A provision in the expansive “One Big Beautiful Bill Act,” currently under consideration in Congress, would strip Medicare eligibility from certain groups of lawfully present immigrants, many of whom have worked and paid into the Medicare program for decades. Though not widely publicized, the measure would dramatically alter longstanding Medicare rules and jeopardize the health and economic security of a significant share of older and disabled U.S. residents. The provision is part of a broader assault on immigrants’ health care. As far as the Center for Medicare Advocacy knows, the law would mark the first time Congress has categorically eliminated Medicare eligibility for entire groups of people, denying them benefits they would otherwise receive. It would set a dangerous precedent.

Under current law, legally present non-citizens who are older or disabled can qualify for Medicare by either 1) having sufficient work history in jobs where they or their spouses paid Medicare taxes, or 2) residing in the US for at least five years, being a “lawful permanent resident” (green card holder), and “buying in” to Medicare (Undocumented immigrants are not eligible for Medicare). The proposed bill would upend this framework by barring Medicare eligibility for many of the immigrants who currently qualify through their work experience. Groups who would lose Medicare eligibility include individuals with Temporary Protected Status (TPS), refugees, asylees, trafficking survivors, domestic violence survivors, and other statuses under which many immigrants live, work, and contribute to Social Security and Medicare. Their lawful immigration status is often based on severe hardship they endured before arriving in the U.S. But in many cases these individuals have no pathway to a green card or citizenship, or they face major barriers or delays. The ability to qualify for Medicare based on work history is critical for their access to medical care.

Notably, the proposed ban would apply retroactively, meaning that individuals who have been receiving Medicare for years would lose coverage. The Commissioner of Social Security would be tasked with identifying and notifying affected individuals that their Medicare benefits will terminate one year from the date that Congress enacts the proposed law. Immigrants who legally paid into the system would be cut off from care, likely leading to devastating health outcomes and increased strain on emergency services and safety-net programs, as well as shifting costs to state and local governments.

This termination of Medicare eligibility would not only harm individuals but also reverberate through families and communities. Many older immigrants live in multigenerational households and serve in caregiving or economic support roles. Stripping Medicare from these individuals risks pushing entire families into poverty or forcing impossible choices between health care and other essentials. It also raises equity concerns: a disproportionate number of those who would be affected are people of color, in particular members of Latino and Asian American communities.

This radical shift would upend decades of Medicare law and move the country away from equitable, inclusive aging policy. It would penalize individuals who have worked, paid taxes, and contributed to their communities, thus undermining the integrity and universality of the Medicare program.

This measure must be strongly opposed. Policymakers and advocates should act swiftly to protect Medicare as a lifeline for all who qualify under existing, longstanding law, regardless of immigration status.

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June 16, 2025 – A. Bers