What are the Special Provisions for Native Americans?

Family health coverage for American Indians and Alaska Natives

Health Coverage for American Indians and Alaska Natives:

  • Native Americans who are members of a federally recognized tribe are exempt from the individual mandate.
  • Native Americans who earn less than 300% of the Federal Poverty Level (FPL) are exempt from cost sharing; for example, they will not have to pay copayments or deductibles when they use medical services.
  • There are special provisions for the calculation of Modified Adjusted Gross Income for Native Americans, meaning that some revenue earned on reservations and from Federal Trust payments are exempt.
  • Native Americans can change Qualified Health Plans (QHPs) once per month, and they are not bound to the open enrollment dates.

Frequently Asked Questions:

Q: Why do I need health insurance coverage if I get services from the Indian Health Service, a tribal program, or an urban Indian health program?

A: By enrolling in health coverage through the Marketplace, Medicaid, or CHIP, you have better access to services that the Indian Health Service, tribal programs, or urban Indian programs (known as I/T/Us) may not provide.

If you enroll in a Marketplace health plan, Medicaid, or CHIP, you can keep getting services from your I/T/U the same way you do now. When you get services from an I/T/U, the I/T/U can bill your insurance program. This benefits the tribal community, allowing I/T/Us to provide more services to others.

Q: What American Indian and Alaska Native income do I include on my application?

A: The Marketplace application asks you to provide income information that’s reportable on your federal income tax return. In general, you won’t report American Indian or Alaska Native (AI/AN) income that the IRS exempts from tax (income from treaty fishing rights, for example).

The Marketplace application will ask you to report income from various sources and will determine your eligibility for Marketplace insurance plans, Medicaid, and the Children’s Health Insurance Program (CHIP).

Most AI/AN trust income and resources aren’t counted when determining eligibility for these programs. But per capita income derived from gaming is taxable and therefore counted for these programs.

Q: My children and I are tribal members, but my spouse is not. Can we enroll as a family with a Special Enrollment Period?

A: If your state uses the federal Marketplace, yes. If one family member on the application is eligible for the Special Enrollment Period (SEP), all family members who apply on the same Marketplace application are eligible. This is true even if different family members are eligible for different Marketplace plans, based on differing eligibility for lower monthly premiums or out-of-pocket costs.

Q: Will I need my tribal documents when applying for coverage?

A: The special monthly enrollment periods and cost-sharing reductions apply only to members of a federally recognized tribe or Alaska Native Claims Settlement Act (ANCSA) Corporation shareholders. When applying through the Marketplace, you’ll need to provide documentation that you’re a member of a federally recognized tribe or an ANCSA shareholder.

• A document issued by a federally recognized tribe indicating tribal membership

• A document issued by an Alaska Native village/tribe, or an ANCSA Corporation (regional or village) indicating shareholder status

Q: How do I apply for the Indian exemption?

A: Members of federally recognized tribes, ANCSA Corporation shareholders, and people who are otherwise eligible for services through an Indian health care provider can claim the Indian exemption when filing a federal income tax return.

• Download IRS Form 8965—Health Coverage Exemptions (PDF) and instructions (PDF)

• On Part III of the form, enter the code for the Indian Exemption (Code E) in column “c” and check the box in column “d” for “Full Year.” You don’t need to provide additional documentation.

• Be sure to include your completed Form 8965 when you file your tax return

No penalty for the 2019 plan year and later

• Starting with the 2019 plan year (for which you’ll file taxes in April 2020), the fee no longer applies for anybody, regardless of Indian status. (The fee is sometimes called the “Shared Responsibility Payment” or “mandate.”)

• If you don’t have coverage during 2019, you don’t need an exemption in order to avoid the penalty.