Medicare for Green Card Holder who already had Medicare and Soc. Security Benefits

[LazarusW679735]

Hello Folks,

I have a situation that is very atypical, as far as I can tell. I am a US citizen since I was born, even though I was born overseas – due to having a US citizen father who worked abroad for most of his life. My mother is not a US citizen, both my father and mother lived overseas for most of their life (father still lives overseas to this day).

My father and mother divorced many years ago. Many years after the divorce, my mother started to receive Social Sec (small payment every month) and Medicare Benefits while living overseas due to have been married to my father. My mother is in her 80s now; and few years ago, I sponsored my mother to come to the US (i-551 or green card).

Currently, my mother receives a small Soc. Sec payment every month and is enrolled in Medicare Part A and Part B. However, I have to pay every month for her medicare supplemental plan (Part F). Normally, if you sponsors someone (a parent) to come to the US, you would be considered liable (as a sponsor) for the use of any government assistance. However, her situation is rather unusual given that she have had Soc Sec and Medicare benefits before even moving to the US as a permanent resident. Would she be able to enroll and receive Medicaid benefits without further financial ramifications to the sponsor in this case.

Any insights would be appreciated. 

[SpringIsHereVA]

Lazarus @LazarusW679735 , I had tried to reply to your LAST post to me and the AARP software is blocking it. I am sending the AARP Moderator a PM (AARP private message) to ask them to post for me. Take care, Nicole 👵

[LazarusW679735]

Nicole, thanks for letting me know. It must be some glitch with the software.

[SpringIsHereVA]

Yes you are correct Lazarus @LazarusW679735 !!! The AARP Moderator had told me that sometimes the software tags posts as spam when they are not. Lol, trying to remember what I said = OLD. I had suggested contacting your LOA (local office of aging) if you have one. Mine here in Cave Spring, Virginia has been an AWESOME support to us seniors and our caregivers. They may know of some FREE resources to help you out. Take care, Nicole  👵

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➡️[*** Lazarus wrote on Wednesday 4/30/25: Nicole, thanks for letting me know. It must be some glitch with the software. ***]

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[LazarusW679735]

Thanks Nicole, I will get in touch the LOA or equivalent here in Indiana.

[SpringIsHereVA]

You are welcome Lazarus @LazarusW679735 !!! Take care, Nicole  👵

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➡️[*** Lazarus wrote on Wednesday 4/30/25: Thanks Nicole, I will get in touch the LOA or equivalent here in Indiana. ***]

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[SpringIsHereVA]

Lazarus @LazarusW679735 , awesome meeting someone else who was born in a foreign country to an American dad. Both of my parents are now gone, my dad died in Jamaica West Indies on his way home from work - car accident. My mom as was all of us kids was born there. She like your mom needed a green card. My 1/2 cent advice - try to avoid depending on the Government (Medicaid). It maybe different in YOUR STATE, but here in Virginia - there is talk of reducing Medicaid or eliminating. 2025 has just started and way too much going on. Anyway, glad your mom has you looking out for her.  💛  Take care, Nicole  👵

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➡️[*** Lazarus wrote Tuesday 4/29/25:

Hello Folks,

I have a situation that is very atypical, as far as I can tell. I am a US citizen since I was born, even though I was born overseas – due to having a US citizen father who worked abroad for most of his life. My mother is not a US citizen, both my father and mother lived overseas for most of their life (father still lives overseas to this day).

My father and mother divorced many years ago. Many years after the divorce, my mother started to receive Social Sec (small payment every month) and Medicare Benefits while living overseas due to have been married to my father. My mother is in her 80s now; and few years ago, I sponsored my mother to come to the US (i-551 or green card).

Currently, my mother receives a small Soc. Sec payment every month and is enrolled in Medicare Part A and Part B. However, I have to pay every month for her medicare supplemental plan (Part F). Normally, if you sponsors someone (a parent) to come to the US, you would be considered liable (as a sponsor) for the use of any government assistance. However, her situation is rather unusual given that she have had Soc Sec and Medicare benefits before even moving to the US as a permanent resident. Would she be able to enroll and receive Medicaid benefits without further financial ramifications to the sponsor in this case.

Any insights would be appreciated. ***]

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[LazarusW679735]

Hi Nicole. It is very nice talking to you. I am sorry that you lost your Dad in a such a tragic way at an early age. Life can present us with unexpected challenges, indeed.

As a kid I lived in different countries (mostly South America) or different regions of the same country. My father used to work for a multinational oil company as an engineer. When he left the company (still young, in his 40s) he got a lump sum payment and they decided to settle down in Brazil. 

Recently (about a year ago), I moved from Mid-Michigan to Fort Wayne, IN. A few days ago, I filled out an application online for her within the State of Indiana (just to get the ball rolling). Plan F does provide good coverage and for most part I don’t have to pay any co-pay or anything. About a two years ago, I also enrolled her with a prescription coverage plan (Wellcare Classic PDP) ; there is a co-pay, but it is not too bad.

My mother’s Plan F went up in price substantially in the last two years; but overall, it is a good plan. It does not cover certain things that Medicaid covers, though. It seems that Medicaid covers temporary stay in a nursing home (respite care). While I love to spend time with my mother, sometimes I need to travel and I can not stay with her all the time.

[GailL1]

@SpringIsHereVA wrote

.. . . . try to avoid depending on the Government (Medicaid). It maybe different in YOUR STATE, but here in Virginia - there is talk of reducing Medicaid or eliminating. 2025 has just started and way too much going on.

====================

Medicaid is for people who are low income with a health and/or wellness need.  Medicaid covers a lot of different programs, most of the programs are paid for by a shared joint effort of state and Federal.    However, some of the programs are paid in a different way with the Feds paying more for the program.  

The states who have expanded Medicaid for those who are abled bodied and childless but who are less than 138% of the Federal Poverty Level have a higher reimbursement rate to these states than other Medicaid program.  

Currently this Medicaid groups get a 90% reimbursement rate from the Feds than other Medicaid programs of need where the reimburse rate from the Feds is only 50-70% -   This is the 1st and foremost place where the Feds will be focusing their cutback.  

No benefits will be cut by the Feds to Medicaid - only the rate of reimbursement to this ACA expanded Medicaid programs.  States are the ones that manage all of their Medicaid programs. 

Other Medicaid programs will still be need based and the formula of Fed reimbursement will be more equal to all since there is no reason for the Feds to pay more for these ACA Expanded Medicaid Abled bodied, childless folks than those who are low income elderly, blind, disabled, children or pregnant women or newborns.  

I don’t think the Feds help (state specific, like California) pay for the million of illegal immigrants who are on the Medicaid rolls in these specific states.  But I am not sure and if the Feds do - that will be eliminated at the Fed level.

If one is income and asset eligible for Medicaid help in their state, and needs the help, by all means apply at your state office for the applicable program.

[SpringIsHereVA]

@GailL1 , my friendly post to Lazarus @LazarusW679735 was just that. No need to go into all the details below. He can accept my 1/2 cent advice about NOT depending on the Government (Medicaid) or not. Not an issue. 2025 has a long way to end and in my very humble opinion, best to figure out Medicare on your own. As stated in my post to him, here in Virginia, lots and lots of protests about the planned cutbacks. Take care, Nicole  👵

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@GailL1 wrote:

@SpringIsHereVA wrote

.. . . . try to avoid depending on the Government (Medicaid). It maybe different in YOUR STATE, but here in Virginia - there is talk of reducing Medicaid or eliminating. 2025 has just started and way too much going on.

====================

Medicaid is for people who are low income with a health and/or wellness need.  Medicaid covers a lot of different programs, most of the programs are paid for by a shared joint effort of state and Federal.    However, some of the programs are paid in a different way with the Feds paying more for the program.  

The states who have expanded Medicaid for those who are abled bodied and childless but who are less than 138% of the Federal Poverty Level have a higher reimbursement rate to these states than other Medicaid program.  

Currently this Medicaid groups get a 90% reimbursement rate from the Feds than other Medicaid programs of need where the reimburse rate from the Feds is only 50-70% -   This is the 1st and foremost place where the Feds will be focusing their cutback.  

No benefits will be cut by the Feds to Medicaid - only the rate of reimbursement to this ACA expanded Medicaid programs.  States are the ones that manage all of their Medicaid programs. 

Other Medicaid programs will still be need based and the formula of Fed reimbursement will be more equal to all since there is no reason for the Feds to pay more for these ACA Expanded Medicaid Abled bodied, childless folks than those who are low income elderly, blind, disabled, children or pregnant women or newborns.  

I don’t think the Feds help (state specific, like California) pay for the million of illegal immigrants who are on the Medicaid rolls in these specific states.  But I am not sure and if the Feds do - that will be eliminated at the Fed level.

If one is income and asset eligible for Medicaid help in their state, and needs the help, by all means apply at your state office for the applicable program.

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[GailL1]

@LazarusW679735 

There maybe some solutions which your mother will have to evaluate based on her needs.

1.  She could drop Traditional Medicare and pick up the best Medicare Advantage plan to fit her needs - with this option she would get her care and most likely her prescription drug plan thru one of the Medicare Advantage plans available to her.

Medicare.gov - Understanding Medicare Advantage Plans 

Under this scenario she would continue to pay her Part B premiums and continue her Part A and Part B Medicare coverage but she would drop the Medicare supplemental Plan because she would then be covered by her choice of a Medicare Advantage plan with prescription drug coverage, a Medicare managed care choice -  Medicare Part C.

2.  She could keep her Traditional Medicare coverage which she has now along with a Prescription drug plan and just drop her Medicare supplemental plan since it is optional coverage - but this might mean that she would have to pay any of her out of pocket cost out of pocket (what her Plan F covers now),  This may not be advisable without having a substantial income to pay for any high out of pocket cost which she would be responsible for after Medicare pays their part of any claim + her deductibles for Part A and Part B.

3.  If she is located within a state that has widened the guaranteed issue criteria for switching her Medicare supplemental plan to another and/or insurer without underwriting, or otherwise if she able to pass underwriting, she maybe able to save on the premium cost of her current Medicare supplemental plan by switching to another supplemental plan or insurer.

Medicare.gov- Medigap Basics 

Notices the related sub links at the bottom of this page.

Medicare.gov - Can I change my Medigap policy  

4.  She cannot drop Medicare but she could see if she qualifies for a Medicare Savings Program (MSP)- her state would handle this enrollment for which she has to qualify based on her income and assets, including her SS benefit.  Each program is a bit different in its coverage - sometimes only covering her Part A and/or Part B premiums all the way to giving her full Medicaid benefits and covering her Part B premiums -  which would make her a dual eligible - meaning having Medicare as her primary insurer and Medicaid as her secondary insurer.  This link coverage each of the programs, with eligibility limits,  as well as a state link to make application or ask questions.  

Medicare.gov - Medicare Savings Programs 

Medicaid as a combo with Medicare is still needs based on income and assets - the state where she lives will has the authority to evaluate her for the different type of MSP. 

Extra Help is sometimes included in these plans.  If not, she should also apply with the SSA for Extra Help.

SSA.gov - Apply for Medicare Part D Extra Help program 

6.  If she gets ones of these, there is no need for the Medicare supplemental plan however - there is a provision that she can suspend with the insurer her Part F for 24 months which receiving Medicaid coverage - suspension is important in case she loses the Medicaid coverage within those 24 months.

HHS.gov - 11/30/2024 - CMS Guidance on a Beneficiary’s Right to Suspend a Medigap Policy while Entit... 

7.  If she qualifies as a dual eligible (Medicare and Medicaid), she may have a choice of a Special Needs Plan which is a Medicare Advantage Plan which deals with those with chronic illness that have dual eligible status or a chronic disease.

Medicare.gov - Special Needs Plans

There are choices if she is eligible for them but if she has Medicare Parts A and B and a SS Retirement benefit that does open up some choices for her.  I doubt that they will even ask her about her immigration status or history since she has already got the 5-year residency period covered.  

A lot of info is available on Medicare.gov and/or SSA.gov but as always, they are complicated programs.  

[LazarusW679735]

Hello Gail. Thanks for your thorough answer. I am not too familiar with Medcare Advantage (have heard about it.) But, on occasion of looking into plans for my mother, I recall that Medicare Advantage had some restrictions (for instance, can only use facilities and providers in their network). Back then, I was told that “Plan F” (medigap) was the gold standard. I will look into all the options you suggested and do some research, I confess that I don’t remember and in some cases don’t know much about those options.

Regarding the prescription drug coverage; about two years ago, I enrolled my mother in a prescription coverage plan (Wellcare Classic PDP) for that there is no premium. I believe that I enrolled her in this plan online (don’t remember well). There is a co-pay, but it is not too bad.

“2.  She could keep her Traditional Medicare coverage which she has now along with a Prescription drug plan and just drop her Medicare supplemental plan since it is optional coverage - but this might mean that she would have to pay any of her out of pocket cost out of pocket (what her Plan F covers now),  This may not be advisable without having a substantial income to pay for any high out of pocket cost which she would be responsible for after Medicare pays their part of any claim + her deductibles for Part A and Part B. “

=> Yeah, that would not be an option for her given that she can not pay the deductibles.

“6.  If she gets ones of these, there is no need for the Medicare supplemental plan however - there is a provision that she can suspend with the insurer her Part F for 24 months which receiving Medicaid coverage - suspension is important in case she loses the Medicaid coverage within those 24 months. “

=> It is good to know that. I believe that they phased out Plan F for new applicants. Can she have both Plan F and Medicaid at the same time? I heard that she can not. 

Not only would Medicaid stop the need to pay for the Plan F, but Medicaid also does cover certain things that the Plan F does not. It seems that Medicaid covers temporary stay in a nursing home (respite care). While I love to spend time with my mother, sometimes I need to travel and I can not stay with her all the time. Also, her Soc. Security payments are rather small; she nets about $360 per month; and since she never actually worked for any length of time, that is the only income she has as of now.

[GailL1]

@LazarusW679735 

To add to my previous post - Under the MEDICARE/ MEDICAID dual eligible program, a limited respite benefit would be offered under some circumstances under a state’s MEDICAID waiver of Home and Community Based Services.  She would have to be approved for this program if her state has one and in many states, there is a waiting list.

MEDICAID.gov - Home and Community Based Services 1915(c) 

[LazarusW679735]

Yeah, it is good to know that. I have to investigate those options regarding "respite benefits" with a State enrollment specialist.

[GailL1]

@LazarusW679735     No she cannot have Medicare supplemental (Plan F) and Medicaid at the same time.  They do the same thing - pays the part of a claim that Medicare does not cover.

Sounds like she should look into the Medicare Savings Program via her state and if she qualified for Medicaid she can then decide if a Special Needs plan for those who are dual eligible is the right thing for her.  Or IF she just want Medicare and Medicaid as her 2nd payer.  In some states, I believe that it is a requirement to be in a managed care plan like a Special Needs Plan if they are dual eligible.

Think about it - providers under the Special Needs Plan have to accept Medicare and Medicaid so it is like a limited network.  In a SNP, the insurer has to make sure that they accept both types of coverage - Medicare as the primary and Medicaid as the secondary.

You asked about respite care under Medicaid - IN SOME STATES they have a waiver that covers it to some degree. But it is not much - Again, you need to check with the state.

The state is gonna be your point of contact for what you are looking for and have the specific answers you need.  The state contact for the Medicare Savings Program is on the Medicare link I gave you for the Medicare Savings Program or you can start here and they will direct you to the state office. 

Medicaid.gov Contact 

[LazarusW679735]

At first, I thought that Medicaid was an extension of Medicare; but that is not the case. I read that “it is absolutely okay to have both Medicare and Medicaid at the same time in Indiana. In fact, many individuals in Indiana are dually eligible for both programs”.

The general waiting period for a green card holder (Lawful Permanent Resident) to obtain full Medicaid benefits in Indiana is five years from the date they obtained their qualified immigration status. This is in accordance with federal law, but I believe that States may have different rules or a more lenient. My mother used to come to visit every year, but she had a tourist visa. Only about two years she obtained the status of a permanent resident (green card).

I did ask the following question to gemini (AI), “Can a green card holder in Indiana enroll in Medicaid even though he/she obtained his/her qualified immigration status in less than five years? “

“
In general, lawfully present immigrants, including green card holders (Lawful Permanent Residents or LPRs), may be eligible for Medicaid in Indiana if they meet certain requirements. However, there is typically a five-year waiting period after obtaining qualified immigration status before many green card holders become eligible for federally funded Medicaid. This five-year bar begins when an individual is granted their qualified immigration status, not when they first entered the U.S.  

However, there are exceptions to this five-year waiting period. Certain categories of "qualified non-citizens" are exempt and may be eligible for Medicaid sooner. These categories often include:
.
.
.
“

My mother does not fit any of the categories shown (refugees, etc). But, to get a definitive answer regarding her specific situation, a green card holder should contact the Indiana Family and Social Services Administration (FSSA) or a Medicaid enrollment specialist. So, I plan on getting in touch with a Medicaid enrollment specialist in my State (Indiana), as you suggested, in order to obtain more clarifications.

[GailL1]

Medicare and MediCAID is the coverage which a dual eligible beneficiary has.  You asked previously if a beneficiary could have a MEDIGAP (Medicare supplemental) and MEDICAID at the same time -your words were :   Can she have both Plan F and Medicaid at the same time?  That isn’t possible because they do the same thing -  that is to say, they both - Plan F Medigap and MEDICAID pay the beneficiaries out of pocket cost of Medicare.

There is ALWAYS the 5-year wait period for MEDICAID coverage for Legal Permanent Resident.  Federal Law in this case supersedes state law.  However, a state may cover a different subset of individuals but without any matching funds from the FEDS - case in point, California covers some illegal low income immigrants in their Medicaid program but the Feds don’t match the funding - at least they aren’t suppose to.

I was under the impression that your mom had her LPR status longer than 5-years from the way you worded your initial response.  Yes, the state of Indiana is gonna be your source of whether or not she will be eligible for a Medicare Savings Program or full Medicaid to work with her Medicare benefits (dual eligible). 

Actually, Medicare has the same 5-year eligibility rule for LPR so I also assumed that your mother got Medicare under your father’s work record since you did not say that she worked under a US company for the 10 year period to be eligible for her own Medicare nor was she paying a premium for Medicare Part A.

KFF.org- FAQ - Can immigrants enroll in Medicare? 

CMS.gov - Original Medicare (Part A and B) Eligibility and Enrollment 

per the link ~

Individuals who must pay a premium for Part A must meet the following requirements to enroll in Part B:

• Be age 65 or older;
• Be a U.S. resident; AND
• Be either a U.S. citizen, OR
• Be an alien who has been lawfully admitted for permanent residence and has been residing in the United States for 5 continuous years prior to the month of filing an application for Medicare.

Yes, the state of Indiana is gonna be the final source on her Medicaid eligibility status.  

[LazarusW679735]

“Medicare and MediCAID is the coverage which a dual eligible beneficiary has.  You asked previously if a beneficiary could have a MEDIGAP (Medicare supplemental) and MEDICAID at the same time -your words were :   Can she have both Plan F and Medicaid at the same time?  That isn’t possible because they do the same thing -  that is to say, they both - Plan F Medigap and MEDICAID pay the beneficiaries out of pocket cost of Medicare. “

=> Yeah, that is true. I read somewhere the she could not have both at the same time, but was not sure how accurate or up to date that info was. Also, I was wondering if she would need to quit her Plan F (medigap) right away or if there is some grace period. Suppose she qualified to Medicaid today, does she have to quit the Plan F today or have a month to quit or even have to quit before even know if she will qualify in order to qualify. Maybe she could suspend her Plan F (and not have to pay for it) without the risk of losing the Plan F altogether. 

“
I was under the impression that your mom had her LPR status longer than 5-years from the way you worded your initial response.  Yes, the state of Indiana is gonna be your source of whether or not she will be eligible for a Medicare Savings Program or full Medicaid to work with her Medicare benefits (dual eligible). 

Actually, Medicare has the same 5-year eligibility rule for LPR so I also assumed that your mother got Medicare under your father’s work record since you did not say that she worked under a US company for the 10 year period to be eligible for her own Medicare nor was she paying a premium for Medicare Part A.
“

=>I filled out an online application online within the State of Indiana, only to get ball rolling (it can take 45 days to have a response), and will consult with an enrollment specialist. The State of Indiana has different names for Medicaid and different entities that administer each program – what can add to the confusion at first.

=> Correct, my mother only received Medicare and Soc Sec. benefits (small payments) due to have been married to my father. My father used to work for a multinational – mostly overseas -- and contribute to Social Sec., paid taxes, etc; so, she gets her benefits because of him. She started receiving those benefits while still living in Brazil back in 2017 (even though medicare was useless in Brazil). No, she never worked in her life even though she finished college (she was mostly a housewife); so, her situation is rather unusual (was not a LPR or citizen, never worked, and lived abroad all her life; but has Medicare and Soc. Sec. benefits)

I will look into the links for more information. Thanks!