The Patient Protection and Affordable Care Act (ACA) includes certain health insurance benefits specifically designed for members of federally recognized American Indian tribes and Alaska Native Claims Settlement Act (ANCSA) Corporation shareholders. Click here see a list of federally recognized tribes.
Some benefits are also available to people of American Indian descent and those who are otherwise eligible for services from the Indian Health Service (IHS) (also known as Public Health Service (PHS)), a tribal program, or an urban Indian health program.
These groups can purchase health insurance plans through Your Health Idaho and receive the benefits described below:
- Enroll any time during the year and can change plans up to once per month using a Special Enrollment Period (SEP).
- Incur no healthcare or Cost-Sharing expenses depending on income.Those who purchase a plan through Your Health Idaho and whose incomes are between 100% and 300% of the Federal Poverty Level (FPL) can enroll in a zero-cost-sharing plan and not have to pay out-of-pocket costs like co-pays and deductibles. There are also no co-pays, deductibles, or coinsurance when receiving care from Indian health care providers or when receiving essential health benefits through a Qualified Health Plan (QHP).
- Regardless of income, those with plans through Your Health Idaho will have no out-of-pocket costs for items or services provided by the Purchased and Referred Care (PRC), tribal programs, or urban Indian programs (known as I/T/Us). This includes deductibles, copayments, and coinsurance. The only exception to this is those with incomes over 300% of FPL who may have to pay cost-sharing if they do not have a PRC referral when receiving care from an insurance network provider.
- If a member of one of the recognized groups enrolls in a health insurance plan through Your Health Idaho, they can still receive or continue receiving services through Purchased and Referred Care (PRC), tribal health programs, or urban Indian health programs and also begin receiving services from providers with a plan through Your Health Idaho.
Click the links below for answers to frequently asked questions.
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 well-known, private insurance companies. Using one application, you can apply for coverage as well as a tax credit that can cover some or all or your monthly insurance premiums, and Cost-Sharing Reductions.
Yes. Just let them know you have health insurance through Your Health Idaho and they will bill the insurance company for services they provide to you. With an insurance plan through Your Health Idaho, you may also be able to receive care from providers that are not included under PRC coverage.
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. However, you will only be able to sign up for health coverage through Your Health Idaho during Open Enrollment periods each fall. Enrolled members of federally recognized Tribes receive additional benefits under the Affordable Care Act. (See benefits listed above.)
Yes. In order to be eligible for tax credits that can help pay for some or all of your monthly insurance premiums and Cost-Sharing Reductions, you must file an income tax return. Your return must report your total household income including your income from Indian trust land, natural resources, and items of cultural significance.
Tribal clinic budgets often have limited funding. If a Tribal clinic is able to bill your private insurance carrier for services they provide to you, the funding they receive from your carrier will enable them to provide additional services at the local level.