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Health Insurance for American Indians and Alaska Natives

Last updated March 18th, 2020

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According to the 2010 U.S. census, 5.2 million individuals identify as American Indians and Alaska Natives (or AI/AN). However, nearly one in five American Indians and Alaska Natives do not have health insurance. Financial and geographic barriers to adequate healthcare continue to affect the staggering difference of uninsured tribal members.

Members of the 573 federally-recognized tribes have unique benefits when it comes to health insurance coverage. Affordable Care Act plans (also called Obamacare) and Medicaid have addressed some of the limitations in the healthcare system for AI/AN individuals by extending protections to this population. The Indian Health Service also provides care that fits the needs of tribal members’ communities.

By learning more about insurance plans for American Indians and Alaska Natives, you can compare and choose the best plan. Keep reading to learn about the options for AI/AN individuals when it comes to enrolling in health insurance.

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Health Insurance Protections for American Indians and Alaska Natives

  • You can enroll in health insurance at any time of the year – others have to wait until November. Forget about having to wait for the Open Enrollment Period or qualifying for a Special Enrollment Period to join an Affordable Care Act plan. You can also change plans once a month.
  • You won’t have to pay out-of-pocket costs if you have coverage from Indian health programs. Out-of-pocket costs include deductibles, coinsurance, and copayments.
  • You can pay less (or nothing) than others for out-of-pocket costs if you have an Obamacare plan, depending on your annual income. The zero cost sharing plan is specifically for AI/AN individuals whose income lies between 100 to 300 percent of the federal poverty level. With this benefit, you can get zero costs sharing with an ACA plan on any metal level.
    [bctt tweet=”Tribal members who earn less than 300 percent of the federal poverty level per year won’t have to pay any out-of-pocket expenses.” username=”HealthCareInc”]
  • You can still use services from the Indian Health Service or other Indian health programs even if you enrolled in a private health plan. You can also access medical benefits from your private plan, including essential health benefits.

Medicaid Protections for American Indians and Alaska Natives

  • You won’t have to pay premiums or out-of-pocket costs under Medicaid. Under the American Recovery and Reinvestment Act of 2009, states cannot charge Medicaid premiums to individuals using Indian health systems.
  • You may have an easier time qualifying for Medicaid under eligibility rules. As a member of a federally recognized tribe, you face fewer limitations when it comes to applying for Medicaid.

What is the Indian Health Service?

The Indian Health Service, also known as the IHS, provides medical services for eligible AI/AN individuals and is funded by the federal government. As an agency of the Department of Health and Human Services, the IHS promotes the health of American Indians and Alaska Natives in all aspects. They work to provide health services that uphold both cultural and physical standards for AI/AN populations. You can use IHS if you meet the following criteria:

  • You are of American Indian and/or Alaska Native descent,
  • You are enrolled in an AI/AN tribe or group,
  • You live on tax-exempt land, or
  • You actively participate in tribal affairs.

The following individuals may also qualify for IHS even if they are not AI/AN:

  • Children, younger than 19-years-old, of an eligible AI/AN, or
  • Spouses of an eligible AI/AN.

If you are unsure of your eligibility status, check the official guidelines for IHS eligibility here. Keep in mind that individuals whose healthcare is provided by IHS do not have to pay out-of-pocket costs for any health services or equipment.

Currently, IHS centers provide health services for 2.5 million AI/AN throughout the United States. By providing services closer to communities with tribal members, the IHS has increased health resources for many.

The ACA, American Indians, and Alaska Natives

The Affordable Care Act, otherwise known as the ACA or “Obamacare,” reformed the healthcare system in 2010. Under the ACA, individuals who do not have health insurance are required to pay a tax penalty to the federal government, also known as the individual mandate up to the 2018 plan year.

However, if you identify as an American Indian and/or Alaska Native, you will not be penalized for not carrying health insurance. You can be exempt from the individual mandate if you’re eligible for Indian health programs. This was also called the “Indian Exemption.” Simply complete Form 8965 to apply for the Indian health coverage exemption when you file your federal income tax return.

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Health Disparities for Tribal Members

Historically, American Indians and Alaska Natives have faced challenges to access quality healthcare. Compared to the national average, AI/AN communities have less exposure to public health education and resources. And though AI/AN and other population groups encounter similar diseases, AI/AN individuals are disadvantaged by limited treatment options and lack of medical centers.

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