Health Coverage and Indian Country

Here’s some information about new coverage options and special rules for American
Indians under the health law. If you have questions or need help applying, local
enrollment assistants in your community are available to help you. Their assistance is
always free and confidential.

Montana Medicaid

Montana Medicaid offers affordable health coverage for eligible individuals. To qualify, you must:

• Meet income guidelines
• Be a Montana resident aged 19 to 64
• Not be eligible for or covered by Medicare

American Indians (both enrolled members and descendants) who qualify for Montana Medicaid won’t have to pay premiums or copays. They will have access to a full range of benefits.

Health Insurance Marketplace at Healthcare.gov

If you make too much money for Montana Medicaid, you might qualify for a Marketplace plan on Healthcare.gov. Your eligibility depends on your income and whether you are an enrolled member of a tribe or a descendant.

For Enrolled Members of Federally Recognized Tribes:

Enrolled members can apply for coverage anytime during the year through a Special Enrollment Period (SEP). Depending on their income, they might qualify for a plan with no extra costs besides the monthly premium.

For American Indian Descendants:

Descendants of American Indians don’t have the same benefits as enrolled members. They may be eligible for tax credits or cost reductions on the Marketplace based on their income and family size. However, they cannot use the Special Enrollment Period and usually need to enroll during the Open Enrollment period.

Tribal Premium Sponsorship Programs:

Some tribes offer premium sponsorship programs to help eligible members get health insurance through the Marketplace and other programs. This can be a more affordable option than enrolling on your own. To see if your tribe has a sponsorship program, contact your tribal health department.

Using Health Insurance and Indian Health Service, Tribal Health, or Urban Indian Health Center Services

Using your health insurance with IHS, Tribal Health, or an Urban Indian Health Center can help you access more healthcare options and save money. Here are some simple tips:

• Keep Track of Your Health Records: If you see providers at different places, make sure your primary care provider has all your health information. Always ask specialists to share your records with them.
  
• Get Referrals for Specialists: If you need to see a specialist outside your local Tribal Health or IHS Service Unit, you usually need a referral for IHS/Tribal Health to cover the costs. If you choose to pay out of pocket, look for “in-network” providers to save money.
  
• Ask About Cost-Saving Options: When accessing care through IHS, Tribal Health, or an Urban Indian Health Center, ask if there are ways to save money, like affordable prescriptions or imaging services. Keep track of your health records if you’re using multiple providers.
  
• Don’t Hesitate to Ask Questions: Health insurance can be confusing, so feel free to ask questions. Talk to staff at Tribal Health and IHS, as well as your enrollment assister. You can also contact your health insurance company using the information on your insurance card.