When the Patient Protection and Affordable Care Act (ACA) was passed in 2010, special benefits were included for federally recognized tribes, American Indians, and Alaska Natives.
Your Health Idaho (YHI) honors these benefits as well as others available to people of American Indian descent or who are otherwise eligible for services from the Purchase and Referred Care (PRC), tribal, or urban Indian health programs.
Special Benefits Include:
• Monthly Special Enrollment Period: Members of federally recognized tribes in Idaho can buy or change their health insurance plans once a month throughout the year. This means tribal members don’t have to wait for a Qualifying Life Event (QLE) to change coverage outside of the annual open enrollment period.
• No healthcare expenses, depending on income: American Indians and Alaska Natives whose income is between 100% and 300% of the Federal Poverty Level (FPL) do not have to pay certain out-of-pocket costs, such as co-pays, if they purchase a plan through YHI. Those below 100% and above 300% have limited cost sharing.
• Cost-Sharing: Regardless of income, American Indians and Alaska Natives are not required to pay any out-of-pocket costs for items or services provided by the Purchase and Referred Care, tribal, or urban Indian programs. Additionally, individuals under 300% of the FPL are not required to pay deductibles, copayments, or coinsurance. Those over 300% of the FPL may have to pay cost-sharing if they do not have a Purchase and Referred Care referral when receiving care from an in-network provider. American Indians and Alaska Natives do not pay cost-sharing when receiving health care from the Purchase and Referred Care, tribal, or urban Indian health programs.
• Continued Services: If an individual enrolls through YHI, they may receive, or continue receiving, services through Purchase and Referred Care, tribal, or urban Indian health programs in addition to services from providers on a plan through YHI.
Other Considerations:
In order to avoid cost-sharing or out-of-network costs, individuals may receive a referral to a specialist or doctor who does not provide services through the PRC, tribal, or urban Indian health programs.
Consider enlisting the help of an Enrollment Counselor or agent who is close with the tribal community. They are available to assist with enrolling for a coverage plan through YHI at no cost r.
Bottom Line:
Enrolling in health insurance through YHI can help strengthen the Tribal community. When Tribal or Urban Indian clinics bill insurance companies, they receive additional funding which can assist Tribes in offering more services at the local level. For more information, work with your tribal services to complete the referral requests.