Paul Sanchez
Tribal health insurance is a federal program that provides health care coverage for American Indians and Alaska Natives. The Indian Health Service (IHS) is the principal federal health care provider and health advocate for Indian people and offers services at IHS/Tribal/Urban (I/T/U) facilities. To receive IHS health care benefits, individuals must be enrolled members of a federally recognized tribe and can go to the patient registration office of the local IHS facility in person to present proof of their enrollment. There are also health insurance options for tribal employers, who can elect to participate in the Federal Employees Health Benefits (FEHB) Program.
| Characteristics | Values |
|---|---|
| Who is eligible for Tribal Medical Insurance? | American Indians and Alaska Natives who are enrolled members of a federally recognized tribe. |
| What does it cover? | The cost of health services provided at IHS/Tribal/Urban facilities, including prescriptions and surgeries. |
| Are there any out-of-pocket expenses? | No out-of-pocket costs for Medicaid coverage if eligible for services from an Indian Health Service, Tribal programs, or urban Indian programs (I/T/Us). |
| How to enroll | Go to the patient registration office of the local IHS facility and present proof of enrollment in a federally recognized tribe. |
| Annual enrollment period | Mid-November to mid-December |
| Additional benefits | Access to the Federal Employees Health Benefits (FEHB) Program, which offers a wide variety of plans and coverage options. |
| Finding a provider | Use the IHS Find Health Care locator on the IHS website to find the nearest IHS/Tribal/Urban healthcare facility. |
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What You'll Learn
Eligibility for tribal members
Eligibility for tribal health insurance is available for American Indians and Alaska Natives. The Indian Health Service (IHS) is a federal program that provides health services to members of federally-recognized tribes. This is due to the special government-to-government relationship between the federal government and Indian tribes.
To be eligible for IHS health benefits, individuals must be enrolled members of a federally recognized tribe. This can be proven by presenting a document issued by a federally recognized tribe, indicating tribal membership, such as a tribal enrollment card. Other accepted documents include those from an Alaska Native village or tribe, acknowledging descent or affiliation, or a certificate of degree of Indian blood issued by the Bureau of Indian Affairs.
The IHS website provides a locator tool to find the nearest IHS/Tribal/Urban healthcare facility. It is important to call ahead to ensure the facility can provide the required services. The IHS is not an insurance program, and it does not cover out-of-pocket costs for items or services provided by the Indian Health Service, Tribal programs, or urban Indian programs.
Tribal members can also find health assistance and programs through tribal clinics and Medicare. Tribal clinics offer healthcare to tribal members and their families and, in some cases, may serve non-native people in small rural communities.
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Tribal employer health insurance
Tribal employers can choose to participate in the Federal Employees Health Benefits (FEHB) Program, which offers a wide variety of plans and coverage options to meet the healthcare needs of eligible employees and their family members. This program is administered by the Office of Personnel Management (OPM) and is available to tribes or tribal organisations carrying out programs under specific acts, such as the Indian Self-Determination and Education Assistance Act (ISDEAA) and the Tribally Controlled Schools Act of 1988 (TCSA).
The FEHB Program provides choice and competition, allowing employees to select a plan that best suits their needs. The specific effective date of an employee's health insurance coverage should be confirmed with their tribal employer, but it is generally the first day of the month following the end of the Initial Enrollment Opportunity. Tribal employers are expected to contribute to the premium, matching the Government contribution for Federal employees, and this information can be found on the tribal rates page.
Tribal employers can also refer to the National Congress of American Indians (NCAI) for guidance on employer requirements under the Affordable Care Act. Additionally, there are companies like Tribal First that offer specialised services for Native American tribes, including plan design, administration, and clinical care management.
It is important to note that American Indians and Alaska Natives have special cost and eligibility rules for programs like Medicaid and the Children's Health Insurance Program (CHIP). They also have access to services from Indian Health Service (IHS), Tribal programs, and urban Indian programs (I/T/Us) without incurring out-of-pocket costs, regardless of income. Furthermore, AI/ANs with employer-sponsored insurance who receive care at an IHS or tribal facility are protected from cost-sharing and do not have to pay copayments or deductibles.
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Indian Health Service (IHS)
The Indian Health Service (IHS) is a federal health program that provides health services to American Indians and Alaska Natives. It is an agency within the Department of Health and Human Services and is the principal federal healthcare provider and health advocate for Indian people. The IHS is not an insurance program but rather a direct health care service. It is funded by the U.S. Congress and provides services at IHS/Tribal/Urban facilities or through purchased/referred care (PRC) from non-IHS providers when services cannot be provided in their own facilities.
To be eligible for health services from the IHS, individuals must be enrolled members of a federally recognized tribe. This can be proven by presenting documentation at the patient registration office of the local IHS facility. Examples of accepted documents include a Tribal enrollment card, a certificate of degree of Indian blood issued by the Bureau of Indian Affairs, or a document from an Alaska Native village acknowledging descent.
The IHS provides a comprehensive health service delivery system and aims to improve the physical, mental, social, and spiritual health of American Indians and Alaska Natives. Services are provided through IHS-run hospitals, clinics, or tribal contracts, and there is no out-of-pocket cost for eligible individuals. The IHS employs a range of health professionals, including nurses, physicians, pharmacists, physician assistants, dentists, therapists, and more.
In addition to the IHS, American Indians and Alaska Natives can also enroll in a Marketplace health plan, Medicaid, or the Children's Health Insurance Program (CHIP). These options provide access to additional services that may not be available through the IHS and allow individuals to continue receiving services from IHS, tribal programs, or urban Indian organizations.
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Marketplace health plans
If you are an American Indian or an Alaska Native, you can learn about your health coverage options at Healthcare.gov, the Health Insurance Marketplace. Here are some things to know about Marketplace health plans:
Enrollment and Eligibility
You can enroll in a Marketplace health plan, Medicaid, or the Children's Health Insurance Program (CHIP). If you are eligible for Medicaid or CHIP, you may qualify more easily and have special cost and eligibility rules that make it simpler to qualify for these programs. To qualify for year-round enrollment and cost-sharing reductions, you will need to provide documentation to the Marketplace. This documentation may include a document issued by a federally recognized tribe indicating tribal membership, such as a tribal enrollment card, or a certificate of degree of Indian blood issued by the Bureau of Indian Affairs.
Costs and Coverage
If you enroll in a Marketplace plan, you can continue to get services from Indian health care providers, tribal programs, or urban Indian organizations (known as I/T/Us) in the same way you do now. When you receive services from an I/T/U, they can bill your insurance program, and you won't have any out-of-pocket costs like deductibles, copayments, or coinsurance, regardless of your income. Additionally, you won't have to pay any premiums or out-of-pocket costs for Medicaid coverage if you are eligible for services from an I/T/U. With a Marketplace plan, you can also access services from any other providers included in the plan, giving you better access to a wider range of services.
Purchasing Outside the Marketplace
It is possible to purchase health insurance coverage outside of the Marketplace, but this option may be more costly. Individuals would have to pay the full cost themselves and would not be eligible for premium tax credits or certain cost-sharing reductions. However, if an individual enrolls in a Marketplace plan but is not eligible for premium tax credits because they qualify for CHIP or Medicaid, they can still have cost-sharing requirements eliminated when served by an Indian health care provider or when referred to non-Indian health care providers by an Indian health care provider.
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Medicaid and CHIP
Medicaid and the Children's Health Insurance Program (CHIP) are available for qualifying American Indians and Alaska Natives. These programs provide free or low-cost health coverage to low-income people, families and children, pregnant women, the elderly, and people with disabilities.
There are special cost and eligibility rules for Medicaid and CHIP that make it easier for American Indians and Alaska Natives to qualify for these programs. Regardless of income, there are no out-of-pocket costs for items or services provided by the Indian Health Service (IHS), Tribal programs, or urban Indian programs.
The IHS is an agency within the Department of Health and Human Services that provides federal health services to American Indians and Alaska Natives. The IHS is the principal federal healthcare provider and health advocate for Indian people and provides a comprehensive health service delivery system for them. The most common standard applied for eligibility for health services from the IHS is that the individual is an enrolled member of a federally recognized tribe.
To receive IHS healthcare benefits, you should go to the patient registration office of the local IHS facility in person and present proof of your enrollment as a member of a federally recognized tribe. You can locate the nearest IHS/Tribal/Urban healthcare facility to your location by using the IHS Find Health Care service on the IHS website.
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Frequently asked questions
The Indian Health Service is an agency within the Department of Health and Human Services, responsible for providing federal health services to American Indians and Alaska Natives. It is funded by the U.S. Congress and acts as the principal federal health care provider and advocate for Indian people.
The standard for eligibility is that the individual is an enrolled member of a federally recognized Tribe. You can present proof of your enrollment at the patient registration office of your local IHS facility.
The Federal Employees Health Benefits (FEHB) Program is a health insurance program that tribal employers can choose to participate in. It offers a wide variety of plans and coverage to meet healthcare needs.
You can enroll during the annual FEHB Open Season, which is held from mid-November to mid-December. Outside of Open Season, newly eligible employees have 60 days to enroll.
No, regardless of your income, you won't have any out-of-pocket costs for items or services provided by the IHS, Tribal programs, or urban Indian programs (known as I/T/Us).
