poverty. |
| Green card holder, less than five years of residence | Marketplace plan now, revisit Medicare when the five years are complete. |
| Not lawfully present | Emergency Medicaid, community health centers, hospital charity care, and any remaining state program. |
| In the U.S. temporarily on a visitor visa | Visitor or travel medical insurance for the length of the stay. |
Five mistakes we see over and over
- Assuming a Social Security check means free Part A. Totalization credits count for one and not the other.
- Dropping a subsidized Marketplace plan the moment a parent turns 65. If they are not entitled to premium-free Part A, they can keep it, subsidy and all.
- Never checking the spouse's record, including a spouse who died or a marriage that ended decades ago.
- Skipping Part B to save money, then paying a lifetime penalty when a diagnosis forces the decision.
- Applying for QMB without the conditional Part A application, which sends the family in a circle between Social Security and the state agency.
Frequently asked questions
Can a parent visiting on a tourist visa get Medicare or a Marketplace plan?
No to Medicare, and realistically no to the Marketplace, since Marketplace coverage requires residency in the state rather than a temporary visit. Visitor medical insurance is the practical option.
Does buying Part A give access to Medigap?
Yes. Once you have Parts A and B you get the same six-month Medigap open enrollment window, with no health questions, that everyone else gets. Missing that window is costly, because outside it most states allow medical underwriting.
Is there any way to get the five-year residence requirement waived?
No. There is no hardship exception or waiver for the five-year continuous residence rule.
Do the five years have to be after the green card was issued?
The person must have been lawfully admitted for permanent residence and have resided continuously in the U.S. for the five years immediately before applying. Long absences can break continuity, so document trips abroad.
If they enroll in Medicare later, do they lose the Marketplace subsidy retroactively?
The subsidy ends the month Medicare coverage actually begins. Where people get hurt is retroactive Part A, which can create months of overlap and a repayment of advance premium tax credits at tax time. Time the switch carefully and report the change to the Marketplace right away.
Can they have both a Marketplace plan and Medicare?
Technically yes, but it is almost always a bad idea. You would pay two premiums for overlapping coverage and lose the subsidy, and the Marketplace runs periodic data matching that will flag it.
What about someone who worked in the U.S. for six years, then moved abroad?
Twenty-four quarters puts them in the under-30 bracket at $565. Four more years of U.S. work would move them to $311, and ten total would make Part A free. If they are still working, that arithmetic is worth running.
Talk to a licensed iHealthAgents advisor, free
This is a situation where the right answer changes by thousands of dollars a year depending on details like a spouse's age, the exact date a green card was issued, and whether income lands just under or just over a subsidy threshold. We will pull the numbers for your specific case, compare a Medicare buy-in against a subsidized Marketplace plan side by side, and tell you plainly which one wins.
Prefer to book a time? Schedule a free 30-minute consultation with a licensed advisor, any time that works for you.
- Illinois: 312-726-6565
- Texas: 972-666-0578
You can also reach us at help@ihealthagents.com. For free, unbiased one-on-one counseling from your state, the State Health Insurance Assistance Program (SHIP) is an excellent resource, and 1-800-MEDICARE is available 24 hours a day.
For educational use only. Figures are 2026 amounts published by CMS and the Social Security Administration: Part A premiums of $0, $311, and $565; Part A deductible $1,736; standard Part B premium $202.90; Part B deductible $283. Medicare, Medicaid, Marketplace, and immigration rules change, several of them changed in 2025 and 2026, and eligibility is determined by Medicare, the Social Security Administration, your state Medicaid agency, and the Marketplace, not by us. Nothing here is immigration or tax advice.
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