New US permanent residents generally wait five years for Medicaid

A family that becomes a permanent resident of the United States can get a Marketplace health plan without the five-year wait that bars it from means-tested Medicaid, and a member who reaches 65 without a US work record needs five years’ residence to buy into Medicare.

In Canada, a province must keep any wait to three months to receive full federal funding, and Ontario has none. Australia’s Medicare guidance sets no waiting period once permanent residency is granted.

The three systems side by side

United States: no stated wait for the Marketplace, five years for Medicaid

HealthCare.gov, the federal enrolment site, says lawfully present immigrants can get Marketplace coverage, and that those inside the five-year Medicaid wait “might be able to” if otherwise eligible; it describes no waiting period for permanent residents.

HealthCare.gov shows the premium tax credit for annual income between 100% and 400% of the federal poverty level. Read on its face, the page indicates that a household above that band pays the full premium. The tax code had lifted the 400% ceiling only for tax years 2021 to 2025.

Medicaid and the Children’s Health Insurance Program (CHIP) are means-tested. Federal law bars a “qualified alien” who entered on or after 22 August 1996 from federal means-tested benefits for five years from entry with that status, and a lawful permanent resident is a qualified alien.

In an April 2026 letter, the Centers for Medicare & Medicaid Services (CMS) told states to keep applying the wait to permanent residents on and after 1 October 2026. States must give full Medicaid to permanent residents who have worked, or can be credited with, 40 qualifying quarters, but, CMS says, still only after the five years unless an exception applies.

Emergency Medicaid can treat an emergency condition for people who meet a state’s other rules but lack an eligible status.

Medicare at 65: a work record or five years’ residence

Medicare begins at 65. Part A, hospital insurance, is premium-free for people with 40 quarters of Medicare-covered work, their own or a spouse’s; Medicare.gov puts that at generally at least ten years.

Without that record, a permanent resident may buy Part A and enrol in Part B, which covers doctors and outpatient care, only after living in the United States continuously for the five years immediately before. Two sections of the Social Security Administration’s manual add that premium Part A cannot be held without Part B and that the five years may begin before permanent residence is granted.

In 2026 Part A costs USD 311 a month for people with at least 30 quarters, their own or a spouse’s, and USD 565 for those with fewer. Part B’s standard premium is USD 202.90 a month and rises with income, to USD 689.90 for single filers with modified adjusted gross income of USD 500,000 or more, or joint filers at USD 750,000 or more.

Under the five-year residence rule, a permanent resident with no US work record, own or spouse’s, who lives in the United States continuously from 62 could therefore buy into Medicare at 67.

What the 2025 budget law changed

Public Law 119-21, approved on 4 July 2025, narrows these programmes for many lawfully present non-citizens. Permanent residents remain eligible for Medicaid, Medicare and the premium tax credit, with one exception for those on low incomes:

• Section 71109: from 1 October 2026, federal Medicaid and CHIP funding goes, with limited exceptions, only to citizens and nationals, permanent residents, Cuban and Haitian entrants, and migrants under the Compacts of Free Association (COFA).
• Section 71302: for tax years beginning after 31 December 2025, it removes the rule that let lawfully present people below the poverty line, barred from Medicaid by their status, claim the premium tax credit. That includes permanent residents inside the five-year wait.
• Section 71301: for tax years beginning after 31 December 2026, only permanent residents, Cuban and Haitian entrants and COFA migrants among lawfully present non-citizens qualify for the credit, which HealthCare.gov applies from 1 January 2027.
• Section 71201: Medicare is limited to the same four groups. For people already entitled or enrolled at enactment, the limit applies 18 months after enactment, that is on 4 January 2027. The text indicates that it applies to new enrolment from enactment; no CMS notice was found on how it will be applied.

EB-5 investors, their spouses and children first receive permanent residence “on a conditional basis”. A Department of Homeland Security regulation says a conditional permanent resident has been lawfully admitted for permanent residence and, unless otherwise specified, has the same rights as other permanent residents.

This indicates that conditional residents count as permanent residents under these rules. None of the CMS, HealthCare.gov or Social Security texts read for this article names them.

The EB-5 amounts and the conditional green card are covered in a separate article.

Canada: three months at most, none in Ontario

For a province to qualify for a full federal cash contribution, the Canada Health Act requires its health insurance plan to meet several criteria; under the portability criterion in section 11, the plan must not impose a minimum period of residence or a waiting period longer than three months. Within that limit, the provinces differ.

Ontario revoked its three-month wait from 19 March 2020 and says eligible people, permanent residents among them, are covered immediately. They must be physically in Ontario for at least 153 of the first 183 days after starting to live there and apply in person. The Ontario Health Premium, CAD 0 to CAD 900 a year depending on taxable income, is collected through income tax and does not affect eligibility.

In British Columbia, the wait runs for the rest of the month in which a person becomes resident plus two more months, and the Ministry of Health sets the residence date, partly on immigration status.

The province tells arrivals from outside Canada to arrange private insurance before they arrive and says care during the wait must be paid in full unless other insurance applies; waivers are approved only in the most serious and exceptional cases. The plan’s premiums were abolished in 2020.

Québec’s health insurance board, RAMQ, treats a person as settled in Québec when their main residence is there and they are present at least 183 days a calendar year. For arrivals from another country, cover usually begins after at most three months, counted from registration if the person is in Québec with all documents.

The wait does not apply to children under 18 or to arrivals from countries with a social security agreement with Québec (whether Vietnam is one was not established), and some care, including pregnancy-related care, is free of charge during it.

RAMQ strongly recommends private insurance on arrival. Its public prescription-drug plan charges up to CAD 789 a person a year, collected through the tax return, for months without access to a private plan.

Alberta says arrivals from outside Canada might be covered from the date they establish residency if they apply within three months, otherwise from a date set when the application is processed, and that there may be a waiting period.

Australia: Medicare once residency is granted, costs through tax

Services Australia’s guidance for staff says a migrant can enrol in Medicare once granted permanent residency and living in Australia; neither it nor the public enrolment pages read for this article set a waiting period. Enrolment is possible only from within Australia.

A person living in Australia who has applied for a permanent visa other than a parent visa can enrol from the application date if they hold a visa allowing work or have a parent, spouse or child who is an Australian citizen or permanent resident. Enrolment ends after more than 12 months abroad, and Medicare cannot be used outside Australia.

The cost runs through the tax system. The Medicare levy is 2% of taxable income, with reductions or exemptions depending on income and circumstances.

Taxpayers above set thresholds without approved hospital cover from a registered health insurer also pay a surcharge of 1% to 1.5%. For the 2026–27 income year, which began on 1 July 2026, it starts above AUD 105,000 for singles and AUD 210,000 for families, up from AUD 101,000 and AUD 202,000, and reaches 1.5% from AUD 164,001 and AUD 328,001. Overseas visitors’ and students’ policies do not count.

Hospital cover has its own clock. Under Lifetime Health Cover, a new migrant’s deadline is the later of 1 July after their 31st birthday and the first anniversary of registering for Medicare. Buying hospital cover after that adds 2% to the hospital premium for each year over 30, up to 70%, removed after ten years of continuous cover.

The 2026 government fact sheet for new migrants says a missed deadline has no exemptions and international health insurance does not count. The same sheet says a person overseas on their deadline avoids the loading if they buy hospital cover within 12 months of first returning to Australia for 90 consecutive days or more.

By the 2% formula, a person aged 45 on the 1 July before joining pays 30% more on the hospital premium.

What this article has not established

No CMS, HealthCare.gov or Social Security text naming conditional permanent residents was found, nor any CMS notice on how the Medicare limit will be applied to people already enrolled outside the four groups.

It was not established whether the credit above 400% of the poverty level was extended beyond 2025, which states lift the Medicaid wait for lawfully residing children and pregnant people, what Marketplace plans cost, or what cover is available to a permanent resident between 65 and Medicare eligibility.

No firm Alberta rule for arrivals from abroad was found, and whether Vietnam has a social security agreement with Québec was not established. It was not confirmed with Australia’s Department of Home Affairs which investor visas count as permanent visas for Medicare.

Residence status and healthcare in Portugal, Dubai and Singapore were compared in a separate article in August.