Native American Health and Medicare

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.

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