Haris Ashley
There are several health insurance options for Native Americans, including members of federally recognized tribes and Alaska Natives. They can access health insurance through the Health Insurance Marketplace (Healthcare.gov), Medicaid, the Children's Health Insurance Program (CHIP), and private insurance. Native Americans are provided with special assistance to sign up and purchase insurance on the Marketplace, and they can enroll at any time, not just during the yearly Open Enrollment Period. They may also qualify more easily for Medicaid and CHIP due to special cost and eligibility rules. Additionally, Native Americans can continue to receive services from Indian Health Services, tribal programs, and urban Indian organizations while enrolled in these insurance programs.
| Characteristics | Values |
|---|---|
| Health Insurance Marketplace | Available to Native Americans in New Mexico and Arkansas |
| BeWell | Offers additional benefits to members of federally recognized tribes |
| Medicaid | Available to qualifying federally recognized American Indians and Alaska Natives |
| Children's Health Insurance Program (CHIP) | Available to qualifying federally recognized American Indians and Alaska Natives |
| Special Enrollment Period | Members of federally recognized tribes can enroll in a Marketplace plan at any time |
| Out-of-pocket costs | No out-of-pocket costs for items or services provided by the Indian Health Service, Tribal programs, or health programs |
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What You'll Learn
Special enrolment and cost-sharing rules
As a member of a federally recognized tribe or an Alaska Native shareholder, you have certain protections in the Marketplace. You can enroll in a Marketplace plan at any time for coverage this year. You can change plans up to once a month or enroll for plan coverage for the following year during the yearly period (November 1 – January 15).
There are advantages to enrolling in Marketplace coverage. You will have access to a wider range of providers and services, in addition to healthcare services you get through Indian healthcare providers. You may qualify for a premium tax credit that lowers your monthly premium and extra savings when you get care (called cost-sharing reductions). This is a discount that lowers the amount you have to pay for deductibles, copayments, and coinsurance.
If you enroll in a Marketplace health plan, you can keep getting services from your I/T/U (Indian Health Service, Tribal Health Programs, or Urban Indian health programs) the same way you do now. When you get services from an I/T/U, the I/T/U can bill your insurance program. This benefits the tribal community, allowing I/T/Us to provide more services to others.
American Indians and Alaska Natives (AI/ANs) who meet the eligibility criteria under section 4 of the Indian Health Care Improvement Act (as a “Member of an Indian Tribe,” which includes members and shareholders in Alaska Native regional and village corporations) qualify for monthly special enrollment periods under the Affordable Care Act. This means that a qualifying AI/AN can enroll in health insurance coverage through a Marketplace throughout the year and not just during the yearly open enrollment period.
If your income is below a certain level, you won't have to pay copayments or other cost-sharing. If you qualify for Medicaid or the Children’s Health Insurance Program (CHIP) and you're eligible for or have gotten services from the Indian Health Service, tribal health programs, or urban Indian health programs--you won't have to pay Medicaid or CHIP premiums, enrollment fees, and out-of-pocket costs.
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Eligibility for Medicaid and CHIP
Medicaid and the Children's Health Insurance Program (CHIP) are available to qualifying federally recognised Native Americans (American Indians and Alaska Natives). These programs provide better access to services that a local Indian health clinic might not be able to provide.
Native Americans may qualify for Medicaid and CHIP more easily. There are special cost and eligibility rules that make it easier to qualify for these programs. Certain Indian resources and payments aren't counted for Medicaid and CHIP eligibility, making it easier for some people to qualify. Regardless of income, there are no out-of-pocket costs for items or services provided by the Indian Health Service, Tribal programs, or Health programs available to American Indians and Alaska Natives living in urban areas.
If you enrol in a Marketplace plan, you can continue to get services from IHS, Tribes and Tribal organisations, or urban Indian organisations. By enrolling in health coverage through the Marketplace, Medicaid, or CHIP, you have better access to services that the Indian Health Service (IHS), Tribal programs, or urban Indian programs (known as I/T/Us) may not provide.
If your income is too high to qualify for Medicaid, your child may still qualify for CHIP. CHIP qualifications are different in every state, and in most cases, they depend on income. In all states, CHIP provides low-cost health coverage to children in families that earn too much money to qualify for Medicaid. In some states, CHIP covers pregnant people.
Medicaid and CHIP agencies may accept an individual's attestation regarding Indian status. If the agency requires documents, Native Americans may need to prove Indian status or eligibility for services from an Indian health provider.
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Tax credits and exemptions
Native Americans are eligible for various tax credits and exemptions. Firstly, they are eligible for the same premium tax credits (premium subsidies) that are available to other Marketplace enrollees, including subsidy enhancements under the American Rescue Plan and Inflation Reduction Act. Native Americans who earn less than 300% of the Federal Poverty Level (FPL) qualify for these premium tax credits and are exempt from cost-sharing, meaning they do not pay copayments or deductibles.
Additionally, there are special provisions for the calculation of Modified Adjusted Gross Income for Native Americans, where some revenue earned on reservations and from Federal Trust payments are exempt from federal income tax. Native Americans are also exempt from cost-sharing for any health services received directly from Indian Health Service (IHS) providers, tribal organisations, or urban Indian organisations.
Furthermore, members of federally recognised tribes who qualify for cost-sharing reductions are not exempt from premiums but may qualify for advance payment of premium tax credits based on their income. Some tribes participate in a tribal sponsorship program where they pay premiums on behalf of tribal members. Native Americans also qualify for a Special Enrollment Period, allowing them to enroll in coverage at any time of the year, outside of the Open Enrollment Period.
It is important to note that if an overpayment of premium tax credits occurs, enrollees may be required to repay the excess amount through the federal income tax filing process. However, to protect the enrollee, many tribal sponsorship programs reimburse the individual for any repayments owed to the federal government.
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Health Insurance Marketplace
Native Americans can access health insurance through the Health Insurance Marketplace, which is a platform that connects individuals with quality and affordable health insurance plans. The Marketplace offers special considerations for American Indians and Alaska Natives, who may qualify for additional benefits and tailored coverage options.
The Health Insurance Marketplace provides flexibility for Native Americans, allowing them to enrol in a health insurance plan at any time. This is in contrast to the general population, who are typically restricted to enrolling during specific periods. Native Americans can also take advantage of special cost-sharing options that reduce out-of-pocket expenses, such as deductibles and premiums.
Additionally, members of federally recognized tribes can continue receiving healthcare services from Indian Health Service (IHS) providers, tribal healthcare centres, or urban Indian organisations, while also accessing a wider range of providers and services through their Marketplace plan. This ensures that Native Americans can maintain cultural connections in their healthcare while benefiting from expanded options.
Medicaid and the Children's Health Insurance Program (CHIP) are also available to qualifying Native Americans, providing better access to services that local Indian health clinics may not be able to offer. Certain Indian resources and payments are not considered for Medicaid and CHIP eligibility, making it easier for Native Americans to qualify for these programs.
Overall, the Health Insurance Marketplace, along with Medicaid and CHIP, offers Native Americans enhanced healthcare support, improved access to services, and financial considerations, ensuring that this population can access the healthcare they need in a culturally sensitive and affordable manner.
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Supplemental insurance plans
Native Americans can access a range of supplemental insurance plans to enhance their healthcare coverage. These include Marketplace plans, Medicaid, and the Children's Health Insurance Program (CHIP).
Marketplace Plans
Members of federally recognized tribes and Alaska Native Claims Settlement Act (ANCSA) Corporation shareholders can enroll in Marketplace plans at any time during the year. These plans offer access to a wider range of providers and services, in addition to those provided by Indian Health Services, tribal programs, or urban Indian health programs.
Medicaid and CHIP
Native Americans may qualify more easily for Medicaid and CHIP due to special cost and eligibility rules. Regardless of income, there are no out-of-pocket costs for items or services provided by the Indian Health Service, tribal programs, or health programs available to Native Americans living in urban areas. Enrolling in Medicaid or CHIP can provide better access to services that may not be available through Indian Health Services or tribal programs alone.
State-Specific Options
In addition to the above options, there are state-specific supplemental insurance plans available for Native Americans. For example, BeWell in New Mexico offers enhanced healthcare support, additional benefits, and tailored coverage options for Native Americans who are members of federally recognized tribes. Similarly, in Texas, there are Affordable Care Act (ACA) plans available specifically for Native Americans, including zero-cost sharing plans and limited cost-sharing plans, depending on household income.
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Frequently asked questions
Native Americans can get health insurance through the Health Insurance Marketplace (healthcare.gov). Native Americans can enrol at any time and can change their health plan once a month.
Native Americans can get help paying for health insurance, including tax credits and zero or limited cost-sharing plans.
Native Americans in Colorado can access health insurance through Health First Colorado (Colorado's Medicaid program) or Child Health Plan Plus (CHP+).
Health insurance can cover emergency care when travelling outside the Indian Health Service (IHS) and Tribal Health Care service area. It can also cover services that IHS and Tribal Health Care programs do not provide.
Applicants may need to provide documentation of US citizenship and tribal membership. This can include a certificate of degree of Indian blood issued by the Bureau of Indian Affairs.
