Tribal Members

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, American Indians, and Alaska Natives

  • Enroll any month of the year regardless of Open Enrollment and can have a Special Enrollment Period (SEP) once per month. Members of federally recognized tribes in Idaho can buy or change their health insurance plans at any time during the year without the need to experience a Qualifying Life Event.
  • No healthcare expenses and cost-sharing, 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 an insurance plan through Your Health Idaho and have limited cost-sharing. American Indians and Alaska Natives can also enroll in a zero-cost-sharing plan at any metal level, which means no co-pays, deductibles, or coinsurance when receiving care form Indian health care providers or when receiving essential health benefits through a qualified health plan.
  • Cost-Sharing. 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. 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.

Click here for the Tribal Health Referral Form.

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 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.

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.

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.

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.

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.