The Patient Protection and Affordable Care Act (ACA) includes benefits specific to American Indians and Alaska Natives. Certain American Indians and Alaska Natives can buy a health insurance plan through Your Health Idaho and receive the benefits described below.
Some benefits are available to members of federally recognized tribes. Others are available to people of American Indian descent or who are otherwise eligible for services from the Purchased and Referred Care (PRC), a tribal program or an urban Indian health program.
Special Benefits for Federally Recognized Tribes
- 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 copays, if they purchase an insurance plan through Your Health Idaho. Those below 100% and above 300% have limited cost sharing.
- Enroll any month of the year
Members of federally recognized Tribes in Idaho can buy or change their health insurance plans at anytime during the year.
Benefits for American Indians or Alaska Natives or those otherwise eligible for services from the Purchased and Referred Care, tribal program, or urban Indian health program. Please contact your Tribe to Determine PRC eligibility:
Regardless of income, you won’t have any out-of-pocket costs for items or services provided by the Purchased and Referred Care, tribal programs, or urban Indian programs (known as I/T/Us). American Indians and Alaska Natives that are under 300% of the FPL will not have to pay out-of-pocket costs like deductibles, copayments, and coinsurance. Those over 300% of FPL may have to pay cost sharing if they do not have a PRC referral when receiving care from an insurance network provider. All American Indians and Alaska Natives will never have to pay cost-sharing when receiving health care from the PRC, tribal or urban Indian health programs.
- Continued Services
If you enroll in a health insurance plan through Your Health Idaho, you may receive or continue receiving services through Purchased and Referred Care, tribal health programs or urban Indian health programs and also get services from providers on a plan through Your Health Idaho.
- The Individual Mandate and American Indians and Alaska Natives
If you don’t have health insurance, you won’t have to pay the fee that most other people without health insurance must pay.
What is Your Health Idaho and how is it different from Purchased and Referred Care?
- Your Health Idaho is an online marketplace where you can enroll in health insurance for yourself and your family. Your Health Idaho offers plans from private insurance companies and public medical programs (Medicaid and CHIP). Using one application, you can apply for coverage and financial help to pay for all or a portion of your coverage.
If I enroll in a health plan through Your Health Idaho, can I continue to use my Contract Health Service/Tribal/Urban Indian Health Clinic?
- Yes. Just let them know that you have health insurance obtained through Your Health Idaho so they can bill the insurance company for services they provide to you. If you enroll in a plan through Your Health Idaho, you may also be able to receive care from providers who are not included under PRC coverage.
How do American/Alaska Natives apply for an exemption from the tax penalty?
- When filing income taxes, you may apply for an exemption from the tax penalty by completing an application and submitting it to the State or Federal Marketplace.
Do I need to do anything if I am on Medicare?
- No. Most people over 65 years old are covered by Medicare.
What if I am a descendant of a federally recognized Tribe or I receive health care services through an Indian Health Service or Tribal clinic, but I’m not an enrolled member of a Tribe? Do the benefits for American Indians or Alaska Natives apply to me?
- Just like enrolled members of a Tribe, you may be eligible for free or low-cost coverage, based on income, and you may be eligible for financial help to pay for premiums and copays. You will be exempt from the penalty for not enrolling in a health plan that offers the “minimum coverage” If you complete the exemption form. However, you will only be able to sign up for health coverage through Your Health Idaho during open enrollment periods. Enrolled members of federally recognized Tribes receive additional benefits under the Affordable Care Act.
If I have to report my income when applying for coverage, does that mean I have to include my income from Indian trust land, natural resources and items of cultural significance?
- Yes. In order to be eligible for financial help such as tax credits, an individual must file an income tax return. Your total household income will need to be reported when applying for health coverage through Your Health Idaho. You will be required to include your income from Indian trust land, natural resources and items of cultural significance in the application.
How will getting health insurance help my Tribal community?
- Tribal clinic budgets often have limited funding. If you have health insurance, you can get the health care you need and use your insurance to help pay for the services at your Tribal or Urban Indian clinic. Your Tribal or Urban Indian clinic will benefit by billing your insurance company. This includes billing for Purchased and Referred Care (PRC) referrals. With additional funding received from billing insurance carriers, Tribes will have more resources to offer more services at the local level.