Do you need health coverage?
North Dakota Navigators can help you find and enroll in health insurance. Our assisters are local, unbiased, and helping to break down barriers to care. We are trained to understand the details so that you don’t have to, making the enrollment process easier and teaching you how health insurance works. We want all North Dakotans to have better access to healthcare.
Plans on the Health Insurance Marketplace can be a great option for American Indian/Alaska Native (AI/AN) enrolled tribal members.
Important Facts about Indian Health Service and Health Insurance
You may be wondering why you should consider getting health insurance when you are eligible for health care from Indian health care programs, including Indian Health Service (IHS), your tribe, or an urban Indian health program. Here are some facts to help answer those questions.
- IHS is not health insurance
- Even people eligible for IHS need insurance
- You’ll pay little or nothing
- Marketplace plans, Medicaid, and CHIP are not welfare
- You can stay with your Indian health clinic, get healthcare somewhere else, or both
- You won’t have to wait to sign up
- Indian Trust income won’t stop you from qualifying for Medicaid or CHIP
- Medicaid estate recovery doesn’t apply to your Indian Trust property
- Even though health care is a treaty right, you should till get insurance – additional Marketplace tax credits and cost sharing provides additional health care options that are supported by federal funds
Marketplace rules for AI/AN members to qualify for Premium Tax Credits and unique Zero or Low Cost-Share Plans
- Enrolled member of any 574 of Federally Recognized American Indian/Alaska Native (AI/AN) Tribes
- Income above the Medicaid eligibility line (138% FPL – see chart below)
- Parents of children eligible for CHIP only
- Enrollment is available year-round (not limited to Open or Special Enrollment Periods).
Below are things that could make your family ineligible for Premium Tax Credit Savings. You family may still qualify for cost-share plans
If you are eligible for Medicaid, you are NOT eligible for premium tax credits (PTCs) for Marketplace plans.
You can fill out a Marketplace application and choose to have it also sent to ND Medicaid for review to determine which programs you are eligible for.
If you have an offer of health coverage from an Employer, you will likely NOT be eligible for premium tax credits, but it depends on the cost of employer plan. (See Job-Based Coverage guidelines for healthcare.gov).
Navigators can help you calculate premiums to determine if the cost may be considered “unaffordable,” which WOULD qualify you for the Marketplace.
If you are eligible for Medicare, you are generally NOT eligible to enroll in Marketplace insurance plans. Even if you’re eligible, you will not receive any premium tax credits and can’t enroll in Low or Zero Cost Share plans.
The people in your house who don’t qualify for Medicare may still be eligible for a Marketplace plan.
Zero Cost-Sharing plans
For AI/AN to qualify for Zero Cost-Sharing plans on the Marketplace, your tax-household income should fall between 100-300% of the federal poverty level. These numbers can be found here, and change annually.
- Members can visit any clinic that accepts their insurance plan for preventive care that falls under the 10 Essential Health Benefits.
- Cost for preventive and essential benefits health care is covered 100% by insurance, no referral is need.
- With Premium Tax Credits, zero cost share plan holders will have $0 monthly Premiums.
- Health care that falls outside of preventive services may still be covered, however a referral may be needed for care received outside of IHS. This is NOT the same as a PRC referral, as your insurance coverage will pay the cost, not IHS.
Premiums: $0
Copays: $0
Coinsurance: 0%
Deductibles: $0
Limited Cost-Sharing plans
For incomes above 300% and above the Federal Poverty Level (FPL), AI/AN members may qualify for Limited Cost-Sharing plans.
- You will need a referral from IHS for care received from a non-IHS facility in order to have costs covered by your Marketplace insurance carrier (requires enrollment in a Silver Plan)
- May be eligible for Premium Tax Credits to reduce monthly costs (based on income), but will have $0 out of pocket costs (such as copays and coinsurance) as long as you get a referral from IHS
Premiums: Based on Income
Copays: $0
Coinsurance: 0%
Deductibles: $0
$0 out-of-pocket costs if you get a Marketplace referral for health care received outside of IHS. You are still eligible to use IHS facilities, also.Â
If your income falls below 138% FPL, your family will likely qualify for Medicaid Expansion. If you aren’t eligible for other reasons, you may enroll in a Zero or Limited Cost-Sharing plan based on actual income level.
Members can still use IHS if and when they want to. Your Marketplace Health Insurance plan will pay for cost of care at your in-network clinic or at an IHS clinic, instead of IHS paying for services or referral care. This leaves more money in your community’s IHS budget for those who don’t have other insurance options.
The Marketplace and North Dakota Medicaid should NOT count income from:
- Per capita payments from a tribe that come from natural resources, usage rights, leases, or royalties
- Payments from natural resources, farming, ranching, fishing, leases, or royalties from land designated as Indian trust land by the Department of Interior (including reservations and former reservations):
- Money from selling items that have cultural significance
Lisa Hale
Certified Navigator, Tribal Liaison
701-858-3053
Lisa.Hale@MinotStateU.edu
For additional questions and assistance with ND tribal health issues and questions, you can also contact:
ND HHS State Medicaid Tribal Liaison
Monique Runnels
Call: (701) 328-5841
Email: mrunnels@nd.gov
For more information about affordable healthcare plans or to request enrollment assistance, call us at 1-833-545-9448
or locally at 701-858-3580.
You can also email us at: NDNavigators@MinotStateU.edu
Health Insurance Marketplace
This grant is supported by the Centers for Medicare and Medicaid Services (CMS) of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $125,000 with 100 percent funded by CMS/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by CMS/HHS or the U.S. Government.