For Native Americans who become eligible for Medicare, it’s important to understand how Medicare works with Indian Health Services. Medicare allows access to and helps pay for a broader range of care for eligible Native people.
Medicare and Native American Health
The Centers for Medicare & Medicaid Services (CMS) facilitates health care for American Indians and Alaskan Natives who are eligible for such government health programs. Eligibility requirements for those who have Indian Health Services (IHS) are the same as for those who do not; the program covers people over 65, disabled under 65, and those with ESRD or ALS.
Indian Health Services provides coverage for care at IHS facilities. However, IHS is not insurance. Thus, Medicare can supplement IHS by providing coverage at a larger range of facilities. Your provides who accept IHS will also accept Medicare.
Almost one-quarter of American Indian and Alaska Native Medicare beneficiaries also rely on IHS for health care. With Medicare and other federal health programs, Native communities benefit from more health care resources. Additionally, Medicare is beneficial to have alongside IHS when you travel out of range of an IHS facility.
How Much Does Medicare Cost for a Native American?
For many who are both IHS and Medicare eligible, Medicare is low in cost or free. Ultimately, your income will determine what you pay for Medicare. Individuals with lower incomes are eligible for Medicare Savings Programs. Yet, certain income doesn’t count toward your total income, such as distributions from trust or reservation property. For more specific information about what income is exempt from determining your modified adjusted gross income (MAGI), contact your tribe.
Indian Health Services and Medicare Part B
Original Medicare refers to Part A and Part B, which are your inpatient/hospital and outpatient insurance, respectively. Anywhere IHS is accepted will accept Medicare Parts A and B as well. You can also use your Medicare benefits at any facility or with any practitioner who accepts Medicare assignment. Fortunately, most doctors accept Medicare assignment, so Medicare offers a broad range of coverage
When you enroll in Medicare, Part B provides access to coverage for preventive services, many of which are available at tribal clinics. Mental health services also receive coverage, including treatment for alcoholism.
As IHS is not health insurance, it is also not considered creditable for Parts A and B. Thus, if you don’t enroll during your Initial Enrollment Period or don’t have creditable coverage later, you could pay a late penalty.
Indian Health Services and Medicare Advantage Plans
Medicare Advantage plans are available through private insurance companies and stand in for original Medicare. IHS facilities also accept this coverage, which is available for premiums as low as zero dollars per month. Those who enroll in Original Medicare are eligible for an Advantage plan. As most Advantage plans are HMOs and PPOs, it’s best to select one whose network includes your preferred providers.
Indian Health Services and Part D
Unlike the case with Part B, IHS is creditable coverage for Part D prescription drug coverage. This means that if you enroll in Medicare but delay enrollment in a Part D prescription drug plan, you can avoid the penalty for late enrollment.
FAQs
How to Get Help with Medicare and Native American Health Insurance
If you are approaching Medicare eligibility and have further questions about how your benefits will coordinate with Indian Health Services, we can help! If you're considering supplementing your IHS and Medicare coverage with an Advantage or Medigap plan, we'll find the right policy for you.
Call the phone number above to get started. If you'd like to compare monthly premiums for plans near you, fill out our online rate form. An agent licensed in your state will prepare a comparison of plans near you.
Does being enrolled in IHS automatically qualify a beneficiary for an election period to enroll in an MA plan at any time or do they have to follow the same rules as any other Medicare beneficiary?
Hi Michelle! I believe you would have to follow the same rules as other beneficiaries regarding enrollment periods. However, I would contact the Indian Health Service support desk to confirm.
My dad is 78 and receives Part A & Part B Medicare. We live in Texas. I am specifically interested in knowing if our tribal benefits will pay some portion in addition to medicare in the event of long term or palliative care. Can you assist me with information around this?
Hi Amy! Unfortunately, this information is out of our scope. I would contact the U.S. Department of Indian Affairs to find out. I also found this resource that may be of help.
Lindsay, I am Native American from the Kaw Nation I have Medicare A an B I am looking for a gap insurance to cover the 20 percent Medicare doesn’t cover. Can you help me out with advise as to what to look into I am 73 an can’t figure out a plan to cover the gap.
Hi Rick! All Medigap plans will cover the 20% coinsurance under Part B. The main difference between the different letter plans is some cover both the Part A & Part B deductible, some include coverage during an emergency with traveling outside the US, and some cover the coinsurance for skilled nursing. Here is a Medigap comparison chart that may help you compare the different benefits. What you pay for your monthly premium depends on many different factors such as your location, gender, health, and letter plan you choose to enroll in. When you’re ready to enroll, or if you have any additional questions, don’t hesitate to give us a call.
I took early Social Security at 62. I have been drawing Social Security for 11 years. I am Native American and have been in the IHS system for thirty years or more. I only took Medicare A because I always used the Indian system for medical and prescription drugs and also was covered by employer insurance. I am now retired and want to apply for Medicare B. I need to know if I will be penalized for Medicare B since I didn’t take it when I initially applied for Medicare. I was told at one point that I would not be penalized because I was covered by IHS.
Hi Barbara! If your employer has more than 20 employees, then your coverage would be considered creditable and you wouldn’t be penalized for delaying Part B.
Since I am an enrolled member of a federally recognized tribe, turning 65, how does this impact paying for prescription drugs. I can’t afford Eliquis or Flecainide since changing to a Ucare drug plan. The Eliquis copay is 660.00 for a 90 day supply. Do you know where I can get assistance. I need the blood thinner to prevent strokes. I have heart failure and afib.
Hi Cynthia! The good news is, Part D drug plans do cover both Eliquis and Flecainide. Depending on the plan you choose, your copay could only be $1.
If I have private health insurance coverage through a spouse does IHS require me to purchase Medicare B?
Hi Wendy! It’s not required to enroll in Part B. IHS coverage is considered creditable. However, it’s recommended to enroll in Part B and Part D so you have more comprehensive coverage.
What happens when a Native American covered by a Marketplace healthplan becomes eligible for Medicare?
In this case, you would want to drop your marketplace plan and enroll in Medicare. The only time you would want to keep your marketplace plan is if you didn’t work enough quarters and don’t get Part A premium free.