Information for Native Americans

Members of federally recognized tribes and Alaska Native Claims Settlement Act (ANCSA) shareholders are eligible for additional health coverage benefits and protections through the Marketplace.

Enrollment Flexibility

Members of federally recognized tribes and ANCSA shareholders qualify for a Special Enrollment Period which allows them to enroll in coverage at any time of year, not just during the Open Enrollment Period. Your CoverME.gov eligibility results will also explain that members of Federally Recognized Tribes and ANCSA shareholders can change plans up to once a month.

Financial Assistance

Members of federally recognized tribes and ANCSA shareholders are not exempt from paying monthly premiums for a Marketplace plan through CoverME.gov, but can qualify for tax credits that lower premiums.

  • Tribal members with household income between 100% and 300% of the federal poverty level can enroll in a zero cost-sharing plan (this means no deductibles, copayments, or other out-of-pocket costs).
    • Note: if a family includes both tribal members and non-members, they should enroll in separate plans to ensure tribal members can benefit from these extra savings.
  • Regardless of income, tribal members with a Marketplace plan won’t have to pay any out-of-pocket costs when accessing health services from an Indian Health Service Provider.
  • 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 American/American Indian FAQs on Specific Benefits:

What are the special provisions for Native Americans?

Health Coverage for American Indians and Alaska Natives:

  • Tribal members with household income between 100% and 300% of the Federal Poverty Level (FPL) can enroll in a zero cost-sharing plan. This means no deductibles, copayments, or other out-of-pocket costs.
  • Regardless of income or eligibility for premium tax credits, tribal members can enroll in a limited cost-sharing plan. This means no deductibles, copayments, or out-of-pocket costs when accessing health services from an Indian Health Service Provider.
  • 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 qualify for a Special Enrollment Period which allows them to enroll in coverage at any time of year, not just during the Open Enrollment Period.
  • Your CoverME.gov eligibility results will also explain that members of Federally Recognized Tribes and ANCSA shareholders can change plans up to once a month.
What is a limited cost-sharing plan?

Limited cost-sharing plans are available to members of federally recognized tribes and Alaska Native Claims Settlement Act (ANCSA) Corporation shareholders regardless of income or eligibility for premium tax credits. People enrolled in this type of plan:

  • Don’t pay co-payments, deductibles, or coinsurance when getting care through an Indian Health Service Provider
  • Do need a referral from an Indian Health Service Provider when getting essential health benefits through a Marketplace plan to avoid paying co-payments, deductibles, or co-insurance
  • Can get limited cost-sharing with a plan at any metal level on the Marketplace
  • Don't need to have their income verified in order to enroll
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?

By enrolling in health coverage through the Marketplace, MaineCare (Medicaid), or Cub Care (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, MaineCare, or Cub Care, 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.

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

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, MaineCare, and Cub Care.

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.

Will I need my tribal documents when applying for coverage?

When applying through the Marketplace, you do not need to provide documentation but will be asked to confirm that you’re a member of a federally recognized tribe or an ANCSA shareholder.