10 Important Facts about IHS and Health Insurance

10 Important Facts

about Indian Health Service

and Health Insurance

For American Indians and

Alaska Natives

Why your Indian health

beneﬁts may not be enough

ou may be wondering why you should

consider getting health insurance when

you are eligible for health care from Indian

health care programs, including Indian

Health Service (IHS), your tribe, or an urban

Indian health program. Here are some facts

to help answer those questions.

FACT #1: IHS is not health

insurance

The Indian Health Service (IHS) is a part of the federal

government that delivers health care to American Indians and

Alaska Natives (AI/ANs) and provides funds for tribal and urban

Indian health programs. Health insurance, on the other hand,

pays for health care covered by your plan. It protects you from

paying the full costs of medical services when you are injured or

sick and pays for services to prevent you from becoming ill.

FACT #2: Even people eligible for

IHS need insurance

Health insurance covers many things Indian health care

programs do not provide. With health insurance. you can:

• Get in to see specialists

• Get health care for covered services without IHS

Purchase Referred Care authorization

• Get health care when you are away from home

FACT #3: You’ll pay little or nothing

American Indians and Alaska Natives can ﬁnd affordable insurance.

If your income is:

• Between 100% to 300% of the federal poverty level (FPL),

enroll in a zero cost sharing plan and have NO out of

pocket costs for services received from an Indian health

provider or a qualiﬁed health plan (QHP).

• Below 100% FPL or above 300% FPL, enroll in a limited

cost sharing plan (regardless of income). NO out of

pocket expenses for services received from an Indian

health provider or through a referral to a QHP.

• Less than $12,000 for an individual and you reside in a state

that has not expanded Medicaid, limited cost sharing

plans are an important option to receive low cost

health care coverage.

Medicaid and CHIP insurance

• There are no premiums, enrollment fees, copays,

deductibles, or coinsurance.

Health care from IHS, tribal health programs, or urban Indian

health programs

• There are no deductibles, coinsurance, or copayments for

covered services provided directly or when referred to non-

Indian health providers under the IHS Purchased/Referred

Care (PRC) program.

FACT #4: Marketplace plans,

Medicaid, and CHIP are not welfare

Marketplace plans, Medicaid, and the Children’s Health Insurance

Program (CHIP) are health insurance programs for individuals,

families, and children who meet income and eligibility requirements.

Medicare and employer-sponsored insurance plans are other

examples of health insurance with eligibility requirements.

FACT #5: You can stay with your

Indian health clinic, get health care

somewhere else, or both

Indian health care programs gladly accept health insurance,

Medicaid, and CHIP. You won’t have to change doctors or facilities

if you don’t want to, even if your state has a Medicaid managed care

network. If you want a choice about who to see for health care, you

will have more options.

FACT #6: You won’t have to wait

to sign up

Members of federally recognized tribes and Alaska Native Claims

Settlement Act shareholders can purchase or change Marketplace

health insurance coverage every month, rather than waiting for the

yearly open enrollment period. So can non-enrolled family members,

if they are included on the same application. This special protection

for American Indians and Alaska Natives can be a lifesaver during a

health crisis because it means insurance coverage can start much

sooner. And you can enroll in Medicaid or CHIP at any time. But why

wait? The sooner you sign up, the sooner you can get the services

you need.

FACT #7: Indian Trust income

won’t stop you from qualifying for

Medicaid or CHIP

Certain types of income, such as income from selling culturally

signiﬁcant jewelry or basketwork and payments received from

farming, ﬁshing, and natural resources on Indian trust lands, are not

used to decide Medicaid or CHIP eligibility. For example, the money

you make ﬁshing won’t count against you, as long as your tribe has

ﬁshing treaty rights.

FACT #8: Medicaid estate recovery

doesn’t apply to your Indian Trust

property

Don’t let concerns about Medicaid estate recovery stop you from

signing up. Indian trust property and income cannot be recovered to

pay Medicaid back for long-term care. This includes:

• Trust property located on reservations, certain trust lands,

and Alaska Native regions

• Income from treaty-protected natural resources

• Cultural, religious, or spiritually signiﬁcant items

• Items that support traditional or subsistence lifestyles

FACT #9: You must take action to

avoid paying a tax penalty for not

having health insurance

Health care provided by an Indian health program does not count as

insurance for purposes of avoiding a tax penalty. But there are three

ways to avoid owing a penalty:

• Enroll in a Marketplace insurance plan or other qualiﬁed

health plan (such as one offered by your employer)

• Sign up for Medicaid or CHIP

• Apply for and receive the American Indian and Alaska Native

exemption by ﬁling Form 8965 with your federal income

tax return

FACT #10: Even though health care

is a treaty right, you should still

get insurance

IHS has to work within yearly budgets approved by Congress

and does not receive enough funds to meet all the health needs

of American Indians and Alaska Natives. That is why IHS does

not offer certain services and why some services aren’t available

at certain times of year. In fact, the IHS budget only meets about

half of the need, so enrollment in health insurance helps expand

needed care. And with insurance, health care is available when

you need it.

Signing up for the Marketplace or

Medicaid is easy and affordable

The Health Insurance Marketplace is a resource where you can learn

about options; compare health insurance plans based on costs,

beneﬁts, and other important features; choose a plan; and enroll in a

Qualiﬁed Health Plan. You can apply for the Marketplace or Medicaid

through healthcare.gov call centers and in-person assistance.

• Ask for help from your Indian health program,

• Call 1-800-318-2596, or

• Go online to healthcare.gov/tribal

@CMSGov

#CMSNativeHealth

CMS ICN No. 909322-N • August 2016