Refugees, asylees and other lawfully present immigrants who lose Medicare under the 2025 tax and spending law are due formal termination notices toward the end of December 2026, according to a fact sheet from the Center for Medicare Advocacy, a nonprofit law organization. The group built that timeline from a proposed rule at the Centers for Medicare & Medicaid Services that has not been finalized. Social Security is expected to send earlier preliminary notices between August and November, and Medicare coverage for the first group of affected people would end February 1, 2027. The fact sheet says Social Security retirement and disability checks are not changed.
The change reaches people who are on Medicare today because of a humanitarian immigration status: refugees, asylees, people with Temporary Protected Status, humanitarian parolees, survivors of human trafficking or domestic violence, and people granted withholding of removal. For anyone in one of those groups, the open questions come with dates attached. A preliminary notice may still be on the way, the information Social Security holds may be wrong, and replacement coverage has to be lined up before the termination notice lands in December.
Termination notices for the group are due in late December, with coverage ending February 1, 2027, and CMS has not yet finalized the rule that sets the process.
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Who stays on Medicare and who does not
Federal law now limits Medicare to four groups: citizens or nationals of the United States, lawful permanent residents, people granted Cuban and Haitian entrant status, and people who lawfully reside in the country under a Compact of Free Association. The statute, section 1899C of the Social Security Act, came with the law signed July 4, 2025. It told the Social Security commissioner to review current beneficiaries within a year and identify anyone outside the four groups. For people already enrolled on July 4, 2025, the limit applies 18 months after that date, which falls on January 4, 2027.
The Center for Medicare Advocacy’s August 2026 fact sheet sorts the groups. Refugees, asylees, Temporary Protected Status holders, parolees admitted for at least a year, trafficking and domestic violence survivors, and people granted withholding of removal lose Medicare. Lawful permanent residents keep it, subject to the five-year continuous residency rule, as do Cuban and Haitian entrants and citizens of Micronesia, the Marshall Islands and Palau living under the compact. The sheet adds that Social Security will not terminate anyone before notifying them.
Two notices from Social Security, and dates that do not match
The fact sheet describes two letters. The first is a preliminary notice, which Social Security is to send to the affected group “sometime between August and November 2026,” with no specific mailing date set. The second is the termination notice, expected toward the end of December 2026, which works as a formal initial determination. A July 2 alert from the same group, written by D. Lipschutz, said an HHS presentation to Medicare stakeholders had projected the first notices for “Likely July or August 2026.”
The end date is less settled. The fact sheet says coverage for the first group terminates February 1, 2027, yet it also refers to coverage ending in January 2027, and the statute itself keys the limit to January 4, 2027. For people who fall outside that first group, the fact sheet says a termination notice takes effect at the end of the month after the notice date. Until CMS publishes a final rule, the exact day coverage stops remains a proposal rather than a settled date.
A termination notice carries appeal rights, according to the fact sheet, and appeals go to Social Security under its reconsideration rules. Anyone who gets a preliminary notice with wrong information is told to contact Social Security and send updated evidence before termination. The July alert said the HHS presentation suggested people who receive a notice that does not apply to them ask Social Security for an in-person appointment, which it expected to be needed in some cases. The advocacy group asks people who get these notices to contact it confidentially.
What CMS proposed in July
CMS put the policy into its calendar year 2027 Physician Fee Schedule proposal, a rule mostly about doctor payments. The Federal Register notice, published July 16, 2026 at 91 FR 43842, lists the topic in section III.E, “Limiting Medicare Coverage of Certain Individuals.” It covers people entitled to Medicare on July 4, 2025, a termination process for noncitizens Social Security did not identify and notify, an enrollment path for those who gain or regain eligibility, and coverage under Medicare Advantage, Part D and cost plans. Comments closed September 14, 2026.
The fact sheet says the proposal would add the newly specified groups to the regulations, set termination and appeal procedures, and create enrollment options for people who later gain or regain eligibility. If finalized as proposed, it would take effect January 1, 2027. Those people would get a six-month special enrollment period. Premium Part A and Part B coverage would start only going forward, while premium-free Part A may include up to six months of retroactive coverage. CMS would disenroll people from Medicare Advantage, Part D and cost plans automatically, and plans would not have to send separate notices.
Neither the law nor the advocacy group’s material gives a count of how many people are affected. The July alert said that when it was written, neither CMS nor Social Security had issued public guidance on the changes. The fact sheet also says the proposal may change before it is final, and it advises affected people to consult an immigration law specialist about whether a change in immigration status could restore eligibility for coverage.
Answering a Social Security notice
The first step for anyone who receives a preliminary notice is to check the details against their own immigration documents. The fact sheet says the notice is the chance to correct information and to send updated evidence of eligibility before termination, and the fact sheet says Social Security will not terminate anyone before notifying them. Social Security lets people search for a local office by address, city, state or ZIP code, which matters if an in-person appointment is needed.
The notice dates are the part to track. A preliminary notice can arrive any time through November. The termination notice is expected in late December, and its appeal rights begin there. Because the fact sheet gives both February 1 and January as end dates, the date printed on the termination notice itself is the one to hold Social Security to.
The fact sheet says CMS handles disenrollment from Medicare Advantage, Part D and cost plans automatically, and that plans are not required to send separate notices, so the Social Security letters are the main written warning. People who regain eligibility later can use the six-month special enrollment period the proposal describes. The final rule, which CMS has not yet issued, will settle whether the February 1, 2027 date holds.
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This article was produced with AI assistance and reviewed by The Money Overview’s editorial team.
