Cases Where You Can’t Get Medicare or Social Security at 65 — and the Alternatives

When people turn 65 in the United States, Medicare is usually the first thing that comes to mind. Many also assume that once they reach a certain age, they will receive Social Security retirement benefits as well. In practice, though, not everyone gets the same benefits simply because they have turned 65.

For immigrants in particular, several things have to be looked at together: whether you have U.S. citizenship or lawful immigration status, how many Social Security work credits you have, and whether you qualify for premium-free Medicare Part A. Add income and household composition to that, and the health coverage available to you can look very different.

In this article I want to walk through two representative situations, using the example of a 65-year-old immigrant living in New Jersey.

Case 1. A citizen who does not have enough work credits

Mr. Park is a 65-year-old U.S. citizen living in New Jersey. He has worked since he was young, running his own business and taking on various jobs — but his period of work subject to Social Security tax was not long enough, and he currently has only about 20 credits. When he turned 65 and applied for Medicare, he was told he did not qualify for premium-free Medicare Part A.

Why 40 credits matters

Social Security builds work credits based on your earned income and self-employment income. In 2026, you earn one credit for each $1,890 in qualifying earnings, up to a maximum of 4 credits per year. Generally, 40 credits is the key threshold for retirement benefits and for premium-free Medicare Part A.

There is an important point here, though. Falling short of 40 credits does not mean someone over 65 simply cannot use Medicare at all. If you meet the eligibility conditions, you can buy Medicare Part A by paying a monthly premium. What that Part A premium costs can vary depending on your work history, and if you buy Part A you may also be required to enroll in Part B.

So when you turn 65, rather than concluding “Medicare isn’t available to me,” it is important to distinguish carefully between premium-free Part A and premium Part A.

If you are short on work credits, is the ACA Marketplace an option?

This is an important option that many people do not know about. Even if you are over 65, if you do not qualify for premium-free Medicare Part A you may be able to use the ACA Marketplace, provided you meet certain conditions.

KFF explains that people aged 65 and over who do not qualify for premium-free Medicare Part A can generally enroll in Marketplace coverage, and can receive a Premium Tax Credit if they meet the other requirements such as income.

So in a situation like Mr. Park’s, it is worth checking not only your Medicare eligibility but also whether you can enroll through the ACA Marketplace. Because Medicare eligibility and Marketplace subsidy eligibility are linked to each other, the safe approach is to confirm exactly what you qualify for before choosing a plan.

Case 2. Living in the U.S. without documented status

Now consider Mr. Kim. He is 65 and has lived in New Jersey for a long time. He originally entered on a short-term visa and stayed past his authorized period, and he does not currently have lawful immigration status.

Because he has filed taxes for many years, he might reasonably think: “I’ve paid taxes for more than 20 years — shouldn’t I be able to get Medicare and Social Security?”

There is something that has to be separated out here. Having paid taxes does not, on its own, automatically create eligibility for a particular federal benefit program.

Undocumented status and Medicare

Medicare Part A and Part B each have their own eligibility rules. For someone over 65 to apply for premium Part A and Part B, they must be a U.S. citizen or a lawful permanent resident meeting certain requirements. Enrolling in premium Medicare generally requires lawful permanent residence in the United States plus 5 years of continuous residence.

So a person who is currently undocumented is generally not eligible to enroll in Medicare. Having lived in the United States for a long time, or having filed tax returns, does not by itself create Medicare eligibility.

If you paid taxes with an ITIN, do you earn work credits?

This part matters a great deal. ITIN stands for Individual Taxpayer Identification Number — a taxpayer identification number the IRS issues for tax filing purposes. Having an ITIN does not mean you have a Social Security Number, and it does not mean you have work authorization or lawful immigration status.

Social Security credits, meanwhile, are generally built from work or self-employment income that is subject to Social Security. So the simple fact of having filed a tax return is not sufficient on its own. You should not assume that “I paid taxes with an ITIN, so Social Security credits accumulated automatically.” To know your actual credits and work record, you have to check your own Social Security earnings record.

How is Social Security retirement different?

Social Security retirement benefits are likewise not paid simply because you have turned 65. Generally you need sufficient Social Security credits to receive retirement benefits. A work record is central to most retirement benefit eligibility, and 40 credits is the key threshold for qualifying on your own record.

Immigration status is also a significant factor. Under Social Security rules, in certain circumstances you must be a U.S. citizen or a non-citizen lawfully present in the United States in order to receive monthly Social Security benefits. So if you are currently undocumented, the fact that you paid taxes in the past does not on its own mean Social Security retirement benefits will be paid.

That said, if your circumstances change — your immigration status changes, for example — the rules that apply to you can change too. So it is important to check your Social Security record and your current immigration status together.

So how does a 65-year-old without documented status handle medical costs?

Difficulty enrolling in Medicare or the ordinary Marketplace does not mean you cannot access health care at all. New Jersey has separate medical assistance programs available depending on immigration status, income and other factors.

First, the emergency medical assistance program. New Jersey operates a program that covers the cost of emergency medical services for people who cannot enroll in NJ FamilyCare because of immigration status, provided they meet certain income and other requirements. For people aged 65 and over, separate income and asset standards may apply, so you need to check the eligibility that fits your own situation. If an emergency arises, it is worth asking the hospital or a relevant social services agency whether the program might apply.

Second, community health centers. Federally Qualified Health Centers — FQHCs — are federally designated community health centers that in many cases provide care on a sliding fee scale based on income, for people who are uninsured or facing a heavy cost burden. Even without insurance, finding and talking to a nearby FQHC is one option.

Third, Charity Care. New Jersey also operates a Charity Care program that reduces hospital bills for low-income patients who meet certain conditions. So rather than giving up on a hospital bill because you have no insurance, it is worth asking the hospital’s financial assistance department whether Charity Care or another financial assistance program is available.

One thing to watch closely in New Jersey

The immigration-status rules for NJ FamilyCare, New Jersey’s Medicaid program, are subject to change. The State of New Jersey has advised that, beginning October 1, 2026, NJ FamilyCare and Medicaid eligibility may change for some non-citizens. Non-citizens currently using NJ FamilyCare should make a point of reading the notices the state sends them.

Medicaid rules relating to immigration status in particular are likely to keep changing, so rather than relying on something you heard a long time ago, it is important to confirm the current rules at the time you apply.

If you are a 65-year-old immigrant, what should you check first?

After turning 65, working through your situation in the following order makes it much easier to understand.

First, check your Social Security record. Knowing how many work credits you currently have is important. Through your SSA account you can review your work record and your estimated retirement benefit.

Second, check your Medicare Part A eligibility. Even if you are short of 40 credits, check whether you might qualify through a spouse’s work record. It is also worth confirming whether you are in a position to enroll in premium Part A rather than premium-free Part A.

Third, check your Marketplace eligibility. Citizens aged 65 and over — or qualifying immigrants — who do not have premium-free Medicare Part A eligibility can in some cases use Marketplace coverage if they meet other conditions such as income. In New Jersey, you can check enrollment and financial assistance through Get Covered New Jersey.

Fourth, check your current immigration status. Different rules apply to citizens, permanent residents, other lawfully present people, and people without documented status. Medicare and Social Security in particular are not decided simply by how long you have lived in the U.S. or whether you have paid taxes.

The summary

If you are a citizen with sufficient work credits, you can generally look at Medicare and Social Security together.

If you are a citizen but short on work credits, check first whether you qualify for premium-free Medicare Part A, and if necessary compare options such as premium Medicare Part A or the ACA Marketplace.

If you are a permanent resident, you need to look at your length of residence since obtaining the green card, your work credits and your income together in order to determine Medicare and Social Security eligibility accurately.

If you are currently undocumented, ordinary Medicare enrollment is difficult, and Social Security benefits may also be limited depending on immigration status and work record. Instead, it is worth checking the medical assistance programs available in New Jersey — emergency medical assistance, community health centers and Charity Care.

In conclusion

Turning 65 in the United States is an important moment to re-examine your retirement and your health coverage. But for immigrants, Medicare and Social Security eligibility is not determined by age alone.

Am I a citizen? A permanent resident? Do I currently have lawful status? How many work credits do I have? Can I use a spouse’s work record? Do I qualify for premium-free Medicare Part A? Can I enroll in Marketplace coverage? The benefits and the coverage available to you depend on the answers to these questions.

If you are a 65-year-old citizen who is short on work credits in particular, don’t think only about Medicare — check whether ACA Marketplace enrollment is possible as well. Conversely, if you are currently undocumented, having lived in the United States a long time or having paid taxes does not automatically create Medicare or Social Security eligibility.

Immigration law and public benefit rules can also change, so making a decision based only on something you heard a while ago, online or from people around you, can be risky. The safest approach is to check your Social Security record, your Medicare eligibility, your current immigration status, and your income and family situation each in turn, and then compare the programs that apply to you.

This article is for general informational purposes and does not substitute for legal, tax or insurance advice. Before deciding on enrollment or applying for benefits, please confirm your own situation through the Social Security Administration, Medicare, Get Covered New Jersey, or a qualified insurance and benefits professional.