A Social Security letter says your Medicare will end because of immigration status: what it means (proposed rule)

In short: a 2025 federal law limits Medicare to U.S. citizens and nationals, green-card holders, Cuban-Haitian entrants, and COFA migrants. CMS has proposed, not finalized, how that will work: Social Security would send a first letter, then a termination letter near the end of December 2026, with Medicare ending February 1, 2027. The letter would explain how to appeal. If you get one, do not ignore it. If you are in one of the four groups, send Social Security proof right away.

Last checked October 6, 2026. CMS had not published the final rule on that date. Dates below are from the proposed rule (CMS-1848-P) and New York's notice GIS 26 MA/14, and may change.

What is law, and what is still proposed

• Law: Public Law 119-21 (often called H.R. 1), section 71201, limits Medicare to four groups: U.S. citizens and nationals, lawful permanent residents (green-card holders), Cuban-Haitian entrants, and people lawfully living in the U.S. under a Compact of Free Association (COFA).
• Medicare's own 2027 guide: Medicare.gov's September 2026 fact sheet "Your Medicare in 2027: What's New & Changing" now says you must be in one of those four groups to get Part A and Part B or to join a Medicare health or drug plan. It does not give dates for ending coverage; those are still only proposed.
• New York's notice: GIS 26 MA/14 says affected non-citizens may keep Medicare until the federal changes take effect on January 4, 2027.
• Proposed by CMS: for people who had Medicare on July 4, 2025, Social Security would send a preliminary letter, then a termination letter near the end of December 2026. Medicare would end February 1, 2027.
• Proposed for everyone else affected: a single termination letter, with Medicare ending at the end of the month after the month on the letter, and not before January 1, 2027.
• Not yet known: the final wording, final dates, and exactly what the letters will look like. CMS usually publishes this final rule in the fall.

The two letters in the proposed rule

Social Security's usual deadline to ask for reconsideration is 60 days after you receive a decision. Use the deadline printed on your letter.

If you are in a D-SNP or a Medicaid Advantage Plus plan

• These plans require Medicare. If your Medicare ends, you cannot stay in a Medicare plan, including a D-SNP or a MAP plan.
• Medicaid is separate. New York says people outside the federal groups who are otherwise eligible keep Medicaid with state funding. Your plan arrangement could change. Watch for letters from New York Medicaid Choice (1-888-401-6582) and from HRA or your county.
• The Medicare Savings Program already changed. New York ended MSP on September 30, 2026, for people outside the federal groups, with no state-funded replacement.
• Do not drop Medicaid on your own. Ask HRA or your county before you change anything.

Step by step if a letter comes

1. Open it and find the date and the deadline. Write the deadline on a calendar.
2. Find your current document. Your status today counts, not the one you arrived with. Many refugees and asylees later got a green card.
3. If you are in one of the four groups, send Social Security copies of your proof, or bring the originals to an appointment. Call 1-800-772-1213 to ask how.
4. If you are not sure, call the New York State New Americans Hotline at 1-800-566-7636 for free immigration help and legal referrals, in more than 200 languages.
5. Ask about your coverage choices for free. HIICAP, the state's Medicare counseling program, is at 1-800-701-0501.
6. Keep using your coverage until the date on a final notice. Do not stop Medicare premiums early.

Watch for scams

Social Security and Medicare will not ask you to pay to keep Medicare. Hang up on anyone who calls asking for money or your Medicare number to "fix" your status. Call Social Security or 1-800-MEDICARE yourself.

Want help with this? Get free one-on-one guidance.

If your Medicare is staying but your plan options are changing, our short plan-help tool ends with an optional request for free one-on-one guidance. We cannot answer immigration questions; the New Americans Hotline can.