Medicare and Medicaid for Immigrants: Rules and Changes for 2026

Medicare and Medicaid are the two main public health programs in the United States, and understanding how they work is essential for any immigrant planning to live in the country long-term. In 2026, these programs will undergo profound changes with the enactment of the One Big Beautiful Bill Act (H.R. 1), which drastically restricts eligibility for various categories of immigrants. Knowing the current rules, the costs involved, and the legislative changes coming into effect is crucial for planning health coverage safely.

How Medicare Works

Medicare is a federal health insurance program administered by the Centers for Medicare and Medicaid Services (CMS). It is primarily intended for people aged 65 and older, although people under that age with certain disabilities or end-stage renal disease (ESRD) may also qualify. The program is divided into four distinct parts.

• Part A (Hospital Insurance): covers hospital stays, care in skilled nursing facilities, hospice, and certain home health services
• Part B (Medical Insurance): covers doctor visits, diagnostic tests, outpatient services, durable medical equipment, and preventive care
• Part C (Medicare Advantage): private plans approved by Medicare that combine Part A and Part B coverage, often including additional benefits such as vision and dental
• Part D (Prescription Drug Coverage): covers prescription drugs through plans offered by private insurers approved by Medicare

Medicare is not free for all beneficiaries. Those who have accumulated 40 or more work credits in Social Security (approximately 10 years of contributions) are entitled to Part A with no monthly premium. Those with fewer credits can purchase coverage by paying monthly premiums that vary according to their contribution history.

How Medicaid Works

Medicaid is a joint federal and state program that provides health coverage for low-income individuals and families. Unlike Medicare, Medicaid rules vary significantly from state to state, both in eligibility criteria and in the scope of coverage offered.

Medicaid coverage is comprehensive and includes doctor visits, hospital stays, lab tests, mental health services, long-term care, and, in most states, prescription drugs. Eligibility criteria are based on household income, family size, disability status, and, crucially for immigrants, immigration status and length of residence in the U.S.

Traditional Eligibility for Immigrants

Until recent legislative changes, eligibility rules for immigrants followed guidelines established decades ago. For Medicare, lawful permanent residents (green card holders) with at least 40 work credits in Social Security were eligible for Part A with no premium, just like U.S. citizens. Those with fewer than 40 credits, but at least 5 continuous years of legal residence, could buy Part A by paying the full premium.

For Medicaid, most states imposed a five-year waiting period after obtaining a green card before allowing enrollment. Refugees and asylees had immediate access during their first seven years in the U.S., with no waiting period. Some states, such as California and New York, used state funds to offer coverage to additional categories of immigrants beyond what federal law required.

Changes from the One Big Beautiful Bill

The One Big Beautiful Bill Act (H.R. 1), enacted in 2025, introduces the most significant changes in immigrant eligibility for federal health programs in decades. The main effects take effect as of October 1, 2026, fundamentally altering who can access Medicare and Medicaid.

The main restrictions include:

• Refugees, asylees, and humanitarian parolees lose eligibility for Medicaid and CHIP (Children’s Health Insurance Program)
• Only U.S. citizens, certain lawful permanent residents, Cuban and Haitian entrants, and citizens of the Freely Associated States (Marshall Islands, Micronesia, and Palau) retain full eligibility
• The same restriction applies to Medicare: the categories excluded from Medicaid also lose access to the federal health insurance
• People already enrolled in Medicare at the time the law is enacted receive an 18-month transition period before losing coverage

As of December 31, 2026, an additional change affects all beneficiaries: low-income adults between 19 and 64 years old without disabilities (the so-called Medicaid expansion population) will have their eligibility re-evaluated every 6 months, instead of the previous 12-month annual cycle. This change significantly increases the administrative burden on beneficiaries and the risk of involuntary loss of coverage due to failure to renew.

Medicare Costs in 2026

The Medicare premium amounts for 2026, as released by CMS, directly impact the financial planning of immigrants in the U.S.:

These amounts are particularly relevant for immigrants who arrived in the U.S. at an older age and did not accumulate enough work history in the country. A green card holder without the 40 credits may pay up to $767.90 per month just in combined Part A and Part B premiums, not counting Part D for medications and possible Medigap supplemental plans.

The Part B premium of $202.90 is mandatory for all who enroll, regardless of work history. Incomes above $106,000 per year are subject to additional surcharges known as IRMAA (Income-Related Monthly Adjustment Amount).

Planning for Immigrants

Given the increasing restrictions, immigrants in the U.S. should take a proactive approach to ensure adequate and affordable health coverage.

For green card holders, the priority should be to accumulate the 40 work credits in Social Security as quickly as possible. Each quarter with income above the minimum limit set by the Social Security Administration generates one credit. The sooner the 40 credits are reached, the lower the cost of Medicare at age 65, since Part A becomes free.

For refugees and asylees, with the restrictions of the One Big Beautiful Bill taking effect in October 2026, it is essential to immediately check current eligibility and explore alternative coverage options. Marketplace plans under the Affordable Care Act (ACA) may be a viable alternative, although they also face restrictions for certain immigrant categories depending on status.

For all immigrants, investigating the specific rules of the state of residence is indispensable. Some states use their own funds to maintain health programs that cover categories losing federal eligibility. In addition, employers who offer health plans as a benefit represent a fundamental source of coverage that is independent of government programs and federal legislative restrictions.

Victoria Harper

Editor-in-Chief

Meet the author

Leading journalism and editorial content at Visto n’ Visa, Victoria helps make immigration topics clear, trustworthy, and easy to understand. Her focus is on delivering useful, human, and relevant content for people exploring new paths abroad.