Federal insurance law creates certain unique provisions for members of federally recognized tribes — or unenrolled individuals who are able to access care through Indian Health Services.
If you are a member of a federally recognized tribe
- You may enroll in health insurance purchased through healthcare.gov monthly, not just during the national open enrollment period.
- You may qualify for assistance to bring your co-pays, deductible and coinsurance to $0. For more information about these costs, check out our dictionary.
- If you buy health insurance, your insurance company will pay your local IHS hospital or other IHS provider for the medical care you receive. This money will stay with the local IHS provider; it will not revert back to the federal government.
- Buying health insurance will not affect your ability to receive healthcare services through IHS, tribal health programs or urban health clinics.
While tribal members — and anyone in Montana — may choose to buy health insurance wherever they please, certain tribal benefits are only available in health plans purchased through healthcare.gov. You can expect protections like:
- No copayments, coinsurance or other cost-sharing if your yearly income is around $78,600 for a household of four. This means you will pay no co-pays and have no deductible. Your only costs will be your share of the monthly premium paid for the insurance. If your income is under 400% of the federal poverty line, you may be eligible for a tax credit, paid directly to your insurance company that will shrink your monthly bill.
- No extra costs for obtaining healthcare from a provider that is “out-of-network.”Most health insurance plans do not cover the full cost of care for doctors or other providers who our “out-of-network.” Plans will still pay some portion of the costs of out-of-network care, but the consumer’s share is higher. If you are a member of a federally recognized tribe, however, your plan cannot charge you more for out-of-network care. Be aware: Although your insurance may not require you to pay more for out-of-network care, the provider can still send you a bill for the difference.
- Indian trust income isn’t counted when determining tax credit eligibility.
- Any Indian who qualifies for Indian Health Services, even if they are not tribal members, are not subjected to the individual responsibility penalty. However, you must apply for this exemption through healthcare.gov and provide proof of your IHS eligibility.
In order to get these benefits, you will need proof of your tribal membership at the time you purchase insurance, or you will need to provide the proof within 90 days after enrolling. You can mail proof of your tribal enrollment to an address provided through healthcare.gov. Or you can upload proof of enrollment directly through healthcare.gov This proof will need to be available in an electronic format so it can be submitted through healthcare.gov. Many tribes do not maintain electronic records.
How to turn your tribal ID card into an electronic document
- Take a picture of your ID card with a smart phone. Your phone will save this image as a JPEG. Healthcare.gov does not accept JPEG images. You will need to turn that image into a PDF document.
- There are numerous free converters available online or through iTunes or Google Play. We do not endorse any particular one. However, you will need to download a converter — or have access to one — to convert your ID image to a PDF.
- If you converted the image to a PDF on your phone, it may be helpful to email or text it to an email account you can access on a computer.
If you have Internet access and are comfortable with digital communication – including uploading and attaching electronic documents – you can buy your insurance through healthcare.gov. However, if you have any concerns – or do not know how to get an electronic copy of your tribal membership card or other proof of tribe enrollment – we recommend you work through a certified navigator, certified application counselor, or a licensed and exchange-certified Montana insurance agent or broker. We keep a list of them here.