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 federally recognized tribes or Alaska Native Claims Settlement Act (ANCSA) Corporation shareholders. Others are available to people of Indian descent or who are otherwise eligible for services from the Indian Health Service, a tribal program, or an urban Indian health program.
Members of federally recognized tribes and ANCSA shareholders can enroll in Marketplace coverage any time of year. There’s no limited enrollment period for these individuals, and they can change plans up to once a month.
The Health Insurance Marketplace benefits American Indians and Alaska Natives (AI/ANs) by providing opportunities for affordable health coverage.
If you buy private insurance in the Health Insurance Marketplace and your income is up to around $70,650 for a family of 4 ($88,320 in Alaska), you can enroll in a zero cost sharing plan. This means you won’t have to pay out-of-pocket costs like deductibles, copayments, and coinsurance when you get care. If your income is above $70,650 for a family of 4 ($88,320 in Alaska), you can enroll in a limited cost sharing plan and pay no out-of-pocket costs when you get services from an Indian health care provider or from another provider if you have a referral from an Indian health care provider.
You can enroll any time. You can enroll in a Marketplace health insurance plan any month, not just during the yearly Open Enrollment period.
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.
You don’t pay out-of-pocket costs for Indian health 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 urban Indian programs (known as I/T/Us), including Contract Health Services.
You don’t have to pay the penalty. If you don’t have health insurance, you won't have to pay the fee that most other people without health insurance must pay.
If you enroll in a private health insurance plan through the Health Insurance Marketplace:
You can get (or keep getting) services from the Indian Health Service, tribal health programs, or urban Indian health programs.
You can also get services from any providers on the Marketplace plan.
However, American Indians and Alaska Natives (AI/ANs) and other people who are eligible for services through the Indian Health Service, tribal programs, or urban Indian programs (like the spouse or child of an eligible Indian) don’t have to pay the fee. This is called an exemption.
Members of federally recognized tribes, ANCSA Corporation shareholders, and people who are otherwise eligible for services through an Indian health care provider may apply for an exemption two ways:
Being exempt from the shared responsibility payment doesn’t prevent you from enrolling in a Marketplace health plan, Medicaid, or CHIP. These options are still available to you. You might qualify for certain protections under Medicaid or CHIP, or for lower costs on monthly premiums and no out-of-pocket costs on private insurance through the Marketplace.
By enrolling in health coverage through the Marketplace, Medicaid, or CHIP, you have better access to services that the Indian Health Service, 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.
For Medicaid and CHIP:
For a Marketplace health insurance plan:
While you are not exempt from paying monthly premiums, you may be able to get lower premium costs based on your income. Eligibility for lower costs depends on your income, family size, and whether you have access to other health coverage.
Members of federally recognized tribes or Alaska Native Claims Settlement Act (ANCSA) Corporation shareholders with a household income at or below 300% of the federal poverty level (about $70,650 for a family of 4 in 2013, or $88,320 for the same family in Alaska) won’t have any out-of-pocket costs like copayments, coinsurance, or deductibles for services covered by their Marketplace health plan.
If you’re a member of a federally recognized tribe or an ANCSA shareholder, you’re eligible for monthly special enrollment periods. If it’s outside the open enrollment period, you can still enroll in (or change) a health plan once per month in order to find a health plan that meets your needs.
Regardless of income, tribal members or ANCSA shareholders who enroll in a Marketplace health plan won’t have any out-of-pocket costs such as copayments, coinsurance, or deductibles for items or services provided by an I/T/U or through contract health services.
For Medicaid and CHIP:
Applicants may need to provide documentation of U. S. citizenship. The following documents meet the requirements:
Medicaid and CHIP agencies may accept an individual’s attestation regarding Indian status. If the Medicaid or CHIP agency requires documents, American Indians and Alaska Natives may need to prove Indian status or eligibility for services from an Indian health provider.
For monthly special enrollment periods and no out-of-pocket costs in the Marketplace:
Members of federally recognized tribes and ANCSA Corporation shareholders who are eligible to enroll in a health plan offered through the Marketplace will need to provide documentation showing membership in a federally recognized tribe or shareholder status in an Alaska Native Claims Settlement Act (ANCSA) Corporation.
For The Marketplace:
The special monthly enrollment periods and cost-sharing reductions apply only to members of a federally recognized tribe or Alaska Native Claims Settlement Act (ANCSA) Corporation shareholders. When applying through the Marketplace, you’ll need to provide documentation that you’re a member of a federally recognized tribe or an ANCSA shareholder.
Yes, if you filed for an exemption from the shared responsibility payment, you can still apply for Marketplace insurance, Medicaid, and CHIP.
If your state uses the federal Marketplace, yes. If one family member on the application is eligible for the Special Enrollment Period (SEP), all family members who apply on the same Marketplace application are eligible. This is true even if different family members are eligible for different Marketplace plans, based on differing eligibility for lower monthly premiums or out-of-pocket costs.
Important Note: If your state runs its own Marketplace, visit your state’s website to apply for a Special Enrollment Period. It may handle SEPs for American Indians and Alaska Natives differently.
The Marketplace application asks you to provide 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 income from various sources and will determine your eligibility for Marketplace insurance plans, Medicaid, and the Children’s Health Insurance Program (CHIP).
Most AI/AN trust income and resources aren’t counted when determining eligibility for these programs. But per capita income derived from gaming is taxable and therefore counted for these programs.
American Indians and Alaska Natives (AI/AN) qualify for special monthly Marketplace enrollment periods. Your Marketplace eligibility results will explain that you can change your plan any month of the year. You can also change plans during the annual Open Enrollment period.
Note: When you change plans during a special monthly period, you could wind up with a gap in your coverage if you enroll after the 15th day of the month. For example, if you change plans after May 15 your current coverage will end on May 31. But your new coverage won’t take effect until July 1. Check with your current plan and the plan you want to enroll in to learn how to avoid a coverage gap. You may find that enrolling before the 15th of the month is the best way to avoid a gap.