Health Insurance Exchanges: Indian Specific Provisions

The Affordable Care Act and Indian Country

Special provisions for American Indians and Alaska Natives (AI/AN) through the Affordable Care Act (ACA), which include:

  • Special monthly enrollment status
  • Zero cost-sharing plan option for household incomes at or below 300% of the Federal Poverty Level
  • Limited cost-sharing plan option for household incomes above 300% of the Federal Poverty Level
  • No copays, deductibles, coinsurance for zero and limited cost-sharing plans when receiving care from Indian health care providers
  • AI/AN exemption from the shared responsibility payment for members of federally recognized Tribes and those eligible to receive service from I/T/U

Determining Your Household Income

Household income must be reported when applying for a Marketplace plan. The income numbers are based on the national Federal Poverty Level (FPL) as determined annually by the federal government. Eligibility for many programs is based on percentage of the FPL and where the household income falls on that scale.

Why Does Household Income Matter?

For example, a family of three with a household income below $27,310, or 138% of the FPL, may be eligible for Medicaid. A member of a federally recognized Tribe or an Alaska Native shareholder living alone with a household income of less than $35,010, may qualify for a zero cost sharing plan in the Marketplace.

NOTE: Medicaid uses the current year’s FPL numbers, while the Marketplace bases income determinations on the previous year’s FPL.