He Was 68 and Looking for Obamacare. What About Medicare?
A 68-year-old man recently called me to ask about an Obamacare health plan. He wanted to know what his options would cost. Before we looked at any plans, I asked whether he had checked his Medicare eligibility.
He had a Green Card and had lived in the United States for more than five years. But he had worked and paid U.S. taxes for only about two years. That second detail was important. It raised a question that comes up more often than people might think: What happens when you are old enough for Medicare but have not worked in the United States long enough to get hospital insurance without paying a premium?
The answer matters, especially when a person is trying to decide between Medicare and health coverage through the Affordable Care Act Marketplace. This is what I explained to him, and what I wish more people knew before making that choice.
First, being 65 does not make every part of Medicare free
Medicare Part A helps pay for inpatient hospital care. Many people get Part A with no monthly premium because they, or a qualifying spouse, have enough Medicare-covered work history, generally 40 quarters. That is roughly ten years of work.
Part B covers things such as doctor visits and outpatient services. Most people pay a monthly Part B premium, including people whose Part A is free.
If someone has fewer work credits, Medicare may still be available. They may simply have to purchase Part A. For a lawful permanent resident who is not otherwise entitled to Medicare, the usual rule is that the person must be at least 65 and have lived continuously in the United States for the five years immediately before applying. A person who buys Part A must also enroll in Part B.
Here is what that can mean in dollars. In 2026, someone with fewer than 30 qualifying work quarters who must buy Part A pays $565 a month for it. The standard Part B premium is another $202.90. Together, that is $767.90 a month, or more than $9,200 over a year, before deductibles, copayments, prescriptions, and any income-related adjustments. Some people with 30 to 39 qualifying quarters pay a lower Part A premium of $311.
Those are official 2026 figures. The amount for 2027 should be checked once the new premiums are announced. Also, never decide that someone must pay for Part A based only on their own two or three years of work. A spouse’s work record can change the answer.
So can you keep Obamacare instead?
For some people, yes. Medicare.gov says that someone who has to pay a premium for Part A can generally choose Marketplace coverage instead of Medicare. That does not mean the Marketplace will always be cheaper or that the person will qualify for financial assistance. It means there is a choice worth examining.
One point often gets lost in these conversations: Obamacare plans are private health insurance plans. The Affordable Care Act Marketplace is where eligible consumers compare those plans and, if they qualify, apply for help with the cost. The coverage still comes from private insurers.
For example, imagine a Marketplace plan costs $750 a month and an eligible applicant qualifies for a $400 monthly premium tax credit. The amount that person pays toward the premium would be $350. That is only an illustration, not an estimate for my client. The real tax credit depends on projected household income, family size, location, and other eligibility rules.
Some eligible Marketplace members also receive cost-sharing reductions, which can lower deductibles and certain out-of-pocket expenses when they select a qualifying Silver plan. A Green Card holder remains among the immigration categories that can potentially qualify for these savings in 2027, under the updated federal rules. Immigration status alone, however, does not guarantee a subsidy.
What if you buy straight from an insurance company?
You may hear the terms “off-exchange” or “off-Marketplace.” They simply mean that the coverage is purchased outside the official Marketplace, directly from an insurance company or through a broker.
An off-Marketplace major medical plan may have a different provider network, benefit design, or price. It is worth comparing, particularly if someone does not qualify for Marketplace savings. But buying off-exchange does not unlock an extra government tax credit. Premium tax credits and Marketplace cost-sharing reductions require eligible coverage through the Marketplace.
And using an insurance broker does not automatically make a plan off-exchange. Brokers can help clients enroll in Marketplace plans too. What matters is where the enrollment takes place.
Ask one more question if a private plan seems unusually inexpensive: Is it an ACA-compliant major medical plan? A short-term policy, fixed-indemnity product, or discount program may leave out protection a person expects from comprehensive health insurance.
The part people forget: enrolling in Medicare later can cost more
There is a catch to choosing Marketplace coverage while delaying Medicare. Marketplace coverage by itself generally does not protect someone from Medicare late-enrollment penalties.
If a person was eligible for Part B and delays for two complete years without an applicable exception, the usual penalty is 20% added to the Part B premium. It generally continues as long as they have Part B. For someone who must purchase Part A, a late-enrollment penalty can raise that premium by 10%, usually for twice the number of years they delayed.
The starting date matters. If a lawful permanent resident did not satisfy the required five years of continuous U.S. residence until after age 65, their first Medicare eligibility date may be later than their 65th birthday. It would be wrong to assume automatically that every year after 65 counts as a late year. Social Security can determine the applicable eligibility and enrollment dates.
People sometimes ask whether a Medicare Advantage “Part B Giveback” solves the penalty problem. That benefit, offered by some plans in some areas, may reduce the Part B premium. It is not a gift card, and it does not cancel a late-enrollment penalty. Medicare Advantage also requires enrollment in both Part A and Part B.
There is help for some people who cannot afford Medicare premiums. State-administered Medicare Savings Programs may pay Part A or Part B premiums for people who meet the program requirements. Eligibility varies, so it is something to check, not a benefit to assume.
I’ve received SSI and Medicaid for about 30 years but didn’t qualify for Medicare because I lacked enough work credits. When I turn 65, will I be eligible for both Medicare and Medicaid?
Yes, you may be eligible for both Medicare and Medicaid when you turn 65, even if you don't have enough work credits. The important thing to understand is that work credits mainly determine whether you qualify for Medicare Part A without paying a monthly premium.Since you already receive SSI and Medicaid, your state may be able to help pay your Medicare premiums through a Medicare Savings Program. You may also be able to keep Medicaid as long as you continue to meet your state's eligibility requirements. I would recommend checking with Social Security and your state's Medicaid office before your 65th birthday so you know exactly what coverage and financial assistance you qualify for.
A few practical checks before choosing
- Check the Medicare eligibility date with Social Security. Age, lawful residence, and enrollment timing are not always the same thing.
- Ask about a spouse’s work record. A person who has not worked ten years may still qualify for premium-free Part A through a spouse.
- Compare a full year, not just one monthly premium. Look at deductibles, out-of-pocket limits, doctors, hospitals, and prescriptions, as well as the monthly price.
- If the choice is Marketplace coverage, check the actual 2027 application and savings. Do not treat a sample tax credit as a promise, and remember that off-Marketplace plans do not come with Marketplace tax credits.
- Keep current coverage in place until any replacement coverage and effective date are confirmed. An enrollment delay or coverage gap can become expensive.
What he decided
In my client’s case, the work history he reported was not enough for premium-free Part A based on his own record. Buying Part A and Part B at the standard 2026 prices would have been a substantial expense. He decided not to commit to paid Medicare at that point and to review what the Marketplace might offer for 2027 before making a final coverage decision.
That does not mean we know yet that an ACA plan will be less expensive. Nor does it settle any Medicare penalty question. Those details still need to be confirmed before an enrollment decision is final.
What the conversation accomplished was simpler, and useful: he learned that being 68 did not necessarily leave him with only one option. For someone with a Green Card and a short U.S. work history, a few questions about residence, work credits, and enrollment timing can make a real difference. Those questions are worth asking before anyone signs up or gives up existing coverage.
About the Author: Nicoletta Catalucci of Sterling Arc Group is a Florida-based licensed insurance agent who has lived in the United States for over 20 years. Her work focuses on Medicare, and she believes every situation is different, which is why clear explanations matter to her. Originally from Italy, she speaks English, Italian, and Spanish, and values connecting with people from different backgrounds.