Medicare Eligibility for New Immigrants

By Reuben Seguritan

Medicare is a US federal government insurance system primarily for people who are 65 years old or older. Medicare has several parts. Part A covers hospitalizations, surgeries, etc. Part B covers outpatient benefits, for example doctor’s office visits, laboratory tests and X-ray procedures. Part D covers prescription drugs and other such items. Medicare is a long-term medical insurance provided for US citizens and US lawful permanent residents (LPR) who live and work in the US continuously and permanently. Medicare is not available for a short term such as for a few months or for tourists in the US. Hence, Medicare is provided for US citizens and LPRs who have the United States as their home country.

Medicare is available to certain LPRs. The LPR must be 65 years old and continuously lived in the US for at least 5 years. If the LPR has worked for 40 quarters or 10 years, he does not have to pay the premium for Part A. For LPRs who have just arrived in the US, they are not eligible for Medicare because they have not met the requirements of continuous residence.

There is an enrollment period for LPRs who become first eligible for Medicare. Once approved, the Medicare will take effect on a certain date. For example, the enrollment period may be from January 1 to March 1. The Medicare coverage for these applicants will take effect on July 1. Until this date comes, the LPR should maintain his previous health insurance or make sure that he has a form of health insurance to pay for his medical needs in case he gets sick during the time that the Medicare has not taken effect yet.

Medicare has copays, coinsurance and deductions. That is why there are Medicare supplemental plans to ensure that the LPR is covered for medical hospitalizations and medications he may need. However, the Medicare supplement plans do not cover certain things such as long-term care, vision or dental care, hearing aids, eyeglasses and private-duty nursing.

Even if the Medicare supplement will not cover a lot of things, it is still advisable to apply immediately for Medicare and Medicare supplement when the LPR becomes eligible. This is because if the LPR enrolls into Medicare later on, there will be penalties and some of these penalties will continue to apply as long as he has Medicare. Sadly, there is no way to opt out of this system and the LPR may still have to pay expenses himself or out-of-pocket because they are not covered by Medicare or the Medicare supplement.

Seniors who are not eligible for Medicare can purchase insurance under the Affordable Care Act.

There are other insurance companies which provide health insurance. However, these companies do not allow the LPRs to apply and obtain a health insurance from them because they only operate for people who have a home country other than the United States. Since the LPR’s home country is the US, he cannot apply for insurance plans such as Atlas America, Diplomat America, Visit US HealthCare or Safe Travels USA.

The US government providing Medicare and other health insurance companies will know if the LPR is living and working in the US and therefore eligible for the Medicare or other health insurance by asking for documents such as a copy of the green card, copy of the passport biopage, or other documents.

If the LPR is younger than 65 years old, he can still apply for health insurance with private companies such as Aetna, Cigna, Blue Cross, Assurant Health, Humana, etc. If the LPR is the parent of the petitioner, the petitioner cannot add the LPR parent as a dependent because dependents are defined as the spouse or minor child of the petitioner. However, if the LPR parent is employed full-time by the petitioner in his company, then he may enroll the LPR in the employees’ health insurance. The LPR could also get health insurance from his employer if he works for another company or person and not the petitioner.