SSA Sends 300,000 Medicare Notices as CMS Projects 32,000 Immigrants Lose Coverage Feb. 1

The Social Security Administration is mailing roughly 300,000 preliminary notices this month to Medicare enrollees whose immigration status it cannot determine. The SSA told service providers about the process in a Nov. 10 notice. People who cannot show an eligible status by the deadline on their notice face losing Medicare on February 1, 2027.

The cause is Section 71201 of Public Law 119-21, the budget law enacted July 4, 2025 (H.R. 1). CMS implemented it in the final 2027 Physician Fee Schedule rule (CMS-1848-F), announced Nov. 4 and published in the Federal Register on Nov. 9.

Who is still eligible

The law limits Medicare entitlement to four groups: U.S. citizens and nationals, lawful permanent residents, Cuban and Haitian entrants, and people lawfully residing in the U.S. under a Compact of Free Association. Applicants must still meet Medicare's other rules. Green card holders enrolling in premium Part A or Part B still face the five-year continuous residency requirement.

Before the law, any noncitizen who was "lawfully present" could qualify. CMS lists asylees, refugees and people paroled into the U.S. for at least one year as examples of groups now outside the four categories. The Medicare Rights Center adds temporary protected status holders, people with pending asylum applications, and trafficking and crime victims to the excluded list.

People who were not lawfully present were already ineligible. U.S. citizens are unaffected.

The timeline

The preliminary notices go to enrollees who were signed up before July 4, 2025 and whose status SSA cannot confirm. A notice is not a termination. Recipients can upload evidence through a my Social Security account or bring it to a local SSA office, and the notice explains how to correct their record with USCIS.

Those who do not establish eligibility are due a formal termination notice in December. CMS will send that notice in 14 languages. Enrollees identified later lose coverage at the end of the month after their notice month, according to CMS guidance for providers.

Several safeguards and limits apply:

• The reconsideration window with SSA is 60 days, and good cause can extend it.
• Coverage does not continue during an appeal, and the law allows no extension of the deadline.
• If SSA later finds a person did qualify, Medicare can be reinstated retroactively, though the person may owe Part A or Part B premiums for that period.
• A 12-month special enrollment period opens when a person contacts SSA with sufficient evidence of eligibility.
• Retirement and disability payments are not affected.

In a Nov. 12 update, CMS suggested people who lose Medicare look into employer or spousal coverage, state social services offices, or community health centers offering low-cost care.

How many people

The CMS Office of the Actuary estimates about 32,000 people will lose coverage, roughly 0.05% of the more than 70 million Medicare enrollees. The 300,000 figure counts notices only, and many recipients are expected to prove they still qualify.

The CBO previously estimated about 100,000 people would lose Medicare. CMS addressed the gap in the final rule: "There is very little information available on the number of beneficiaries who will be affected by this provision of the law... the estimates are likely to be different, and one may turn out to be more accurate than the other." CMS says the actual number remains unknown.

The objections

Immigrant, elderly and disability advocates oppose the change. The Medicare Rights Center said the law "terminates Medicare coverage for many individuals with lawful immigration status who have worked and paid taxes in the US for decades." It said previous policy covered lawful residents who had paid enough Social Security and Medicare taxes and who remain entitled to retirement or disability payments.

The group also warned the terminations will confuse people "as their immigration statuses, working histories, and contributions to the program will not have changed." It said the changes "will cause immense harm." It also called withholding or revoking eligibility from older adults and people with disabilities who followed the rules and paid in "unconscionable." A letter signed by 111 groups, including refugee, disability and senior advocates, raised similar objections.

CMS describes its role as implementing the statute Congress passed. It refers to the law as the "Working Families Tax Cuts" legislation. In its release on the broader fee schedule rule, CMS Administrator Mehmet Oz framed the rule as protecting taxpayers and directing Medicare dollars to clinicians. That statement was about billing practices, not the immigrant eligibility change.

What comes next

The December termination notices are the next fixed date, followed by the Feb. 1 cutoff for the first group. Until the notices land and responses come in, the 32,000 and 100,000 projections remain estimates. Which one proves closer will depend on how many of the roughly 300,000 recipients can document an eligible status in time.