Health Coverage for American Indians & Alaska Natives

If you’re an American Indian or Alaska Native, the Health Insurance Marketplace offers new benefits and protections tailored to your needs. These benefits vary depending on your eligibility, whether as a member of a federally recognized tribe, an Alaska Native Claims Settlement Act (ANCSA) Corporation shareholder, or someone eligible for services from the Indian Health Service (IHS), a tribal program, or an urban Indian health program.

Enroll in a Marketplace Plan Anytime Members of federally recognized tribes and ANCSA shareholders have the flexibility to enroll in a Marketplace plan at any time of the year. Once enrolled, you can switch plans up to once a month or continue your coverage into the next year during Open Enrollment.

Special Protections and Benefits As a member of a federally recognized tribe or an ANCSA shareholder, you have access to health coverage through Marketplace plans, Medicaid, and the Children’s Health Insurance Program (CHIP). Some of the benefits include:

• Expanded Provider Access: In addition to services from Indian health care providers, you gain access to a broader network of providers and services.
• Financial Assistance: You may qualify for a premium tax credit to lower your monthly premiums and extra savings on out-of-pocket costs, such as deductibles and copayments.

Zero Cost Sharing for Marketplace Plans If your income is between 100% and 300% of the federal poverty level, you can enroll in a Marketplace plan with “zero cost sharing,” meaning you won’t pay any out-of-pocket costs when receiving care. If you get services from an Indian health care provider, these services will also have no out-of-pocket costs, regardless of your income.

Medicaid & CHIP Benefits Eligible individuals can access Medicaid coverage with no premiums or out-of-pocket costs if they receive services from IHS, tribal programs, or urban Indian programs (I/T/Us) or through a Purchased/Referred Care (PRC) program. Special eligibility rules make it easier to qualify for Medicaid and CHIP, and you won’t incur any out-of-pocket costs for services provided by I/T/Us.

Combining Marketplace Insurance with IHS Services Even if you enroll in a Marketplace plan, you can continue receiving services from IHS, tribal organizations, or urban Indian organizations. The combination of Marketplace insurance with IHS services can enhance your access to care while benefiting the Tribal community, as IHS can bill your insurance for the services provided.

Income Reporting for AI/AN When applying for coverage through the Marketplace, report only the income required on your federal tax return. Most AI/AN income, such as trust income or treaty fishing rights, is not counted for Medicaid or CHIP eligibility.

Changing Plans As a member of a federally recognized tribe or an ANCSA shareholder, you can change your Marketplace plan any month. Your new coverage will begin on the first day of the month following the change. If you change plans during Open Enrollment, ensure that your new plan continues into the following year by updating your application.

Households with AI/AN and Non-AI/AN Members If your household includes both AI/AN and non-AI/AN members, you can all enroll in the same Marketplace plan. However, for tribal members to take full advantage of cost-sharing reductions, they should enroll in a separate plan from non-tribal members.

For more information and to explore your health coverage options, visit the Health Insurance Marketplace or the Indian Health Service website.

Medicaid & CHIP for American Indians and Alaska Natives

Medicaid and the Children's Health Insurance Program (CHIP) provide essential health coverage to eligible members of federally recognized American Indian and Alaska Native tribes. These programs offer broader access to healthcare services that may not be fully available through local Indian health clinics.

Eligibility and Application You can apply for Medicaid or CHIP even if you've previously filed for an exemption from the shared responsibility payment. To find out how to apply, visit our Medicaid & CHIP page.

Rights and Protections Under Medicaid and CHIP If you're eligible for services from the Indian Health Service (IHS), tribal health programs, or urban Indian programs (collectively known as I/T/Us), you have specific rights and protections:

• No Premiums or Fees: You are exempt from paying Medicaid premiums and enrollment fees.
• No Out-of-Pocket Costs: You won't have to pay copayments, coinsurance, or deductibles for Medicaid services. CHIP also covers you without any out-of-pocket expenses.
• Easier Eligibility: Certain Indian resources and payments are not counted towards Medicaid and CHIP eligibility, making it easier for you to qualify.
• Continued Access to I/T/U Services: You can continue receiving care from I/T/U providers even if they are not part of your Medicaid or CHIP program’s managed care network.

Verifying Tribal Status To verify your eligibility, you may need to provide documentation of U.S. citizenship and tribal affiliation. Acceptable documents include:

• A document from a federally recognized tribe indicating tribal membership
• 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 a personal attestation of Indian status. However, if additional proof is required, you may need to provide documentation to confirm your eligibility for services through an Indian health provider.

For more details, refer to the list of federally recognized tribes.

Coverage Resources for Your Tribal Community

Explore and share important information about healthcare coverage tailored for your tribal community:

• Access Tribal Materials: Discover resources on the health care law specifically designed for tribal communities.
• Indian Health Service (IHS) & the Affordable Care Act: Learn how the Affordable Care Act impacts the Indian Health Service and your community.
• Tribal Outreach & Education: Find valuable tools and materials to support outreach and education efforts within your tribe.
• Federally Recognized Tribes: View the complete list of federally recognized tribes for reference.