Thousands of people who legally immigrated to Pennsylvania and New Jersey, and have spent years working and paying into the Medicare system, will no longer be able to enroll in the health program when they turn 65.
There are also an estimated 100,000 refugees, victims of human trafficking and domestic violence, and other immigrants who are already enrolled in Medicare across the United States who will lose their coverage in 2027 under new eligibility rules established by President Donald Trump’s signature policy package, which he dubbed his administration’s “big beautiful bill.”
Previously, certain groups of people who legally immigrated to the United States were able to enroll in Medicare when they turned 65, if they had paid into the program through an employer for at least 10 years. Others were able to enroll because of a qualifying disability, such as end-stage renal disease.
Under the new rules, only legal permanent residents and immigrants from Cuba, Haiti and certain Pacific Island countries will continue to be covered. All others — including individuals granted asylum and those who are temporary humanitarian parolees — will no longer be eligible for Medicare.
The same groups of immigrants are no longer able to get coverage under Medicaid, the publicly funded health program for low-income individuals. They also can’t qualify for income-based tax credits to buy discounted health plans through the Obamacare marketplaces, such as Pennie and Get Covered NJ.
Combined, the new restrictions will leave some 1.4 million immigrants who have followed all laws to live here legally uninsured, according to KFF, a national healthcare education nonprofit. It’s unclear exactly how many people in New Jersey and Pennsylvania may be affected.
The estimated 100,000 immigrants who are expected to lose Medicare in 2027 represent a small portion of the 68 million people covered under the massive health program. But advocates said the change is troubling because people losing Medicare access are elderly or have a disability that prevents them from working. They will now have no way to get health insurance other than to buy a plan directly from an insurer at full price, an option that is implausible for most working Americans.
“This is pretty unprecedented,” said Natalie Kean, director of federal health advocacy for Justice in Aging, a nonprofit based in Washington, D.C., that advocates for seniors in poverty. “There’s nothing different about this group of people, in terms of their contribution to Medicare, compared to U.S. citizens.”
Analysts said they believe this is the first time Congress has ever taken away access to Medicare, which has been expanded since its introduction in 1965. Medicare has benefited from bipartisan support, with lawmakers from either party reticent to even propose cuts to one of the most popular and widely used healthcare programs.
This Medicare cut narrowly focuses on immigrants, a group targeted under the Trump administration. Many affected may not yet be aware of the pending change to their Medicare status, which has been overshadowed by other Trump initiatives, such as an increase in deportation efforts, said Gabily Gonzalez, whose Camden-based nonprofit organization, Cerrando La Brecha, works with undocumented immigrants and refugees.
“There’s so much going on so fast, and also there’s a lot of misinformation,” she said. “I feel like people are getting bombarded with information.
“I don’t even know if they know right now,” she said.
Medicare eligibility explained
People are eligible for Medicare if they have worked for at least 10 years in a job that collected Medicare payroll taxes. Generally, people pay 1.45% of their gross income in Medicare taxes, which is matched by their employer.
People who do not have a work history are eligible if their spouse worked or if they have a qualifying disability.
People can also buy into the Medicare program when they turn 65.
The program covers virtually all Americans in their later years, when healthcare needs tend to become more complex and expensive to manage.
The program’s costs topped $1.3 trillion in 2023 and accounts for about 14% of federal spending, according to the most recent data available from the Congressional Budget Office.
Under the Trump administration, Republicans have targeted so-called entitlement programs, including Medicaid and food benefits, as sources of waste and abuse.
A spending bill signed into law over the summer is expected to cut some $900 billion from Medicaid over the next decade.
» READ MORE: What’s at stake for five Philly-area families facing Medicaid cuts.
The new Medicare restrictions on immigrants are expected to save $5.1 billion by 2034, according to the Congressional Budget Office.
“These are people who have worked, have paid into Medicare,” said Jeannie Fuglesten Biniek, an associate director for the Program on Medicare Policy at KFF. “Many will continue to be subject to those payroll taxes but will no longer get the benefits they would previously have been entitled to.”
Needed healthcare for immigrants
The immigrant groups that will no longer be able to access Medicare, Medicaid, or Obamacare marketplace plans include refugees, victims of violence, and others who have been granted asylum in the United States because their home is unsafe and they have nowhere else to go.
Refugees are required to apply for permanent status after one year.
Healthcare programs like Medicaid and Medicare are critical to helping them establish livelihoods here, said Meredith Owen, senior director of policy and advocacy for Refugee Council USA, a coalition of organizations that help refugees resettle.
People who have fled war zones often have physical injuries, mental health challenges, and untreated disease, such as cancer, that need immediate attention.
Yet because resettlement programs emphasize self-sufficiency and expect immigrants to find work quickly, most are unable to secure jobs that offer health benefits right away.
“Access to healthcare in whatever form has always been really important in helping folks heal, get integrated,” she said.
Just over 12,200 refugees were resettled in Pennsylvania between fiscal 2018 and fiscal 2024.
About 56% were between ages 16 and 64; 1.5% were over age 65, according to American Immigration Council data that Refugee Council USA and partner organizations received through a Freedom of Information Act request.
Monitoring Medicare changes
Medicare and immigration advocates said they will be watching to see how the government approaches removing immigrants from Medicare when their coverage ends in 2027.
Medicare officials should be able to determine members’ citizenship status through basic enrollment paperwork, but distinguishing which type of immigrant they are may be much harder. Owen said she worries that immigrants who should remain covered could mistakenly lose Medicare as the government looks to weed out people it no longer deems eligible.
Advocates said they are also concerned that the new Medicare restrictions could set a precedent to further limit who is eligible for coverage.
“What does that mean for the future? Will Congress try to restrict eligibility further?” said Kean, of Justice in Aging. “And for whom?”
