American Indians and Alaska Natives
The Affordable Care Act offers many new opportunities for Tribal health programs and American Indian/Alaska Native (AI/AN) individuals. If you are an AI/AN living in Washington State, you may be eligible for free or low-cost health insurance options available through Washington Healthplanfinder. These options can help improve your health, the health of your family members and your own Tribal community.
New coverage options can also help Tribes and urban Indian health programs enhance health care services you may already receive. The AI/AN Indian Health care system does not receive the full funding needed, and many Tribes and urban Indian health organizations are limited in what health services can be provided to their communities. The more insurance coverage Tribal community members have, the more funding Tribal health programs have to provide improved and additional health services to you.
In recognition of the federal government’s trust responsibility for providing health services to AI/AN, the Affordable Care Act created regulations that benefit Indian people who enroll in Qualified Health Plans through Washington Healthplanfinder.
If you are an enrolled Tribal member of a federally-recognized Tribe or a shareholder in an Alaska Native Corporation, you are eligible for the following benefits:
- No co-pays or deductibles when you see your health care provider: If you are a family of four and make less than $70,650 a year or are an individual making less than $34,470 a year, you will have no co-pays, deductibles or co-insurance costs (the amount you pay upfront when you see the doctor).
- No costs for using Indian Health Services or Contract Health Services: Regardless of income, you will still have no costs when using a Tribal or urban Indian clinic or when your Contract Health Services program refers you to another doctor for more care. With health insurance for Tribal communities, Tribal/urban clinics can afford to make referrals for more Tribal members to get the care they need.
- Enroll or change health plans any time during the year: As an enrolled Tribal member or shareholder in an Alaska Native Corporation, you are not subject to the open enrollment period, which runs from Nov. 1, 2015, to Jan. 31, 2016. You can enroll throughout the year.
- Choice in coverage options: Plan options are broken down into metal tiers based on the level of coverage they provide. Platinum, gold, silver and bronze plans are available through Washington Healthplanfinder. AI/ANs receive cost-sharing subsidies through any metal-level plan. While Bronze level plans have the lowest premiums but highest deductibles, if you are an enrolled tribal member, you won’t have a deductible and will have a lower premium than the Platinum, Gold or Silver plans.
Certain AI/ANs may qualify for an exemption from purchasing health care coverage. For a tax exemption form, please click here.
Tribal In-Person Assister Program
The Exchange has established a specific Tribal Assister program to help AI/ANs through the Washington Healthplanfinder application process. Most Tribes and urban Indian health organizations have trained and certified Tribal Assisters to help community members. The Exchange contracts with the American Indian Health Commission to host webinars where Tribal Assisters come together to troubleshoot, learn about updates, and share best practices in getting AI/ANs enrolled in coverage. For more information about the Tribal Assister program, please click here.
Tribal Consultation Policy and Tribal Advisory Workgroup
The Washington Health Benefit Exchange has worked closely with the American Indian Health Commission for Washington State, Tribes and urban Indian health organizations to: 1) establish a Tribal Consultation Policy that outlines how the Exchange will consult and collaborate with Indian Tribal Governments and urban Indian health organizations in the development of Exchange policies or actions that have tribal implications; and 2) ensure Washington Healthplanfinder addresses the unique needs of the 29 federally recognized Tribes and urban Indian health organizations. The Exchange works with Tribes on a government-to-government level. The Exchange’s Tribal Advisory Workgroup helps guide this relationship.
Tribal Sponsorship Program
Tribes, urban Indian health organizations and some other organizations are able to participate in the Exchange’s Premium Sponsorship Program. It is a Tribal decision whether they will pay for premiums on behalf of their communities and what criteria they will use to determine whether to sponsor premiums. General information about the sponsorship program can be found here.
Tribal Status Verification
If an individual identifies as an enrolled Tribal member or an Alaska Native shareholder in their Washington Healthplanfinder application, this status must be verified in order to be eligible for the AI/AN benefits. The Exchange has developed a process that allows Washington’s Tribes, urban Indian health organizations and Tribal Assisters to verify an individual’s membership without uploading documentation if the documentation is already on file with the Tribe or urban Indian health organizations. For AI/ANs not associated with a Washington Tribe or an urban Indian health organizations, documentation of Tribal status must be uploaded in Washington Healthplanfinder.
Click here for the Verification Process and two forms: 1) Statement of Good Faith Effort; and 2) Exception Policy
For a report on AI/AN enrollment during Washington Healthplanfinder’s first open enrollment period, please click here.
There are 29 Tribes and 2 urban Indian health organizations in Washington State. This report, however, also shows that more than half of the AI/ANs who are now enrolled in a Qualified Health Plan are members of tribes from outside Washington State.
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