Medicare

Medicare is federal health insurance for people aged 65 and older, certain people with disabilities, and people with end-stage renal disease. Unlike Medicaid, it is not income-based; most people qualify through the premiums they paid while working. On this page, you will find Medicare's parts, 2026 costs, enrollment periods and penalties, the immigration requirement introduced by the 2025 law, assistance for people with low incomes, and information people living in Türkiye need to know. The Open Enrollment Period for 2027 plans runs from October 15 to December 7, 2026.

• People aged 65 and older
• People who have received disability benefits from Social Security or the Railroad Retirement Board (RRB) for 24 months
• People with ALS (starting with the first month their disability benefits begin)
• People receiving regular dialysis or who have had a kidney transplant because of end-stage renal disease (ESRD)
• Premium-free Part A: If you or your spouse paid Medicare taxes long enough while working (usually at least 10 years), you do not pay a premium for Part A. This period is measured by credits earned through FICA payments (see 17.2).
• Premium Part A and Part B: Someone who does not qualify for premium-free Part A may buy Part A and enroll in Part B if they:
  • Are aged 65 or older
  • Live in the United States
  • Are a U.S. citizen or a green card holder who has lived continuously in the United States for 5 years before applying
  • People who buy Part A must also enroll in Part B.

• Under the law enacted on July 4, 2025 (Public Law 119-21, Section 71201), only the following people may enroll in Medicare:
  • U.S. citizens and U.S. nationals
  • Green card holders
  • Cuban and Haitian entrants
  • People lawfully residing in the United States under COFA
• This requirement also applies to enrollment in Medicare Advantage (Part C) and prescription drug plans (Part D).
• People who had Medicare when the law was enacted but do not belong to these groups: Their Medicare will end 18 months after the law's enactment, on January 4, 2027. The law requires SSA to identify these people and notify them clearly.
• Earnings counted for Part A must have been earned with work authorization.

• Part A (hospital insurance): Inpatient hospital care, skilled nursing facility care, hospice, and home health care.
• Part B (medical insurance):
  • Services from doctors and other health professionals
  • Outpatient care and home health care
  • Medical equipment (wheelchairs, walkers, hospital beds)
  • Many preventive services: screenings, vaccines, and yearly Wellness visits
• Part D (prescription drugs): Prescription drugs. Plans are offered by private insurance companies that follow Medicare rules.
• Part C (Medicare Advantage): A Medicare-approved private plan that combines Part A, Part B, and usually Part D.
  • You may need to use doctors in the plan's network and obtain prior authorization for some services.
  • There is an annual out-of-pocket maximum.
  • Most plans offer additional services such as vision, hearing, and dental care.
• Medigap (supplemental insurance): Standardized policies sold by private companies that pay costs that are your share under Original Medicare (such as the 20% coinsurance). In most states, they are named with letters (for example, Plan G and Plan K).
• Two main paths: Original Medicare (Part A + Part B; any doctor who accepts Medicare; optionally Part D and Medigap) or Medicare Advantage (Part C).
• If you qualify, you can have Medicare and Medicaid together. Medicaid may provide additional support, such as nursing home services and help with Medicare premiums.

• Part A:
  • premium: $0 for most people. People without premium-free eligibility pay $311 or $565 per month, depending on their or their spouse's work history.
  • hospitalization: a $1,736 deductible for each benefit period
  • days 1–60: $0; days 61–90: $434 per day; days 91–150 (lifetime reserve days): $868 per day; after day 150, you pay all costs
  • skilled nursing facility: $0 for days 1–20; $217 per day for days 21–100; after day 100, you pay all costs
• Part B:
  • standard monthly premium: $202.90 (it may be higher based on income)
  • annual deductible: $283
  • after the deductible, 20% of the Medicare-approved amount for most services
  • clinical laboratory tests: $0
• Part D:
  • premiums, deductibles, and copayments vary by plan; an additional income-related premium may apply
  • annual out-of-pocket maximum: $2,100 (2026). According to the Medicare & You 2027 handbook, it will be $2,400 in 2027.
• Original Medicare has no annual out-of-pocket maximum. Medigap or Medicare Advantage reduces this risk.
• 2027 premiums and deductible amounts had not been announced when the handbook went to print. Check Medicare.gov for current amounts.

• Initial Enrollment Period: It begins 3 months before the month you turn 65 and ends 3 months after that month (7 months total).
  • If you enroll before your birth month, coverage begins in your birth month. If you enroll in your birth month or during the following 3 months, coverage begins the next month.
  • Premium-free Part A begins in the month you turn 65. For people born on the first day of the month, it begins the previous month.
• General Enrollment Period: Every year from January 1 to March 31. Coverage begins the month after you enroll. You may have to pay a late enrollment penalty.
• Special Enrollment Period:
  • If you have group health insurance through your own or your spouse's job, you can enroll in Part B without a penalty during the 8 months after the job or insurance ends, whichever comes first.
  • COBRA and retiree insurance do not provide this right.
  • Special periods also exist for situations such as losing Medicaid, a disaster, incorrect information from an employer or plan, and release from prison.
• Open Enrollment: October 15 to December 7 every year. You can join or change a Medicare Advantage or drug plan, or leave one. The new plan starts January 1. The plan must receive your request by December 7.
• Medicare Advantage Open Enrollment: January 1–March 31. You may change plans or return to Original Medicare only if you are already enrolled in a Medicare Advantage plan.
• Penalties:
  • Part B: 10% for each full 12-month period in which you could have enrolled but did not. It is paid as long as you have Part B. Example: Someone 24 months late pays $243.50 instead of $202.90 in 2026.
  • Part D: If you go 63 days or longer without comparable drug coverage, 1% of the national base premium is added for each uncovered month (the 2026 base premium is $38.99). It is paid as long as you have drug coverage.
  • Premium Part A: If you do not take it when first eligible, the monthly premium may increase by 10%. You pay it for twice the number of years you did not enroll.

1. Will you be enrolled automatically? If you started receiving Social Security (or RRB) benefits at least 4 months before turning 65, you will be automatically enrolled in Part A and Part B. Your Medicare card will arrive by mail 3 months before you turn 65. You can decline Part B if you do not want it.
   • If you live in Puerto Rico or outside the United States, only Part A comes automatically. You must apply separately for Part B.
2. If not automatic, apply to the Social Security Administration:
   • online, through your my Social Security account (the easiest and fastest way)
   • by phone: +1 800 772 1213 (TTY: +1 800 325 0778)
   • at a local SSA office
   • if you or your spouse worked for the railroad, contact the RRB: +1 877 772 5772 (TTY: +1 312 751 4701)
3. Use the form appropriate to your situation (mail or fax it to your local SSA office):
   • You have Part A and want to add Part B (January 1–March 31 only): Form CMS-40B
   • You will add Part B because your employer coverage ended: CMS-40B together with CMS-L564, completed by your employer. If the employer cannot complete it, complete Section B yourself but do not sign it; attach proof of workplace insurance.
   • You missed the Initial Enrollment Period because of an exceptional circumstance: CMS-10797
4. Wait for your card. About 2 weeks after enrollment, you will receive a welcome package containing your Medicare card. Your Medicare number is printed on the card.
5. Choose additional coverage. Review Part D, Medigap, or Medicare Advantage options with Medicare's plan comparison tool.
6. If you have a Health Savings Account (HSA): To avoid an IRS penalty, you must stop contributing to your HSA 6 months before applying for Medicare.

• Medicare Savings Programs (state programs): They pay Part A and Part B premiums and sometimes deductibles and copayments as well. Apply through your state. 2026 federal limits:
  • QMB: monthly income of $1,350 for an individual and $1,824 for a couple; assets $9,950 / $14,910. If you have QMB, health care providers cannot charge you for Medicare-covered services.
  • SLMB (Part B premium only): monthly income of $1,616 for an individual and $2,184 for a couple; assets $9,950 / $14,910.
  • Limits are slightly higher in Alaska and Hawaii. States may apply higher limits; apply even if you exceed the limit.
• Extra Help (drug assistance): It helps with Part D premiums, deductibles, and copayments. While receiving Extra Help, the Part D late enrollment penalty is also waived.
  • People with full Medicaid, a Medicare Savings Program, or SSI receive it automatically.
  • Others apply to SSA. 2026 limits: annual income of $23,940 for an individual and $32,460 for a couple; assets $18,090 / $36,100.
  • If you have QMB or SLMB, in 2026 you pay no more than $12.65 for each covered drug.
• Medicare is an earned benefit; it is not considered income-based assistance in a public charge assessment. For the effect of income- and asset-based programs (Medicare Savings Programs and Extra Help) on the green card process, see 16.5.

• Original Medicare (Part A and Part B) generally does not cover health care outside the United States.
  • Some Medigap policies may cover emergency care abroad.
  • Some Medicare Advantage plans may provide emergency and urgently needed care while traveling.
• According to the U.S. Embassy in Türkiye, Part B can be used only in the United States. If you do not plan to return to the United States, you may stop paying the Part B premium. However, if you enroll again later, you will pay a higher premium and can enroll only during January–March.
• According to Medicare.gov, if you live outside the United States but plan to return and receive health care in the United States, you may want to keep Part B.
• Ending Part B: Mail a signed and dated letter containing your name, address, date of birth, and Social Security number to: Federal Benefits Unit, American Embassy, Vas. Sofias 91, 101 60 Athens, Greece. Part B ends the month after the month the letter is received.

• 1-800-MEDICARE — plan selection, coverage, bills, general questions
  • Phone: +1 800 633 4227 (TTY: +1 877 486 2048)
  • Hours: 24 hours, including weekends
  • Live chat: Medicare.gov – Talk to someone
  • Mailing address: PO Box 1270, Lawrence, KS 66044
• Social Security Administration (SSA) — Part A/B enrollment, address changes, Extra Help applications, verification of citizenship or residency requirements
  • Phone: +1 800 772 1213 (TTY: +1 800 325 0778)
  • Online enrollment: SSA – Sign up for Medicare
• Railroad Retirement Board (RRB) — railroad workers and spouses
  • Phone: +1 877 772 5772 (TTY: +1 312 751 4701)
• State Medicaid office — Medicare Savings Programs
  • Web: list of state agencies
• SHIP (State Health Insurance Assistance Program) — free, independent counseling on plan selection and costs. It is available through Medicare.gov's "Talk to someone" page.
• From Türkiye: Federal Benefits Unit, FBU.Athens@ssa.gov

• Not enrolling in Part B at age 65 and paying a lifetime penalty.
• Assuming COBRA or retiree insurance provides a Special Enrollment Period.
• Missing the 8-month period after workplace insurance ends.
• Not reviewing your plan and drug list during Open Enrollment (October 15–December 7).
• Moving to Türkiye without carefully considering your Part B decision.
• Being unaware of the immigration requirement introduced by the 2025 law.

• I have a green card and am 65, but I have never worked in the United States. Can I get Medicare? You need enough credits for premium-free Part A. After living continuously in the United States for 5 years, you can buy Part A with a premium and enroll in Part B.
• I worked for 15 years with H-1B but did not get a green card. Can I get Medicare? Since the 2025 law, Medicare is available only to U.S. citizens, green card holders, Cuban and Haitian entrants, and people covered by COFA.
• Is Open Enrollment happening now? Yes. Changes made between October 15 and December 7, 2026, begin January 1, 2027.
• My spouse has workplace insurance. Should I enroll in Part B at age 65? If you have group workplace insurance, you can use the Special Enrollment Period to enroll later without a penalty. Apply within 8 months after the job or insurance ends.

• Medicare & You 2027 – official handbook (PDF)
• Medicare plan comparison tool (Plan Finder)
• Form CMS-40B – Part B enrollment request (PDF)
• Form CMS-L564 – proof of workplace insurance
• Form CMS-10797 – Special Enrollment Period request for exceptional conditions (PDF)
• Form CMS-18-F-5 – Part A application (PDF)
• SSA – enroll in Medicare online
• SSA – Part B assistance for people living outside the United States