American Indian and Native Alaskan Coverage

American Indian and Native Alaskans have unique and expanded access to health care coverage options. Learn about the special protections, requirements, and coverage options available for this population so you can help your patients get the coverage they need. 

Special Protections

Native Indian and Native Alaskans in federally recognized tribes have the following special protections making healthcare more accessible and affordable:

  • Ability to enroll in Marketplace plans at any time of year, with no limited enrollment period;
  • Can change plans up to once a month;
  • No referral needed from an Indian health care provider when receiving essential health benefits (EHBs) through the qualified health plan (QHP);
  • Exempt from Medicaid premiums or enrollment fees, co-pays, deductibles and co-insurance
  • No out-of-pocket costs for CHIP enrollees. 

Coverage Options

Over half of the total American Indian and Alaska Native population live in seven states, AL, MT, AZ, ND, SD, NM, and OK. If your center is located in one of these states or is caring for an American Indian or Native Alaskan be sure to explore all insurance options. You can learn more about coverage options below and can share these resources with your patients:

  • Visit the marketplace to determine which plan a patient qualifies for.
  • Access assistance to find insurance or enrolling in the marketplace.

Indian Health Services Coverage

Indian Health Services (IHS) is an agency within the Department of Health and Human Services. The IHS is the principal health care provider for these populations, and serves over 1.9 million people in 567 different tribes, across 35 states. Specifics about the IHS can be found in the Indian Health Manual ( 

IHS is considered a “discretionary program” where federal funding must be approved on an annual basis by Congress, leaving it open to broad budget cuts. This means that coverage is not guaranteed under IHS if funding runs out or is cut.

Learn more about transplant access through IHS.

  • Required Registration for IHS Transplant Services 

    All IHS eligible patients undergoing transplant must be registered for the transplant registry, regardless of the source of payment for transplant benefits under IHS. A form must be submitted to IHS at the time of pre-transplant evaluation, within 2 weeks post-transplant, at 6 months and one year post-transplant, and when payment Information becomes available. Access the Transplant Registry Form. For more information, please view the IHS Transplant Management Policy

Medicaid and CHIP Coverage

Medicaid and the Children’s Health Insurance Program (CHIP) may be available to qualifying federally recognized American Indians and Alaska Natives. Those eligible for services from the Indian Health Service, tribal programs, or urban Indian programs are exempt from Medicaid premiums or enrollment fees, co-pays, deductibles and co-insurance. There are no out-of-pocket costs for CHIP enrollees.

Marketplace Coverage

American Indians and Native Alaskans may be covered under IHS and a Marketplace plan – in this case the Marketplace plan extends coverage to services not covered by IHS, but your patient can also continue services through IHS. Beneficiaries are able to enroll in Marketplace plans at any time of year, with no limited enrollment period and they can change plans up to once a month.

Patients residing in states that did not expand Medicaid may have trouble affording premiums on the exchange plans. Impacted people are those making less than 100% of the Federal Poverty Level (FPL) and people making over 300%. View FPL charts

  • Zero Cost Sharing Plans or Limited Cost Sharing Plans:
    Members of federally recognized tribes may enroll in zero cost sharing plans or limited cost sharing plans depending on income level.
  • Zero cost plans: 
    These are available to beneficiaries whose income is between 100% and 300% of the FPL, and who qualify for premium tax credits. The zero cost sharing plan has no copays, deductibles or coinsurance for care received from Indian health care providers or when getting care from an Essential Health Benefits (EHBs) through a Qualified Health Plan (QHP) in the Marketplace.  These plans do not require a referral from an Indian health care provider when receiving EHBs through the QHP.

  • Limited cost sharing plans: 
    These are available for beneficiaries whose income is below 100% or above 300% of the federal poverty level.  These plans have no out-of-pocket costs when services are provided by an Indian health care provider or from another provider if you have a referral from an Indian health care provider.