500 University Avenue West, Minot, ND
ND Navigators logo in white

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.

Two professional women at a table
  • 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

Eligible for Medicaid = NOT eligible for premium tax credits (PTCs) for Marketplace plans.

Offer from an Employer = May not be eligible for PTCs (depends on cost) / affordability % (9.14%) (Navigators can help calculate affordability)

Eligible for Medicare
= NOT eligible to enroll in Marketplace insurance plans (in most cases) – Can not get PTCs or Low/Zero Cost Share plans.

Poverty Guidelines table
Zero Cost-Sharing plans
  • Members can visit any clinic for basic healthcare (assuming the clinic accepts their insurance plan) no Purchased Referred Care (PRC) referral is needed
  • Cost for care covered 100% by insurance
  • With Premium Tax Credits, zero cost share plan holders will have $0 monthly Premiums

Premiums: $0
Copays: $0
Coinsurance: 0%
Deductibles: $0

Limited Cost-Sharing plans
  • Need a PRC referral from IHS for costs to be fully covered by insurance carrier (req. Silver Plan)
  • May be eligible for Premium Tax Credits to reduce monthly costs (based on income), but will have $0 out of pocket costs with referrals

Premiums: Based on Income
Copays: $0
Coinsurance: 0%
Deductibles: $0

$0 costs based on
getting a PRC
referral for health
care outside of IHS

Members can still use IHS if and when they want to. Your Marketplace Health Insurance plan (not IHS) will pay for cost of care no matter which clinic you choose. 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
Shawn L C

Shawn Lisa Charging
Certified Navigator,
Tribal Liaison

Patti H in the Standing Rock region

Patti Harrison
Certified Navigator, Tribal Liaison Standing Rock

Zachery K

Zachery King
Certified Navigator,
Tribal Liaison

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 1-800-233-1737
or locally at 701-858-3580

You can also email us at: NDNavigators@MinotStateU.edu

Health Insurance Marketplace

his 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 $1,049,340 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.