If you’re an American Indian or an Alaska Native, you may have new health coverage benefits and protections in the Health Insurance Marketplace.
Some benefits are available to members of federally recognized tribes or Alaska Native Claims Settlement Act (ANCSA) Corporation shareholders. See the list of federally recognized tribes.
Others are available to people of Indian descent or otherwise eligible for services from the Indian Health Service (also known as an Indian hospital or Public Health Service (PHS)), a tribal program, or an urban Indian health program.
Members of federally recognized tribes and ANCSA shareholders can enroll in a Marketplace plan any time. You can change plans up to once a month.
Special health coverage protections and benefits for American Indians and Alaska Natives
The Health Insurance Marketplace benefits American Indians and Alaska Natives (AI/ANs) by providing opportunities for affordable health coverage through Marketplace health insurance plans, Medicaid, and the Children’s Health Insurance Program (CHIP).
Marketplace health insurance plans
While you’re not exempt from paying monthly premiums for an insurance plan you buy through the Marketplace, like all Americans you may qualify for tax credits that lower your premiums based on your income.
- If you buy a Marketplace plan and your income is between 100% and 300% of the federal poverty level, you can enroll in a “zero cost sharing” plan. This means you won’t have to pay any out-of-pocket costs -- like deductibles, copayments, and coinsurance -- when you get care.
- If you get services from an Indian Health Care Provider, you won’t have any out-of-pocket costs like copayments, coinsurance, or deductibles, regardless of your income. (This benefit also applies to Purchased and Referred Care.)
- You can enroll in a Marketplace health insurance plan any time, not just during the yearly Open Enrollment Period. You can change plans as often as once a month.
Medicaid & CHIP benefits for Tribal members and Alaska natives
American Indians, Alaska Natives, and others eligible for services from the Indian Health Service, tribal program, or urban Indian health program
- 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 Purchased/Referred Care.
Indian Health Services and Marketplace insurance
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 (also known as tribal 638 programs or tribal health clinics), or urban Indian health programs.
You can also get services from any providers on the Marketplace plan.
- Why do I need health insurance coverage if I get services from the Indian Health Service, a tribal program, or an urban Indian health program?
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.
- Will I need my tribal documents when applying for coverage?
For Medicaid and CHIP:
- 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 or a document from an Alaska Native Claims Settlement Act (ANCSA) Corporation indicating shareholder status
- An enrollment card
- 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
Medicaid and CHIP agencies may accept an individual’s attestation regarding Indian status. If the agency requires documents, you may need to prove Indian status or eligibility for services from an Indian health provider.
For the Marketplace:
- To qualify for tribal member and ANCSA shareholder year-round enrollment and cost-sharing reductions, you’ll 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
- When you apply, your eligibility results will explain how to provide the documents.
- See the list of federally recognized tribes.
- My children and I are tribal members, but my spouse is not. Can we enroll as a family with a Special Enrollment Period?
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.
- Example 1
- 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.
- 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 SEP because she applied to the Marketplace on the same application as Bob. If she applied to the Marketplace on a different application from Bob or her children, however, she wouldn't have access to the SEP. She would have to wait for an Open Enrollment period or be eligible for an SEP for another reason.
- 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 in order for the rest of the people on the same application to have access to the SEP.
Important: 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.
- What American Indian and Alaska Native income do I include on my application?
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.
- How can I change plans?
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.
- To change plans outside Open Enrollment: Log into your Marketplace account and select the “Report a Life Change” button. Select “status as an American Indian/Alaska Native or tribal status.” The application will show you how to continue to shop and enroll in a new plan.
- To change plans during Open Enrollment: Log into your Marketplace account. Select “My Plans and Programs.” Select the red “End/Terminate All Coverage” button. Select “Eligibility & Appeals.” Select the green “Continue to Enrollment” button. You can then shop for plans and enroll in the one you choose.
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.
- My household consists of both AI/ANs and non-AI/ANs family members. Can we all enroll in the same Marketplace plan?
- Yes, but a member of a federally recognized tribe won’t be able to use the special cost-sharing savings 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.