Green Card Holders and Medicare When Working Past 65

The green card residence rule

SSA says a person who is not eligible for premium-free Part A may buy Part B if the person is age 65 or older and is a U.S. citizen or a lawfully admitted noncitizen who has lived in the United States for at least 5 years. SSA policy describes continuous residence for the 5 years immediately before the first month of eligibility.

A green card alone does not answer every Medicare question. Ask Social Security to review your lawful status, residence, and work record.

Work credits and a spouse's record

Premium-free Part A usually follows enough Medicare-covered work, generally about 40 quarters. Medicare.gov says the work of you or your spouse can determine whether Part A has a premium. If you have fewer credits, premium-Part A may be available and the amount can depend on the work record.

Ask Social Security to check both spouses' records. Do not assume that a short U.S. work history means no Medicare, or that a spouse's record automatically solves every eligibility issue.

Working after 65 and who pays first

If you are 65 or older and have group health coverage from your or your spouse's current employment, an employer with 20 or more employees generally pays first and Medicare pays second. If the employer has fewer than 20 employees, Medicare generally pays first.

Ask the employer whether the coverage is current-employment group coverage. Retiree coverage, individual coverage, and COBRA have different rules.

HSA and COBRA warnings

Once Medicare coverage begins, you cannot contribute to an HSA. SSA says to stop HSA contributions at least 6 months before applying for Medicare, Social Security, or Railroad Retirement benefits because premium-free Part A can start retroactively.

COBRA is not current-employment group coverage for extending the Part B sign-up window. Medicare says do not wait for COBRA to end before signing up for Part B.

Part B SEP and penalties

If you delayed Part B because you or your spouse were still working and you had employer group coverage, the Part B SEP generally lasts while the coverage continues and for 8 months after the work or coverage ends, whichever comes first.

Without a valid SEP, Part B generally adds 10% for each full 12-month period you were late. Part A can also have a penalty when premium-Part A was available but not purchased on time. Part D has a separate penalty if you go 63 days or more without creditable drug coverage.

Can a green card holder get Medicare?

A lawfully admitted noncitizen may qualify for Part B or premium-Part A after meeting the age and continuous 5-year U.S. residence rule, along with the other Medicare requirements. Ask Social Security to review your case.

How many work quarters usually make Part A premium-free?

Premium-free Part A generally follows about 40 quarters of Medicare-covered work. Your spouse's work record can also matter. Social Security must check the record.

Does an employer with 20 employees pay first?

For people age 65 or older with current-employment group coverage, an employer with 20 or more employees generally pays first. Confirm the exact coverage with human resources.

Does COBRA extend my Part B SEP?

No. Medicare says COBRA does not extend the limited time to sign up for Part B.

Can I contribute to my HSA after Medicare starts?

No. Medicare and SSA warn that HSA contributions after Medicare coverage begins can create tax problems. Ask a tax professional about the correct stop date.

How long is the Part B SEP after work ends?

Generally 8 months after employment or employer coverage ends, whichever comes first, if you had qualifying current-employment coverage.