Did you know the Health Insurance Marketplace gives American Indians and Alaska Natives (Al/ANs) special help to sign up and pay for insurance? Many AI/ANs know they can get care from Tribal and Urban Indian clinics and Indian Health Services facilities. However, Indian health care is not health insurance.
Special Enrollment Periods (SEP):
Al/ANs can enroll in the Health Insurance Marketplace throughout the year not just during the yearly Open Enrollment period. Non-tribal members applying on the same application as a tribal member can take advantage of the SEP.
Al/ANs with incomes between 138% and 300% of (Federal Poverty Level) FPL:
· May be able to enroll in a zero-cost sharing plan, which means no copays, deductibles, or coinsurance when receiving care from Indian health care providers or when receiving Essential Health Benefits (EHBs) through a Qualified Health Plan (QHP).
Al/ANs with incomes below 100% and above 300% FPL:
· Can enroll in a limited cost-sharing plan, which means no copays, deductibles, or coinsurance when receiving care from Indian health care providers.
· Will need a referral from an Indian health care provider to avoid cost sharing when receiving EHBs through a provider outside the Indian health system. Attach referral (Referrals are sent directly to us from the Indian health care provider in order to waive member out-of-pocket cost).
Al/ANs can enroll in a zero-cost sharing or limited cost-sharing plan at any metal level, including less expensive bronze plans.
Al/ANs who qualify for cost-sharing reductions are not exempt from premiums. However, they may qualify for Advance Premium Tax Credits depending on income.
Any applicable preauthorization requirements, balance billing or overage from out-of-network providers, and any maximum benefit limitations or exclusions still apply. Remember, it’s important to check member benefits at the time of service.
Share this flier with your tribal patients for more information and resources.
Blue Cross and Blue Shield of Oklahoma, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association