Oct. 21, 2019
The Affordable Care Act (ACA) is a law that changed the way people can get individual health insurance. People who don't have insurance through work can buy it on the Health Insurance Marketplace.
American Indians and Alaska Natives (Al/ANs) can get care from Tribal and Urban Indian clinics and Indian Health Services (IHS) facilities. However, Indian health care is not health insurance. The Health Insurance Marketplace gives Al/ANs special help to sign up and pay for insurance:
Special Enrollment Periods (SEP):
Al/ANs can enroll in the Health Insurance Marketplace throughout the year not just during the yearly Open Enrollment period. Nontribal members applying on the same application as a tribal member can take advantage of the SEP.
Al/ANs with incomes between 100% and 300% of Federal Poverty Level (FPL):
- May be able to enroll in a zero cost sharing plan, which means no copays, deductibles, or coinsurance when receiving care from Indian health care providers or when receiving Essential Health Benefits (EHBs) through a Qualified Health Plan (QHP).
- There is no need for a referral from an Indian health care provider when receiving EHBs through the QHP.
Al/ANs with incomes below 100% and above 300% FPL:
- Can enroll in a limited cost sharing plan, which means no copays, deductibles, or coinsurance when receiving care from Indian health care providers.
- Will need a referral from an Indian health care provider to avoid cost sharing when receiving EHBs through a provider outside the Indian health system.
Any applicable preauthorization requirements, balance billing or overage from Out-of-Network providers, and any maximum benefit limitations or exclusions still apply. It is important to check member benefits at the time of service.