Who qualifies.
The Marketplace protections are for enrolled members of federally recognized tribes and shareholders of Alaska Native Claims Settlement Act (ANCSA) corporations. People of Indian descent who are not enrolled, and others eligible for IHS services, get the Medicaid and CHIP protections but not the Marketplace ones.
These protections come from section 1402(d) of the Affordable Care Act (42 U.S.C. 18071(d)), signed in 2010 and in effect since Marketplace coverage began in 2014. They grow out of the federal government's trust responsibility to tribal nations.
What you get.
| Protection | Who | What it means |
|---|---|---|
| Zero cost-sharing | Enrolled members at 100% to 300% of the poverty level who qualify for the premium tax credit | No deductibles, copays or coinsurance for covered care, on any metal level except catastrophic |
| Limited cost-sharing | Enrolled members at any income | No out-of-pocket costs at IHS, tribal or urban Indian programs, or elsewhere with their referral |
| Monthly enrollment | Enrolled members, and family on the same application | Enroll or change plans once a month, all year |
| Premium tax credit | Based on household income, like anyone else | Lowers your monthly premium |
| Tribal premium sponsorship | Where your tribe or program offers it | Your tribe or an Indian health program may pay your premium |
See zero vs limited cost-sharing for the income chart.
What it costs.
Zero and limited cost-sharing remove what you pay when you get care. They do not remove the monthly premium. The premium tax credit, based on your household income, lowers that premium, and some tribes and tribal health programs pay premiums for their members. Our help enrolling is free; licensed agents are paid by the insurance company.
With zero cost-sharing, you have no deductible on any metal level, so a bronze plan often gives you the lowest premium after the credit while still costing nothing when you use covered care. Networks differ between plans, so we check your doctors first.
Want a licensed advisor to check your household?
Check my eligibilityHow to enroll.
- Apply on HealthCare.gov (both Oklahoma and Texas use it) and answer yes to the American Indian or Alaska Native questions.
- Enter your household and estimated income for the year.
- Upload proof of tribal membership within 90 days. See tribal documents.
- Pick a plan. Coverage starts the first day of the next month.
Or let us do it with you. A licensed advisor walks through the application, the documents and the plan choice, at no cost.
Questions people ask.
Do Native Americans get free health insurance?
Not free premiums. Enrolled tribal members can get no deductibles or copays (zero cost-sharing) between 100% and 300% of the poverty level, and $0 care at Indian health providers at any income, but a monthly premium still applies unless the tax credit or a tribal program covers it.
Can Native Americans get Obamacare?
Yes. Enrolled members of federally recognized tribes can buy Marketplace plans like anyone else, with extra protections, and can enroll any month.
Do I need a CDIB card?
Not necessarily. HealthCare.gov accepts a tribal enrollment card or other tribal or ANCSA document, or a BIA Certificate of Degree of Indian Blood that shows tribal enrollment.
Sources.
- HealthCare.gov, Health coverage for American Indians and Alaska Natives. healthcare.gov
- 42 U.S.C. 18071(d) (ACA section 1402(d)), Special rules for Indians. law.cornell.edu
- 45 CFR 155.350, Special eligibility standards for Indians. ecfr.gov
- 45 CFR 155.420(d)(8), Special enrollment period for Indians. ecfr.gov
- CMS, American Indians and Alaska Natives in the Health Insurance Marketplace, fact sheet for agents and brokers. cms.gov
- Indian Health Service, Frequently asked questions for patients. ihs.gov
General information for Texas and Oklahoma residents, not tax or legal advice. Rules and numbers can change; this page is reviewed on the date shown above. Your eligibility and prices are set by HealthCare.gov or the insurer when you apply.
Who wrote this.
RedHealth Advisors LLC is a licensed health insurance agency in Round Rock, Texas (Texas agency license 3449979, NPN 22110493), serving Texas and Oklahoma. Ryan Hutson is a licensed agent (NPN 21321807). EnrollNative was founded by Mike Grimes, a Chickasaw Nation citizen. Licensing details.