Q: How can Native Americans get coverage under the ACA? Are there specific plan options for them?
A: American Indians and Alaska Natives (AI/AN) benefit from the Affordable Care Act’s expanded coverage. In fact, 94 percent of American Indians/Alaska Natives have incomes that make them eligible for either Medicaid expansion or exchange subsidies. The bad news is that a significant percentage of their low-income uninsured population lives in states that have not yet expanded Medicaid.
No cost-sharing if income up to 300% FPL
Native Americans who apply for coverage in an ACA exchange and who have income below 300 percent of the Federal Poverty Level do not have to pay cost-sharing (deductibles, copays, and coinsurance). An AI/AN is also exempt from cost sharing for any health services received directly from “IHS (Indian Health Service), Indian tribe, tribal organization, urban Indian organization or through the Contract Health Service program.”
To be eligible as a Native American, you must be a member of a recognized Indian tribe, band, or nation, according to the Indian Healthcare Improvement Act.
There are rolling monthly open enrollment periods throughout the year for Native Americans who wish to enroll in the exchanges. They are not limited to enrolling during open enrollment. As long as they enroll by the 15th of the month, their coverage will be effective the first of the following month (there are three state-run exchanges – Massachusetts, Washington, and Rhode Island – where enrollments can be completed as late as the 23rd of the month for coverage effective the first of the following month).
Improvements to existing services
The ACA also makes the 1976 Indian Health Care Improvement Act permanent, which enhances and improves the Indian Health Service. American Indians have access to free health care via IHS, but the services provided by IHS are not all-encompassing – which means that referrals to specialists outside of the program are common, and often not covered.
In addition, many people who qualify for tribal care live far from IHS facilities and are thus realistically uninsured. So even though Native Americans don’t face penalties for not complying with the individual mandate, and even though they can get care through IHS, it’s probably in their best interest to enroll in coverage through the exchange if they can afford to do so.