What IHS does and does not do.
IHS and tribally run health programs provide care directly at their own facilities and pay for some outside care through Purchased/Referred Care (PRC). PRC has eligibility rules, and because funding is limited, it prioritizes the most urgent cases. IHS has described its funding as covering roughly 60% of the need. That gap is where a health plan helps.
How the two fit together.
| Situation | What happens |
|---|---|
| Visit at your IHS, tribal or urban Indian clinic | $0 to you. The clinic can bill your plan, bringing money back into the program. |
| Referral from your clinic to an outside specialist | $0 to you with limited or zero cost-sharing, when the specialist is in your plan's network. |
| Seeing an outside doctor without a referral | $0 with zero cost-sharing; normal plan costs with limited cost-sharing. |
| Emergency far from home | Your plan covers emergency care at any hospital, in or out of network. |
| Hospital stay or surgery | Covered by your plan; with zero cost-sharing you pay nothing for covered care. |
Why billing your plan helps your tribe.
When a tribal or IHS clinic sees you and bills your insurance, that payment stays in the program and helps fund care for others. Enrolling in a plan does not take anything away from IHS; it can add resources to it.
Want a licensed advisor to check your household?
Check my eligibilityWhy EnrollNative explains this first.
Mike Grimes, a Chickasaw Nation citizen and chair of the Texas Chickasaw Council, started EnrollNative so tribal families get the coverage federal law already provides. A common misunderstanding is that the clinic is all a family needs. A plan does not replace the clinic you trust; it covers the specialists, hospitals and emergencies that Purchased/Referred Care cannot always reach.
Questions people ask.
Is IHS considered health insurance?
No. IHS is a health care program, not insurance, and it is not minimum essential coverage for premium tax credit purposes.
Can I keep going to my tribal clinic if I get a Marketplace plan?
Yes. You can keep using IHS, tribal and urban Indian programs, at no cost to you.
What is Purchased/Referred Care?
It is how IHS and tribal programs pay for care you get outside their facilities, such as specialists and hospitals. It has eligibility rules and limited funding, so not every referral is covered.
Sources.
- Indian Health Service, Frequently asked questions for patients. ihs.gov
- Indian Health Service, Purchased/Referred Care. ihs.gov
- 26 CFR 1.5000A-2, Minimum essential coverage. ecfr.gov
- 45 CFR 155.350, Special eligibility standards for Indians. ecfr.gov
- HealthCare.gov, Health coverage for American Indians and Alaska Natives. healthcare.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.