The Affordable Care Act (ACA) requires that everyone have health insurance or get an exemption in order to avoid a tax penalty. There are new affordable insurance options available through Montana Medicaid and the new Health Insurance Marketplace that make getting covered easier and more affordable than ever. Additionally, many American Indians may qualify for an exemption to avoid a tax penalty, even if they don’t have health insurance coverage.
Both Montana Medicaid and the Marketplace have specific provisions for Indian Country. Some of these provisions are for enrolled members of federally recognized tribes, while others are for descendants, or those eligibility for Indian Health Service, Tribal Health, or Urban Indian health services. Below, we provide information about the American Indian provisions, but remember that if you have any questions about what you might be eligible for, just ask! Local enrollment assisters are ready to help.
Medicaid expansion and tribal communities:
Montana’s new Medicaid expansion will provide many low-income American Indians with a new health insurance option. To be eligible, you must meet the income guidelines, be a Montana resident ages 19-64, and not already eligible for covered by Medicare.
American Indians (both enrolled members and decedents) who are eligible for Montana Medicaid will not have premiums or copayment and will have access to a robust set of benefits including:
- Doctor, hospital, and emergency services
- Prescription drugs
- Dental and vision care
- Laboratory and x-ray services
- Maternity and newborn care
- Mental health and substance abuse treatment
- Rehabilitative services and supplies
- Transportation to appointments
How to apply?
- Contact a local enrollment assister who can walk you through the process.
- Apply directly at healthcare.gov or over the phone: 1-800-318-2596.
- Apply at your local Office of Public Assistance.
Find out more information here.
Provisions for members of federally recognized tribes:
- Enroll anytime! Members of federally recognized tribes can enroll in coverage through the Health Insurance Marketplace at any time throughout the year. This is done through a Special Enrollment Period (SEP) and allows members to enroll outside of the annual open enrollment period (November 1, 2016 – January 31, 2017).
- Depending on their income, members of federally recognized tribes may be eligible for a zero cost sharing plan. This means tribal members won’t have to pay out-of-pocket costs like deductibles, copayments, and coinsurance when they get healthcare, though they will still have to pay your health insurance premium. To qualify for a zero cost sharing plan, the Modified Adjusted Gross Income (MAGI) of the person or family must meet the following income guidelines:
- Individual: between $11,770 – $35,310
- Family of 2: between $15,930 – $47,790
- Family of 3: between $ 20,090 – $60,270
- Family of 4: between $24,250 – $72,750
- Family of 5: between $28,410 – $85,230
- Members of federally recognized tribes may also apply for an exemption to ensure that they don’t receive a tax penalty if they don’t have health insurance coverage. This is a provision that is also available to those of American Indian descent.
Provisions descendants or those eligible for services from the Indian Health Service, a tribal program, or an urban Indian health program:
- Depending on income, individuals or families in this category may be eligible for a plan with cost sharing reductions. This is a benefit open to everyone, not just those who are of American Indian descent. Individuals or families may be eligible if the Modified Adjusted Gross Income (MAGI) meets the following guidelines:
- Individual: $11,770 – $29,425
- Family of 2: $15,930 – $39,825
- Family of 3: $20,090 – $50,225
- Family of 4: $24,250 – $60,625
- Family of 5: $28,410 – $71,025
- Descendants are eligible for a exemption from the tax penalty for not having insurance. To get a health coverage exemption from paying the fee, those of American Indian descent will need to either claim the exemption when you file your federal income tax return or fill out an exemption application.
Using your insurance coverage in coordination with Indian Health Service, Tribal Health, or Urban Indian Health Center services (ITU), may help increase your access to health care options and save you money.
Here are a few helpful tips for tribal members and those of American Indian descent to keep in mind:
- If you need to see a specialist or someone outside of your local Tribal Health or IHS Service Unit, make sure that your benefits coordinator knows that you have Montana Medicaid or private insurance.
- Here are a few questions you might want to ask:
- Do you have to meet a certain level of medical need to get a Purchase and Referred Care (PRC) referral if you have insurance?
- If your clinic requires you to wait for a PRC referral even if you have insurance, is there a way to get around waiting? If you decide to not wait for your PRC referral, will you be responsible for any co-pay or out of pocket costs?
- If you see a specialist or go for testing, will your clinic receive your results? Can someone help to make sure your medical records make it back to your regular healthcare provider?
Insurance can be confusing so don’t be afraid to ask questions! Ask questions of the staff at tribal health and IHS as well as the enrollment assister who helps you enroll in coverage. In addition, you can and should call your health insurance company if you have questions about your coverage and benefits. Their contact information is on your insurance card and the paperwork that was mailed to you when you enrolled.
Get started asking questions and getting the coverage you need by contacting a local enrollment assister, IHS Service Unit, Tribal Health Department, or Urban Indian clinic.