Medicare and Medicaid in 2026: New Rules for Immigrants

Since July 2025, the rules for immigrant access to Medicare and Medicaid in the United States have changed drastically. The One Big Beautiful Bill Act (HR-1), signed by President Trump, restricts non-citizen eligibility to specific immigration status categories, eliminating access for refugees, asylees, and TPS holders starting October 2026. For Brazilians planning to build a life in the US, understanding these changes is essential for making informed decisions about health coverage.

Previously, legal immigrants could access Medicaid after five years of continuous residence, and green card holders with sufficient work history automatically qualified for Medicare at age 65. The 2026 scenario is fundamentally different: eligibility now depends not only on length of residence but on a restricted list of immigration categories defined by federal law. Those who do not fit these categories must seek alternatives in the private market or in state programs.

This guide presents both programs with updated 2026 financial data, details the new eligibility restrictions, and explores the alternatives available for those excluded from federal rules.

What These Programs Are

Medicare is a federal health insurance program administered by the Centers for Medicare & Medicaid Services (CMS). It primarily serves people aged 65 and older, as well as individuals with certain disabilities and patients with end-stage renal disease. The program is funded by payroll taxes that workers and employers pay throughout their professional lives.

Medicaid is a joint federal-state program that provides coverage for low-income individuals and families. Unlike Medicare, which has uniform rules nationwide, Medicaid is administered individually by each state, resulting in significant variations in eligibility criteria, covered services, and income limits. Both programs are forms of government health coverage, but they serve different populations and needs.

The Parts of Medicare

Medicare is divided into four components that cover different aspects of medical care. Part A covers hospital stays, care in skilled nursing facilities, and home health services. Part B covers doctor visits, diagnostic tests, outpatient services, and durable medical equipment.

Part C, known as Medicare Advantage, consists of plans offered by private insurers approved by Medicare that combine Parts A and B and often include additional coverage such as dental, vision, and hearing. Part D covers prescription drugs and is offered by private insurers contracted by Medicare.

Medicare Costs in 2026

Medicare amounts for 2026 reflect significant increases compared to the previous year. The standard monthly premium for Part B is $202.90, an increase of $17.90 (about 10%) from $185.00 in 2025. Beneficiaries with higher incomes pay IRMAA-adjusted premiums ranging from $284.10 to $689.90 per month.

Part A has a deductible of $1,736 per hospitalization period. For immigrants who have not accumulated 40 quarters of Social Security contributions, the Part A premium is charged in full: $565 per month for those with fewer than 30 quarters, or $311 per month for those who have accumulated between 30 and 39 quarters. Green card holders with 40 or more quarters of work do not pay a premium for Part A.

Eligibility After HR-1

The One Big Beautiful Bill Act redefined which non-citizens can access Medicare and Medicaid. As of October 1, 2026, only the following categories remain eligible for federal health benefits: lawful permanent residents (green card holders), Cubans and Haitians with legal entry into the country, and citizens of Compact of Free Association (COFA) nations, which include Micronesia, the Marshall Islands, and Palau.

All other immigration categories lose eligibility, including refugees, asylees, Temporary Protected Status (TPS) holders, victims of human trafficking, victims of domestic violence, and work visa holders. It is estimated that more than one million legally present immigrants will be affected by these restrictions.

For immigrants already enrolled in Medicare when the law was enacted, there is an 18-month transition period. The Social Security Administration must identify and notify all individuals losing eligibility by July 4, 2026, and disenrollment becomes effective by January 4, 2027. Even immigrants who have paid payroll taxes for years will be disenrolled if they do not fit the eligible categories.

Medicaid and State Variations

Medicaid has always varied significantly between states, and this complexity remains under the new rules. Each state sets its own income limits, covered services, and enrollment processes. Some states expanded Medicaid under the Affordable Care Act, offering coverage to adults with incomes up to 138% of the federal poverty line, while others maintain more restrictive criteria.

With HR-1 restrictions, states that previously offered Medicaid to broad immigrant categories now face federal limitations. Some states may choose to fund their own state-funded programs to cover immigrants excluded from federal rules, but this is a discretionary decision that depends on specific state legislation. Brazilians relying on Medicaid should check the rules in their state of residence, as coverage can vary drastically.

Alternatives for the Ineligible

Immigrants who do not qualify for Medicare or Medicaid under the new rules have alternatives in the private market. The ACA Marketplace (Healthcare.gov) offers health insurance plans with income-based subsidies, although HR-1 has also restricted premium tax credits for non-citizens starting January 2027. Checking eligibility for subsidies is essential before choosing a plan.

Community health centers (Federally Qualified Health Centers) serve patients regardless of immigration status or ability to pay, using income-based sliding fee scales. Emergency care remains guaranteed by the EMTALA (Emergency Medical Treatment and Labor Act) law at any emergency room, regardless of immigration status or insurance. Short-term private health plans and medical discount programs are other options, though they offer more limited coverage.

Costly Mistakes

• Assuming that five years of legal residence guarantees access to Medicaid, when under HR-1 the type of status matters more than length of residence
• Ignoring the Medicare Initial Enrollment Period and facing permanent late enrollment penalties for Part B
• Confusing Medicare with Medicaid and applying for the wrong program, wasting time and documentation
• Not checking your state’s specific Medicaid rules, which vary substantially between jurisdictions
• Being unaware of the January 2027 disenrollment date and being left without coverage without an alternative plan in place
• Not considering community health centers or private plans as viable alternatives when excluded from federal programs

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.