Char-Koosta News

The Official Publication of the Flathead Nation online

The Affordable Care Act and the individual Indian

The Affordable Care Act, also known as Obamacare and/or the health care law, was created to expand access to affordable health care coverage to all Americans including American Indians and Alaska Natives, lower costs, and improve quality and care coordination.

The Affordable Care Act requires people to:
    • Maintain health insurance coverage that meets the minimum essential coverage requirement by January 1, 2014; or,
    • Qualify for an exemption from the shared responsibility payment; or
    • Make a payment when filing their taxes if they have affordable options but remain uninsured.

If you have access to Indian Health Service health care benefits, you can continue to get your care from IHS, tribal (CSKT Tribal Health and Human Services), or urban Indian health programs (I/T/U). These services will always be available to you.

However, I/T/U is your only source of care, you will need to:
   • Sign up for health insurance coverage, or
   • Apply for and obtain an exemption from the individual shared responsibility requirement.

Please be aware that certain American Indian/Alaska Native protections available through the Health Insurance Marketplace only apply to enrolled members of federally recognized tribes.

For more information, visit website: www.healthcare.gov/exemptions

IHS and Health Insurance

If you have other forms of health care coverage, such as private insurance, Medicare, or Medicaid, CHIP, HMK, TRICARE, or VA Health Benefits, you can continue to use IHS and:
   • The services you receive at your local I/T/U health care facility will continue to be provided at no cost to you.
   • An I/T/U health care facility may be able to bill for services they provided to you.
   • You may be able to receive health care services unavailable at your I/T/U health care facility.

If you don’t have access to affordable health insurance, you may be eligible for coverage at the Health Insurance Marketplace.

To determine if you are eligible for IHS health care benefits, please visit: www.healthcare.gov Frequently Asked Questions

The Health Insurance Marketplace
For enrolled members of federally recognized tribes

Beginning October 1, 2013, the Health Insurance Marketplace provides an easy way to identify health insurance coverage, find out if you’re eligible for health insurance at reduced or no cost, and compare qualified health programs. In the Marketplace, some people may be eligible for lower health premiums and out-of-pocket costs based on their income. The Marketplace offers a streamlined application process to help people understand what benefits are available and which protections may apply. The Marketplace makes it easier to find coverage by offering the following special protections for enrolled members of federally recognized tribes, including:
   • Special monthly enrollment periods
   • Cost-sharing exemptions
   • Shared Responsibility Payment exemption

In order to determine if you qualify for special protections, you may be asked to provide additional documentation for tribal membership and household income.

For more information, visit: www.healthcare.gov

Shared Responsibility Requirement Exemption
(Tribal Membership Exemption)

American Indian and Alaska Native consumers who are enrolled members of federally recognized tribes have access to a “Tribal Membership Exemption” from the shared responsibility requirement payment.

A Tribal Membership Exemption applies to American Indian and Alaska Natives who are members of federally recognized tribes and are unable to maintain minimum essential coverage for any time during the year.

To receive an exemption, members of federally recognized tribes may apply through the Marketplace or apply through their tax return submitted to the Internal Revenue Service.

For more information about exemptions, please visit: www.healthcare.gov/exemptions

The Health Insurance Marketplace

For non-members eligible for IHS, Tribal or Urban health care

Beginning October 2013, the Health Insurance Marketplace is a new way to shop for and purchase private health insurance that fits your budget and meets your needs. People who purchase insurance through the Marketplace may be able to lower the costs of health insurance coverage by paying lower monthly premiums.

For more information, please visit: www.healthcare.gov

Shared Responsibility Requirement Exemption

IHS Eligibility Exemption
If you are eligible to receive care through an Indian health care provider, you may be eligible for the “IHS Eligibility Exemption” available only through the Health Insurance Marketplace. If you do not have access to an Indian health care provider, you may be eligible for other exemptions available through the Health Insurance Marketplace.

These exemptions are based on certain qualifications, including:
   • Various hardships, including lack of affordable coverage based on projected income
   • Lack of insurance coverage for less than three consecutive months between months of coverage
   • Lack of affordable coverage based on actual income
   • Having income below the tax filing threshold
   • Unlawful presence in the U.S.
   • Membership in a health care sharing ministry
   • Membership in a recognized religious sect objecting to health coverage
   • Incarceration status, except pending disposition of charges.

For more information about exemptions, please visit: www.healthcare.gov/exemptions

Not sure of your situation?

If you are ineligible for IHS health care benefits, the Health Insurance Marketplace is available to review affordable health coverage options, visit: www.healthcare.gov

Dependents (qualifying children and qualifying relatives)
If your IHS eligible dependents do not have access to IHS services or are not members of federally recognized tribes, they can still use the Health Insurance Marketplace to get coverage and receive an exemption; or they can be included in your applications for health care coverage.

Dependents who are enrolled members of federally recognized tribes are eligible for the tribal membership exemption available through the Health Insurance Marketplace or the Internal Revenue Service.

Through the Health Insurance Marketplace, your dependents may get lower monthly premiums or out of pocket costs and could be eligible for free or low costs on coverage through Medicaid or Healthy Montana Kids. • Your dependents can submit an application for health care coverage through the Marketplace and learn the amount of assistance they are eligible for, visit website: www.healthcare.gov

Uninsured Dependents
Starting in 2014, if your dependents have access to affordable coverage but remain uninsured, you may have to make a payment when filing your taxes. This payment will either be a flat fee or a percentage of your taxable household income, depending on which amount is higher.

You do not have to make a payment if your family members have coverage that meets minimum essential coverage.

An exemption from the requirement to pay the Shared Responsibility are granted under certain circumstances, including for members of federally recognized tribes or for persons eligible to receive services from an Indian health care provider, and other exemptions are also available.

For more information, visit website: www.healthcare.gov

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