Medicare and the “Big Beautiful Bill”: What Green Card Holders Should Know
Published on: September 2, 2026
The One Big Beautiful Bill Act (also known as HR. 1 or OB. 3) made Medicare eligibility much narrower for immigrants. Green card holders generally remain eligible for Medicare, but many other lawfully present older adults including refugees, people granted asylum, and people with Temporary Protected Status may lose eligibility beginning in 2027.
The main change
Before the law, some noncitizens could qualify for Medicare through their own or a spouse’s work record, or if they met specific rules by living in the United States lawfully for at least five years and paying premiums for Medicare coverage.
Under the new law, Medicare is limited primarily to:
- U.S. citizens and nationals
- Lawful permanent residents, commonly called green card holders
- Certain Cuban and Haitian entrants
- People lawfully living in the United States under Compacts of Free Association with Palau, Micronesia, or the Marshall Islands
That means having a green card is now especially important for an older immigrant’s Medicare eligibility.
What it means for green card holders
Green card holders are still among the immigrant groups allowed to enroll in Medicare, provided they meet Medicare’s other rules. Those rules can include being 65 or older, qualifying because of disability or end-stage renal disease, and meeting the applicable work-history, residency, or premium-payment requirements.
In other words, a green card does not automatically enroll someone in Medicare or guarantee premium-free Part A. But it preserves access to Medicare that many other immigration categories no longer have.
The bill does not create a new five-year Medicare rule for green card holders.
It keeps the longstanding rule: in many situations, a person must be a lawful permanent resident and have lived continuously in the United States for the five years immediately before applying for Medicare.
The rule in plain language: A green card holder who is 65 or older generally may enroll in Medicare if they:
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