The Affordable Care Act offers many new opportunities for tribal health programs and American Indian/Alaska Native (AI/AN) individuals. If you’re 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 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/ANs, the Affordable Care Act created regulations that benefit Indian people who enroll in Qualified Health Plans through Washington Healthplanfinder.
If you’re an enrolled tribal member of a federally-recognized tribe or a shareholder in an Alaska Native Corporation, you’re eligible for the following benefits:
- No co-pays or deductibles when you see your health care provider: If your income is within a certain range (at or below 300% of the Federal Poverty Level), you won’t have co-pays, deductibles, or co-insurance costs (the amount you pay out of pocket when you see the doctor).
- No costs for using Indian Health Services or Contract Health Services: Regardless of income, you still won’t have any 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 aren’t subject to the open enrollment period. You can enroll at any point during the year.
- Choice in coverage options: Plan options are broken down into metal tiers based on the level of coverage they provide. Bronze, Silver, Gold, and Platinum 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’re 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. To apply for an exemption, visit marketplace.cms.gov/applications-and-forms/tribal-exemption.pdf. For guidance on the tax penalty exemption, please see the American Indian and Alaska Native Trust Income and MAGI Fact Sheet.
Tribal In-Person Assister Program
Tribal assisters can help individuals and families apply for coverage through Washington Healthplanfinder. To find a tribal assister, go to wahealthplanfinder.org, click Customer Support, and click Find a Navigator. Type in your search criteria to find navigators – including tribal assisters – in your area. For information about becoming a tribal assister and the navigator program, visit Navigators.
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:
- 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.
- 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.
Tribal Sponsorship Program
Tribes, urban Indian health organizations, and some other organizations are able to participate in the Exchange’s Premium Sponsorship Program. It’s a tribal decision whether they will pay for premiums on behalf of their communities and what criteria they’ll use to determine whether to sponsor premiums. For more information about the program, visit Sponsors.
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.
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