Medicare 2026

Medicare Eligibility Is Narrowing for Some Noncitizens: What the 2025 Law Changed

A federal law signed on July 4, 2025 changed who can be entitled to or enrolled in Medicare. For most people — U.S. citizens and many longtime green card holders — nothing about day-to-day Medicare changes. But for a smaller group of noncitizens who previously qualified based on being "lawfully present," the rules are tightening, and some current enrollees will see their coverage end in early 2027. Here is a plain-English look at what changed, who is affected, and what to watch for.

What the law actually says

Section 71201 of Public Law 119-21 (H.R. 1), signed July 4, 2025, says a person may be entitled to or enrolled in Medicare only if they are:

• a U.S. citizen or U.S. national,
• a lawful permanent resident (green card holder),
• a Cuban or Haitian entrant, or
• a person lawfully residing in the U.S. under a Compact of Free Association (COFA).

Medicare's September 2026 fact sheet, "Your Medicare in 2027: What's New & Changing," repeats the same four categories for Part A, Part B, and for joining a Medicare health or drug plan.

Before this law, a noncitizen who met Medicare's other requirements could generally qualify if they were "lawfully present" in the United States — a broader group that included, for example, people granted asylum and admitted refugees. Those broader categories no longer qualify a person for Medicare.

Two things the new law did not change:

• It did not change Social Security (Title II) retirement or disability benefits. A noncitizen who is lawfully present may still be eligible for Social Security payments even if they no longer qualify for Medicare.
• It did not eliminate the long-standing rule that a lawful permanent resident who is not entitled to premium-free Part A must have lived in the U.S. continuously for the 5 years before applying in order to buy Part A or enroll in Part B.

What happens to people already enrolled

For people who were entitled to or enrolled in Medicare on July 4, 2025, the new rule takes effect 18 months after enactment. CMS, in its 2027 physician fee schedule final rule, says that for enrollees outside the four listed groups, coverage will be terminated effective February 1, 2027.

The law directed the Commissioner of Social Security to review current enrollees within one year of enactment and notify people whose Medicare will be terminated in a way designed to make sure they understand. According to CMS:

• SSA estimated about 300,000 notices would go out in November 2026 to people who may lose coverage.
• SSA will send a formal termination notice toward the end of December 2026 to those it determines are ineligible, stating the February 1, 2027 effective date and explaining appeal rights.
• The notice tells people that SSA records indicate they do not meet one of the four categories, and instructs them to contact SSA with updated evidence if they believe the information is wrong.
• CMS's Office of the Actuary estimates about 32,000 people will actually lose coverage beginning in 2027, because many of those notified are expected to send documents proving they still qualify.

If you or a family member receives such a notice, read it carefully and respond. Contacting SSA quickly, with proof you fit one of the four categories (for example, a green card), is the way to keep coverage from being terminated.

A special enrollment period for people who later qualify

CMS created a special enrollment period (SEP) for people who later meet — or again meet — the four-group requirement, including those whose Medicare was terminated under this law. It begins the month the person contacts SSA and provides enough information to show they qualify, and ends the last day of the 12th month after that month. CMS lengthened this window from the 6 months originally proposed. A person enrolling during this SEP may choose up to 6 months of retroactive coverage, but not earlier than the month they first met all of Medicare's eligibility requirements.

What is not changing for 2027 enrollment

The broader Medicare calendar continues as usual:

• Annual (Open) Enrollment for 2027 runs October 15 – December 7, 2026, with changes effective January 1, 2027.
• The Part D out-of-pocket cap rises to $2,400 in 2027 (up from $2,100 in 2026).
• The maximum Part D deductible any plan may charge in 2027 is $700.
• The Part D base beneficiary premium used to calculate the late-enrollment penalty is $41.33 for 2027; actual plan premiums are set plan by plan.
• Social Security announced a 3.6% cost-of-living adjustment on October 14, 2026, for benefits payable beginning January 2027.

The 2027 Part B standard premium and deductible, and the 2027 IRMAA income brackets, had not yet been announced at the time of writing. CMS announces those figures in the fall, usually in November.

Medicare Advantage vs. Original Medicare + Part D (and Medigap)

For people who do qualify, the choice between Medicare Advantage and Original Medicare paired with a stand-alone Part D plan (often with a Medigap policy) remains personal. Medicare Advantage typically bundles medical and drug coverage with network rules and out-of-pocket maximums; Original Medicare plus Medigap and Part D offers broad provider access with different cost-sharing and premium trade-offs. Neither is "better" in general — it depends on your doctors, prescriptions, travel, and budget.

A note for people with Medicaid or Extra Help

Since 2025, people with Medicaid or Extra Help have a monthly Special Enrollment Period to move to Original Medicare with a stand-alone Part D plan, or to switch stand-alone Part D plans. Full-benefit dual-eligible individuals may also join an integrated D-SNP in any month.

Where to go next

For official details, enrollment windows, and personal help:

• Medicare.gov — plan comparisons, enrollment windows, and publications such as "Your Medicare in 2027: What's New & Changing."
• 1-800-MEDICARE (1-800-633-4227) — 24/7 help with eligibility questions, notices, and enrollment.

This article is for general education only and is not affiliated with any government agency. It does not rank or recommend any plan.