Health Insurance for American Indians and Alaska Natives

According to the 2010 U.S. census, 5.2 million individuals identify as American Indians and Alaska Natives (or AI/AN). Unfortunately, nearly one in five American Indians and Alaska Natives do not have health insurance; that’s twice the national uninsurance rate. Unfortunately, financial and geographic barriers to adequate healthcare continue to impact tribal populations. 

But help is available if you know where to look. Members of the 573 federally-recognized tribes have access to unique health insurance benefits. For example, Affordable Care Act plans (ACA, also called Obamacare) and Medicaid have extended protections to AI/AN communities. The Indian Health Service also provides tribal care.

With a little effort, American Indians and Alaska Natives can compare and find the best plan for them. Here are some options.

Health Insurance Protections for American Indians and Alaska Natives

• As a tribal member, you can enroll in health insurance at any time of the year, whereas nearly everyone else has to wait until the November-December enrollment period. Forget about having to wait for that Open Enrollment Period or qualifying for a Special Enrollment Period to join an Affordable Care Act plan. You can also change plans once a month.
• You won’t have to pay out-of-pocket costs if you have coverage from Indian health programs. That means no out-of-pocket costs for deductibles, coinsurance, and copayments.
• You can pay less (or nothing) for out-of-pocket costs if you have an ACA plan, depending on your annual income. AI/AN individuals with incomes between 100% to 300% of the federal poverty level ($12,760 to $38,280) are eligible for plans that will cost them absolutely zero for medical care, regardless of the type of plan they choose. Individual tribal members who earn less than $38,280 this year won’t have to pay any out-of-pocket expenses.
• You can still use services from the Indian Health Service or other Indian health programs even if you are enrolled in a private health plan. You can also access medical benefits from your private plan, including the 10 essential health benefits.

Medicaid Protections for American Indians and Alaska Natives

• You won’t have to pay premiums or out-of-pocket costs under Medicaid. Under the American Recovery and Reinvestment Act of 2009, states cannot charge Medicaid premiums to individuals using Indian health systems.
• You may have an easier time qualifying for Medicaid under eligibility rules. As a member of a federally recognized tribe, you face fewer limitations when it comes to applying for Medicaid as long as your income is generally under $13,000 for an individual and $25,000 for a family of four. What is the Indian Health Service?

The federally funded Indian Health Service (IHS), provides medical services for eligible AI/AN individuals. As an agency of the Department of Health and Human Services, the IHS provides health services that uphold both cultural and medical standards for AI/AN populations. You can use IHS if you meet any of the following criteria:

• You are of American Indian and/or Alaska Native descent;
• You are enrolled in an AI/AN tribe or group;
• You live on tax-exempt land;
• You actively participate in tribal affairs.

The following individuals may also qualify for IHS even if they are not AI/AN:

• Children, younger than 19-years-old, of an eligible AI/AN; 
• Spouses of an eligible AI/AN.

If you are unsure of your eligibility, check the official IHS guidelines here. Keep in mind that individuals whose healthcare is provided by IHS do not have to pay out-of-pocket costs for any health services or equipment.

Currently, IHS centers provide health services for 2.5 million AI/AN throughout the United States. By providing services closer to communities with tribal members, the IHS has increased health resources for many.

The ACA, American Indians, and Alaska Natives

Under the 2010 Affordable Care Act, individuals without insurance had to pay a federal penalty, through their tax returns. That federal “individual mandate” is no longer being enforced, but some states still require the uninsured to pay a state tax penalty for not having “credible” health insurance. American Indians and/or Alaska Natives may not be penalized for being uninsured, depending on your state.

Health Disparities for Tribal Members

Historically, American Indians and Alaska Natives have faced challenges to access quality healthcare. Compared to the national average, AI/AN communities have less public health education and resources. AI/AN individuals also are disadvantaged by limited treatment options and lack of medical centers. But at least 20% are enrolled in generous plans, and more AI/AN tribal members should apply.