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Native American Health Insurance & Medicare

Native American Health Insurance and Medicare can be a tricky road to navigate. For anyone with these coverage options, understanding benefits are vital.

With Medicare and Native American Health Insurance, you can seek an Indian Health Care Provider or a non-Indian Healthcare Provider for care. Either way, the healthcare provider bills Medicare for you.

Indian Health Service isn’t health insurance; it’s federal funds for tribal and urban Indian health programs. However, health insurance protects you when you’re sick.

If you have questions regarding your Native American health coverage, we’ve got the answers you need! Below you can learn why your Indian Health benefits might not be enough coverage.

How the Indian Health Service Program and Medicare Works

Even those eligible for Indian Health Services need insurance to see a specialist or get care when away from home. Your health care is a treaty right; however, getting Medicare insurance should still be a priority. The Indian Health Service Program is the critical federal branch that ensures that American Indians and Alaska Natives have access to health care treatment and services.

Indian Health Services (IHS) enables individuals with both the services and funds to need to help cover their primary care

They can get attention through facilities that are run by tribal organizations, the IHS, or Urban Indian Health Programs. Further, most of the health facilities operate near or on reservations.

The IHS program is considered a payer of last resort, only paying after all other payers have first contributed.

Indian Health Service works with budgets that must first be approved by Congress. They don’t have enough funds to meet every single health care need of all Alaska Natives and American Indians.

IHS cannot offer specific health services and some services may not be available continuously. When you have both Medicare and IHS, you have access to more comprehensive care.

Medicare gives you access to doctors outside of IHS and gives you more benefits. Like Medicare Advantage plans that become available may have dental, vision, or hearing benefits.

Characteristics of Native Americans That Qualify for Medicare

Distribution of American Indians and Alaska NativesAbout 1 percent of people within the U.S. population are Alaska Native or American Indian. Just about half of that percentage is people whose race is a combination with another ethnicity, and the other half is solely American Indian or Alaska Native.

Women comprise a little more than half of the elderly American Indian and Alaska Native population.

Estimates show that roughly 35 percent of Native American and Alaska Natives live within just four states throughout the United States.

These four states include California, Oklahoma, Texas, and Arizona.

More than any other group in the country, Native Americans and Alaska Natives over 65 are more likely to have an inpatient hospital stay.

Just a few of these health conditions may include the following:

Elderly Native Americans also prove to have drastically higher percentages of people who have increased difficulties with daily activities. Walking, bathing, getting dressed, and undressed all shown to be harder as age increases for these individuals.

Poverty rates tend to be higher for Alaska Natives and American Indians, and studies show that they tend to have a more inferior quality of health.

American Indians and Alaska Natives over the age of 65 have higher rates of poverty and poor health. These individuals also report having issues with access to care in comparison to the over 65 U.S population.

How Does Indian Health Service Program Work

The Indian Health Service is part of the federal government. This program ensures that health care is available to American Indians and Alaska Natives. Funds from this program administer to tribal and urban Indian health programs.

Why Indian Health Services Program Benefits May Not Be Enough

American Indians and Alaska Natives Overall HealthIt’s essential to understand IHS is NOT health insurance because it works within the budget approved by congress. However, buying insurance outside IHS is simple!

Alaska Natives and American Indians will find incredibly affordable health insurance coverage. If an individual’s income falls between 100 and 300 percent of the Federal Poverty Level (FPL), they can choose to enroll in a zero-cost sharing plan.

Zero-cost sharing plans ensure they don’t have any out of pocket costs for services through Indian health providers or qualified health plans.

If a person’s income falls below 100 percent or rises above 300 percent of the FPL, they can enroll in a limited cost-sharing plan. This plan provides no out of pocket costs for any health-related services received by an Indian healthcare provider.

If an individual’s income is less than $12,000 per year, they can utilize limited cost-sharing plans. By enrolling in these plans, they can ensure they won’t have to worry about covering copayments, deductibles, premiums, or coinsurance.

How Many People Have Native American Health Insurance and Medicare

Medicare is a federal program in the U.S. that provides health coverage to seniors who are 65 and older, individuals with end-stage renal disease, and younger people with specific disabilities.

Most Alaska Natives and American Indians utilize the Medicare program. Right around 96 percent are on Medicare. Just about 23 percent of those who are on Medicare also receive coverage through the HIS.

Nearly a third of American Indians and Alaska Natives who enroll in Medicare are under 65 years old. When in comparison to the proportion found in the entire Medicare population, this is a massive number.

Native American Health Insurance and Medicare with Medicaid

Nearly a quarter of the senior Alaska Natives and American Indians who receive Medicare coverage also receive coverage through Medicaid, whether it be partial benefits or full benefits. Around 28 percent of these seniors that have Medicare coverage don’t carry any form of supplemental insurance coverage.

The Indian Trust income you get doesn’t stop you from qualifying for Medicaid. If you think you are eligible, apply.

Also, Indian trust property and income are exempt from estate recovery in the Medicaid payback for long-term care.

How Indian Health Services and Medicare Advantage Plans Work

Once you have Part A and B, you can enroll in a Medicare Advantage plan. Since many people with IHS coverage qualify for Medicaid, a Medicare Advantage Special Needs Plan could be super beneficial if one is available in your area.

If there isn’t one available, no problem, there are standard Medicare Advantage plans that provide further benefits at a low premium.

To learn about the plans in your area, call one of our agents at the number above. Also, you could fill out an online rate form, and an agent will contact you at a more convenient time to discuss your options.

Lindsay Engle

Lindsay Engle is the Medicare expert for MedicareFAQ. She has been working in the Medicare industry since 2017. She is featured in many publications as well as writes regularly for other expert columns regarding Medicare. You can also find her over on our Medicare Channel on YouTube as well as contributing to our Medicare Community on Facebook.

12 thoughts on “Native American Health Insurance & Medicare

  1. 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?

  2. 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.

    1. 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.

  3. 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.

  4. 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.

    1. 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.


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