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Obamacare changes for American Indians and Alaska Natives

If you're an American Indian or Alaska Native, the Affordable Care Act has several special provisions for you -- including the ability to sign up for a health insurance plan throughout the year.

So, how do you know if these provisions apply to you? For you to be entitled to the provisions, you must be one of the 1.9 million members of the 566 federally recognized tribes, meaning those that have an official relationship with the U.S. government. The U.S. Bureau of Indian Affairs offers a current list that includes Cherokee, Navajo, Sioux and other tribes.

Obamacare provisions for American Indians Free health care options for American Indians and Alaska Natives

Some members of federally recognized tribes can get free health care through Indian Health Services (IHS), a federal health program for American Indians and Alaska Natives.

However, the agency gets funds from Congress that cover only about 60 percent of the health needs of those eligible for service according to the IHS website. Being an enrolled member of a federally recognized tribe is the most common way to be eligible for IHS services. However, others sometimes are eligible: for example, a person who is recognized by his or her community as an American Indian or Alaska Native may get services.

Also, a woman who isn’t eligible but is pregnant with the child of an eligible American Indian may get services until about six weeks after the birth.

Some tribal governments operate their own health care systems while some American Indians in cities get care through urban Indian health programs.

How Obamacare helps American Indians and Alaska Natives

So, if you're an American Indian or Alaska Native, here's what you should know about the ACA and its special provisions that might affect you.

1. You should shop for insurance even if you get free care.

Unless you have health insurance already -- for example, group insurance through an employer -- you should shop for a plan on the marketplace in your state, says Dawn Coley, tribal health care reform program manager at the National Indian Health Board, a nonprofit that represents the governments of federally recognized tribes. Here's why.

  • You might get help paying premiums. As many as 9 out of 10 of the 579,000 uninsured American Indians and Alaska Natives could qualify for either Medicaid or for subsidies to reduce premiums, according to the U.S. Department of Health and Human Services.
  • Private health insurance helps fund the IHS. If you get care through the IHS and you have private insurance, the IHS can bill the insurer. "It's putting more dollars back into the IHS health care system to help with services for others," Coley says.
  • Having private insurance will help if you get a serious illness. If you get diagnosed with a chronic illness or serious disease -- for example, diabetes or cancer -- having private insurance will give you more options, Coley says. For example, private insurance could pay for getting a second opinion or going to a private hospital for chemotherapy or radiation treatment, she says.
  • Private insurance can cover you when you travel. Alaska has a strong tribal health system that provides care across the state, but Alaska Natives who live in the state might want private insurance to cover them when they travel, says Monique Martin, government relations specialist for the Alaska Native Tribal Health Consortium (ANTHC), a nonprofit organization that provides health care services. Many plans sold in Alaska cover travel necessary to receive medical care -- for example, flying from a rural area to a hospital in Anchorage, she says. The IHS offers limited funds for travel, but that money is reserved for the sickest patients, Martin says.

When you shop for insurance, you'll need to have your tribal documents ready.

2. You can enroll in a health insurance plan anytime.

For most Americans, the ACA open enrollment period, the time when anyone could sign up for coverage, ended March 31, 2014, though some states offered extensions.

However, ACA rules allow American Indians and Alaska Natives to buy health insurance throughout the year, according to

"That's going to be a huge benefit," Martin says of the year-round sign-up provision, adding that she has talked to many people who still are learning about the ACA and considering their options.

3. You might not have to pay any out-of-pocket costs.

If your household income for a family of four is less than 300 percent of the federal poverty level -- about $70,650 in most states, or $88,320 if you live in Alaska -- you won't make cost-sharing payments. "When they go to any facility, be it private or tribal, they're not going to have any copays or deductibles," Martin says of American Indians and Alaska Natives. "That's a huge help."

The waiver of cost sharing is probably the biggest incentive for Alaska Native and American Indian people to sign up for health insurance, Martin says. She recommends they consider signing up for a bronze plan -- the plan with the lowest premiums and the highest level of cost sharing. "Why pay more per month to reduce cost sharing when it will be waived anyway?" she says.

4. If you're eligible for government insurance, you'll get cost breaks.

If you're a member of a federally recognized tribe or are otherwise eligible for services from the IHS, a tribal health program or an urban Indian health program, you won't pay premiums or cost sharing if you get Medicaid, according to the Native American Health Coalition. And if your child qualifies for the Children's Health Insurance Program, you won't have out-of-pocket costs for your child’s care.

5. You won't get fined for not having health insurance.

If you choose not to purchase health insurance, you can apply for an exemption to avoid the penalty not having insurance, Martin says, adding that you aren’t automatically exempt. In 2014, the penalty will be 1 percent of your household income over $10,150, or $95 per person, whichever is higher. The fine will increase each year until 2016, when it will be 2.5 percent of income or $695 per person. You can apply for an exemption in one of two ways, depending on your status.

  • If you're an enrolled member of a federally recognized tribe or a shareholder in an Alaska Native Corporation -- a regional corporation formed through an act of Congress in 1971 to settle claims made by Alaska Natives -- you can apply for the exemption on your tax return, Martin says.
  • But, if you only have a certificate from the Bureau of Indian affairs stating you have American Indian or Alaska Native blood, you will have to fill out a paper application, she says.

If you don't file for an exemption, you could get hit with a tax penalty, Martin warns.

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