American Indians

Health Coverage and Indian CountryCover Native Montana Logo

With health reform came new health insurance coverage options for American Indians through expanded Montana Medicaid and the new Health Insurance Marketplace.

Below we have provided information about new coverage options and American Indian provisions in the health law. But don’t worry if you have questions or need help applying. There are local enrollment assisters in your community who can help you through the process. Their help is always free and confidential.

Montana Medicaid and American Indians:

Montana Medicaid provides an affordable coverage option for those who are eligible. To be eligible, you must meet the income guidelines, be a Montana resident ages 19 – 64, and aren’t 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 full 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?

The best way is to apply is to contact a local enrollment assister who can walk you through the application process. Find out more about expanded Montana Medicaid here.

Enrolled Members of Federally Recognized Tribes and the Marketplace:

Using a Special Enrollment Period (SEP), enrolled members can apply anytime throughout the year. Depending on their income, members of federally recognized tribes may be eligible for a zero cost-sharing plan. This means that there are no additional out of pocket costs other than the monthly premium. To qualify for a zero cost-sharing plan, the income of the person or family must meet the following income requirements:

  • 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.

American Indian descendants and the Marketplace: 

American Indian descendants who are eligible for Indian Health Service, a tribal program, or an urban Indian health program, may qualify for a health insurance plan with limited out of pocket costs, or cost-sharing reductions. To qualify for cost-sharing reductions, the income of the person or family must meet the following income requirements:

  • 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 also eligible for a exemption from the tax penalty for not having insurance. If you need help applying for an exemption, contact a local enrollment assister.

Coverage Options for American Indians

Your new health insurance and Indian Health Service, Tribal Health, or Urban Indian Health Center services:

Using your health insurance in coordination with IHS, Tribal Health or an Urban Indian Health Center may help increase your access to health care options and save you money. Here are a few helpful tips 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 an enrollment assister located at an IHS Service Unit, Tribal Health Department, or Urban Indian clinic.

American Indians

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