American Indians & Alaska Natives

Health coverage for American Indians & Alaska Natives

If you’re an American Indian or an Alaska Native, you may have new health coverage benefits and protections in the Marketplace.

• Some benefits are available to members of

Any Indian or Alaska Native tribe, Alaska Native Claims Settlement Act (ANCSA) Corporation (regional or village), band, nation, pueblo, village, rancheria, or community that the Department of the Interior acknowledges to exist as an Indian tribe. Refer to glossary for more details.

Members of federally recognized Tribes and ANCSA shareholders can enroll in a Marketplace plan at any time for coverage this year. Once you’re enrolled in a plan, you can change plans up to once a month or enroll for plan coverage next year during

The yearly period (November 1 – January 15) when people can enroll in a Marketplace health insurance plan.

Refer to glossary for more details.

Special health coverage protections and benefits for members of federally recognized Tribes and ANCSA shareholders

You can get health coverage through Marketplace plans, Medicaid, and the Children’s Health Insurance Program (CHIP). There are advantages to enrolling in Marketplace coverage:

• Access to a wider range of providers and services — in addition to health care services you get through Indian health care providers.
• You may qualify for a premium tax credit that lowers your monthly premium and extra savings when you get care (called “

A discount that lowers the amount you have to pay for deductibles, copayments, and coinsurance. In the Health Insurance Marketplace®, cost-sharing reductions are often called “extra savings.” If you qualify, you must enroll in a plan in the Silver category to get the extra savings. Refer to glossary for more details.

Marketplace

• If you buy a Marketplace plan and your income is between 100% and 300% of the

A measure of income issued every year by the Department of Health and Human Services (HHS). Federal poverty levels are used to determine your eligibility for certain programs and benefits, including savings on Marketplace health insurance, and Medicaid and CHIP coverage. Refer to glossary for more details.

, you can enroll in a “zero cost sharing” plan. This means you won’t have to pay any out-of-pocket costs — like

The amount you pay for covered health care services before your insurance plan starts to pay. With a $2,000 deductible, for example, you pay the first $2,000 of covered services yourself. Refer to glossary for more details.

A fixed amount ($20, for example) you pay for a covered health care service after you've paid your deductible. Refer to glossary for more details.

The percentage of costs of a covered health care service you pay (20%, for example) after you've paid your deductible. Refer to glossary for more details.

Medicaid & CHIP benefits

You pay no premiums or out-of-pocket costs for Medicaid coverage if you’re eligible to get services from an Indian Health Service, Tribal programs, or urban Indian programs (known as I/T/Us) or Purchased or Referred Care (PRC) program.

Getting services from Indian Health Service, Tribes and Tribal organizations, or urban Indian organizations

• You may qualify for Medicaid and CHIP more easily. You have special cost and eligibility rules for Medicaid and the Children’s Health Insurance Program (CHIP) that make it easier to qualify for these programs.
• Regardless of income, you won’t have any 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. Refer to glossary for more details.

Indian Health Service, Tribes and Tribal organizations, or urban Indian organizations and Marketplace insurance

If you enroll in a Marketplace plan, you can get (or keep getting) services from IHS, Tribes and Tribal organizations, or urban Indian organizations. You can also get services from any providers on the Marketplace plan.

More answers

Why do I need health insurance coverage if I get services from IHS, Tribes and Tribal organizations, or urban Indian organizations?

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 you enroll in a Marketplace health plan, Medicaid, or CHIP, you can keep getting services from your I/T/U 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.

Will I need my tribal documents when applying for coverage?

Applicants may need to provide documentation of U. S. citizenship. The following documents meet the requirements:

• A document issued by a federally recognized Tribe indicating Tribal membership, such as a Tribal enrollment card
• A document from an Alaska Native village or Tribe or an Alaska Native Claims Settlement Act (ANCSA) Corporation (regional or village) acknowledging descent, affiliation, or shareholder status
• A certificate of degree of Indian blood issued by the Bureau of Indian Affairs
• A Tribal census document
• Any document indicating affiliation with the Tribe

To qualify for year-round enrollment and cost-sharing reductions, you need to provide documentation to the Marketplace. You can provide either of the following:

• A document issued by a federally recognized Tribe indicating Tribal membership
• A document issued by an Alaska Native village/Tribe, or an ANCSA Corporation (regional or village) document indicating shareholder status

My children and I are tribal members, but my spouse is not. Can we enroll as a family with a Special Enrollment Period?

Yes, if your state uses the federal Marketplace. If one family member on the application qualifies for the Special Enrollment Period for coverage this year, all family members who apply on the same Marketplace application can use the Special Enrollment Period to enroll.

• Bob and his family apply to the Marketplace on a single application. Bob is an enrolled member of the Crow Tribe. His wife Betty is non-Indian. Their children are enrolled members of the Crow Tribe. Because they all apply on the same Marketplace application, they’re all eligible for a Special Enrollment Period for coverage this year.
• If the family household income is below 300% of the federal poverty level, Bob and the children may be eligible for a plan where they don’t have to pay deductibles or other cost-sharing. But his wife would need to enroll in another plan. Betty will still be able to use the Special Enrollment Period because she applied to the Marketplace on the same application as Bob.
• If Betty applied to the Marketplace on a different application from Bob or her children, she wouldn’t qualify for the Special Enrollment Period. She would have to wait for the yearly Open Enrollment Period (November 1 through January 15) or have another reason to qualify for a Special Enrollment Period.

• Anna is a non-Indian but her two children are enrolled members of the Ute Tribe. When they apply for coverage through the Marketplace on a single application, all three family members will be able to use the Special Enrollment Period. The head of household doesn’t have to be a member of a federally recognized Tribe for the rest of the people on the same application to qualify for the Special Enrollment Period.

If your state runs its own Marketplace, the rules for a Special Enrollment Period may be different. Visit your state’s website to apply for a Special Enrollment Period. Get my state’s Marketplace website.

What American Indian and Alaska Native income do I include on my application?

The Marketplace application asks you to give income information that’s reportable on your federal income tax return. In general, you won’t report American Indian or Alaska Native (AI/AN) income that the IRS exempts from tax (income from treaty fishing rights, for example).

The Marketplace application will ask you to report your incomes and will determine your eligibility for Marketplace insurance plans, Medicaid, and the Children’s Health Insurance Program (CHIP).

Most AI/AN Indian trust income and resources aren’t counted when determining eligibility for Medicaid and CHIP.

How can I change plans?

A time outside the yearly Open Enrollment Period when you can sign up for health insurance. You qualify for a Special Enrollment Period if you’ve had certain life events, including losing health coverage, moving, getting married, having a baby, or adopting a child, or if your household income is below a certain amount.

Refer to glossary for more details.

When you change plans during a Special Enrollment Period, coverage starts the first day of the month after you change plans. For example, if you change plans on May 15, your new coverage will begin June 1.

The yearly period (November 1 – January 15) when people can enroll in a Marketplace health insurance plan.

Refer to glossary for more details.

1. Log into your Marketplace account and select your current application.
2. Select “Report a life change.”
3. When the pop-up window appears, select the first option and then “Continue.”
4. Continue through your application and make updates, as Then, complete and submit your application.
5. Your Eligibility Notice will confirm that you’re eligible to enroll in a plan. You can then shop and enroll in a new plan.

• You’ll join a new plan for the current year, not next year. For example, if you change plans in November, you’ll have a new plan for December.
• Follow the steps above to change plans for the current year.

If you want your new plan to continue into next year, you’ll need to also update your application and enroll in that plan for next year’s coverage. Then, repeat the steps again to update your application for next year and enroll in that plan or a different one that meets your needs.

My household consists of both AI/ANs and non-AI/ANs family members. Can we all enroll in the same Marketplace plan?

Yes, you can. However, a member of a federally recognized Tribe won’t be able to use extra savings (known as cost-sharing reductions) if they enroll in the same Marketplace plan with a non-Tribal member. Tribal members and non-Tribal members should enroll in separate plans to take advantage of all potential savings.