Covered CA Benefits for American Indians and Alaska Natives

Posted: August 11, 2014

The federal government offers many health care benefits to American Indians and Alaska Natives. To qualify, you must be a member of one of 573 federally-recognized tribes across the country. California currently has 109 federally-recognized tribes.

These benefits and health care options expanded with the launch of the Affordable Care Act on January 1, 2014. While you may already be taking advantage of the free services offered through Indian Health Services (IHS) — the federal agency within the Department of Health and Human Services (HHS) dedicated to providing health services for American Indians and Alaska Natives — you may not realize how beneficial it can be to also enroll in a health insurance plan.

The Affordable Care Act requires most citizens to purchase insurance. However, American Indians and Alaska Natives are exempt from this requirement. You won’t have to pay a penalty for not enrolling. Of course, not enrolling means you could one day be faced with crippling medical bills or lack of proper care. Let us show you the Covered CA difference.

Why You Shouldn’t Rely on Indian Health Services Alone

You may be wondering, if I’m not required to purchase a health insurance policy, and I’m eligible to use free services offered through Indian Health Services, why would I enroll in health insurance? To put it simply, the services for which you are already eligible through IHS may not be enough — having health insurance can help fill in the gaps in your coverage to ensure your health care needs are met thoroughly and affordably.

The IHS only receives about half the amount of funding necessary to meet everyone’s needs, so tribes are often left with about half of what they require to fully serve their tribal members. Indian health clinics have to use other means, such as billing insurance, to make up the difference. Because Contract Health Services (CHS) — a program funded under IHS — can’t financially meet everyone’s requirements, they have a priority list to help determine which types of care receive funding.

If you have a health care need that is not high on the priority list or that your tribal or union program does not cover, you may end up scrambling to pay for these costs on your own. These uncovered services include but may not be limited to:

• Medical tests
• Visits with specialists
• Emergency room visits
• Hospital stays

With your own health insurance, you can receive all the health care services you need without worrying about whether they are high on the CHS priority list or whether the CHS has enough money to cover your care. You can even still use your tribal clinics. You just present your health insurance card to the clinic when you check in for your appointment so they can be paid for the care you receive. When tribes are able to bill your insurance company for you, they can receive money needed for the clinic, which helps make more money available for other tribe members. Between the funds received from CHS and payments from your insurance company, you will be able to have your medical needs more fully met.

Covered CA Perks for American Indians and Alaska Natives

Now that you understand some of the major benefits of having health insurance, let’s look at some benefits you receive as an American Indian or Alaska Native insurance policyholder. When we enroll you through Covered CA, you may be eligible for some additional perks designed specifically for American Indians and Alaska Natives, including the following:

• No health care expenses, depending on your household income and family size. If you are eligible, you will have no out-of-pocket expenses, such as copays, for certain services.
• No health care cost for medical care from certain doctors and hospitals, including care directly from the Indian Health Service, tribes, tribal organizations and contracted organizations.
• Freedom to purchase or switch health plans any time of the year. Whereas most citizens must wait for open enrollment in the fall, you don’t have to wait for this period, and you can switch your plan during any month during the year.

Choosing a Plan Through Covered CA

When it comes to choosing a health insurance plan, you have many options, many of which can cost you very little. Covered CA can offer you either Medi-Cal — California’s Medicaid program — or a health insurance plan based on your family size and household income. These plans come in four levels to indicate the degree of care and the monthly premium cost: Bronze, Silver, Gold and Platinum. These plans are available through various private insurance companies, including Anthem, Blue Shield, Health Net, Kaiser Permanente and more. You can learn more about plans that may fit your needs by using our online tool to get a quote.

When looking at the price of plans, remember that you may not have to pay that cost. If you qualify for Medi-Cal, you will not need to pay a monthly premium at all to receive benefits. You could also qualify for a subsidy to buy your private health plan.

The process of getting a quote, choosing a plan and applying on our website for your plan is user-friendly. In most cases, you don’t even need to complete any forms. Phone support is available for you on weekdays, so you can start and finish in a short amount of time. After you submit your application, you will receive a receipt by email. Later on, you will receive an email confirming the details of your completed enrollment along with payment instructions.

FAQ

If you’re a Native American or Alaska Native and are considering enrolling in health insurance, you may have some remaining questions. Let’s take a look at a handful of common questions you may be asking:

1. How Much Does Health Insurance Cost?

The cost of health insurance depends on several factors, such as the plan you choose, your age and your income. Normally, insurance policyholders pay a monthly premium and pay a flat dollar amount, called a copay, when they receive certain medical services. They also pay a deductible and coinsurance once they have met their deductible.

Many American Indians and Alaska Natives qualify for programs that cover all or part of their health insurance costs. If your annual income is lower than 300 percent of the federal poverty level for a family of four, costs like copays and deductibles that would normally be out-of-pocket will be covered at no cost to you. Note that Indian Trust income does not factor into your household income. Through Covered California, you can find out if you qualify for a program that will help pay for your health insurance.

2. Doesn’t the Federal Trust Responsibility Mean the Government Pays for All of My Health Care?

Health care is a treaty right, but the health care offered through the government is limited. Starting as far back as the U.S. Constitution, the federal government has established a role for itself in interacting with Indian tribes. Though a variety of laws, Executive Orders and court cases have helped to shape the federal government’s responsibility to native people groups, two laws have specifically tasked Congress with appropriating funds for American Indians’ and Alaska Natives’ health care: the Snyder Act of 1921 and the Patient Protection and Affordable Care Act in 2010, which permanently reauthorized the Indian Health Care Improvement Act.

Part of the federal government’s provisions for these people groups is through the Indian Health Service. Unfortunately, Congress has to approve a budget each year, and there aren’t enough funds to meet everyone’s medical needs through IHS. However, the government also offers to pay a portion of the cost of insurance, which can help make up for where available IHS services may be lacking. There are even special provisions for the federal government to pay copays and deductibles for American Indians and Alaska Natives enrolled in Covered California plans.

3. If I Enroll in a Health Insurance Plan, Will I Have to Start Going to a Different Health Clinic?

No, you can still use the tribal or urban clinic you’re used to using. If you do this, be sure to let them know you have insurance, so they can receive payment from your insurance company for the services they provide to you. If you receive covered services through IHS, tribes, tribal organizations or urban American Indian organizations, you won’t have to pay a copay or deductible.

While IHS requires you to use Indian clinics, with your own health insurance plan, you can also visit any provider in your insurance company’s network. Having a whole network of providers available to you opens up many more options, giving you more freedom to choose where you want to go for care. This can be especially helpful when you’re traveling and need health care.

4. Can IHS or My Tribal Clinic Receive Funding From Congress and My Insurance Company?

Yes, they can. In fact, Congress expects Indian Health Service and tribes to bill insurance companies when possible. Funding Indian health care is a team effort that pulls from many sources. Since IHS has a finite amount of money to spend on providing health care and since this amount is never enough to cover all the needs, tribal communities have more money to go around for providing care to their members when insurance companies help provide funding. So, if your insurance helps cover your costs, you can have the satisfaction of knowing IHS is able to provide more for other tribal members.

5. What About All the Paperwork From Health Insurance Companies?

Health insurance does involve some paperwork. Fortunately, you can streamline the process by asking that your insurance paperwork be sent to your Indian health clinic instead of being sent to your home. Your clinic can take care of monitoring the paperwork and can notify you when there’s something you need to do. With this helpful option available, you shouldn’t let a fear of confusing or excessive paperwork hold you back from enrolling in a health insurance policy.

How to Learn More

If you’re interested in enrolling, there are a few different steps you can take to find out more and to enroll. One option is to go to your Indian health clinic and ask for help to see if you qualify for a Covered California plan. Be sure to bring your Social Security card. You can also visit a Covered California enrollment center near you.

If you want to explore options online, you can get a quote for your rate by using our online tool. By putting in some basic information, you can view information related to the plans and benefits you qualify for, including:

• Carrier name (i.e., insurance company)
• Plan category (PPO, HMO and EPO)
• Plan type (Bronze, Silver, Gold or Platinum)
• Total price of the plan
• Price you will pay
• Subsidy for which you qualify

You can also call us at 1-877-752-4737. We would be honored to assist you with your plan selection and discuss the enrollment process with you.

Enrolling as an American Indian or Alaska Native

You can enroll during monthly Marketplace enrollment periods and not just during Open Enrollment in the fall. To enroll, you will submit an application. When you do this, Covered CA will ask you for one of the verification documents below:

1. Authentic document from a tribe that verifies your membership
2. Tribal Enrollment/Membership Card
3. S. American Indian/Alaska Native tribal enrollment or shareholder documentation — can be (1) a document showing enrollment or membership from the Bureau of Indian Affairs or a federally-recognized tribe or (2) a document that’s issued by an Alaska Native tribe/village, or an Alaska Native Corporation Settlement Act regional or village corporation acknowledging shareholder status
4. Certificate of Degree of Indian Blood (CDIB) issued by a tribe or the Board of Indian Affairs — tribal enrollment information must be included
5. Letter from the HHS granting a tribal exemption based on Alaska Native shareholder status or tribal membership
6. I-872 American Indian Card

It’s okay to submit your application on our website and then send us a document for family members. We can help you learn about the types of documents allowed.

Enjoy More Health Coverage and Peace of Mind

Taking advantage of the free care offered through Indian Health Services is great. However, if you rely on IHS alone to meet all of your health care needs, you may run into problems — especially if you experience a serious illness or injury. To give yourself peace of mind, knowing that your health care needs will be more fully met, you should enroll in a health insurance plan for you or you and your family. Not only will you be helping yourself, but you’ll be helping others in your tribe as well. And remember, you don’t have to wait! As an American Indian or Alaska Native, you can enroll in health insurance any month of the year.

If you have questions or need assistance with the enrollment process, we are happy to help. You can visit one of our enrollment centers for in-person assistance, or you can talk with a service representative over the phone or through a web chat. No matter how you connect with us, we’re here for you. Remember, if you decide to enroll in a health insurance plan, you will be helping yourself, your family and your community!