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American Indians

American Indian Family

MNsure is the official health insurance marketplace for Minnesota residents. It's where you can find the right coverage for you and your family, and information about the special protections and benefits provided for American Indians by the Affordable Care Act.

Even if you receive services from your Indian Health Service (IHS), Tribal or Urban Indian health care facility, here's what MNsure can provide for you:

  • Health insurance to help cover the costs you pay for services received outside of your IHS, Tribal or Urban Indian health care facility; things like a hospital stay or specialty care.
  • One-stop shopping to compare and enroll in private insurance plans or public programs such as Medical Assistance (MA) and MinnesotaCare (MCRE).
  • Clear descriptions of all plans with side-by-side comparisons so you can choose the one that is best for you.
  • Quality coverage, including doctor visits, hospital stays, maternity care, mental health services, emergency room care, prescriptions, dental care and more.
  • More choices of doctors and clinics for your health care.
  • Help to cover the cost of premiums if you have any.
  • Consistent care so you can continue to get care from your IHS, Tribal or Urban Indian health care facility.

Verification of American Indian Status

Enrolled members of U.S. federally recognized tribes must be able to verify their enrollment (Source: 45 CFR section 155.350 (c)). Enrolled members can provide MNsure with a copy of one of the following documents to verify their tribal enrollment.

  • Tribal enrollment card
  • Tribal enrollment or membership document such as a certified letter from the tribe or Bureau or Indian Affairs (BIA) that must be on official letterhead
  • Certificate of Degree of Indian Blood (CDIB) issued by the BIA or tribe if the CDIB includes tribal enrollment information.
  • Documents issued by an Alaska Native village/tribe or an Alaska Native Corporation Settlement Act (ANCSA) regional or village corporation.

American Indian Special Enrollment Period Includes Non-Tribal Household Members

Members of federally recognized American Indian tribes may enroll through MNsure or change plans one time per month, year-round, including outside the annual open enrollment period. MNsure expanded this monthly special enrollment period to permit household members who are not tribal members, and who apply for coverage with the qualifying tribal member, to enroll in a qualified health plan, dental plan, or change plans.

Household members who are not enrolled members of a federally recognized tribe are not eligible for this special enrollment period on their own, and may only enroll in or change plans under this special enrollment period in a month in which the qualifying tribal member enrolls in or changes plans.

As with other special enrollment periods, Minnesotans must complete an application and contact MNsure at 1-855-366-7873 in order to determine whether they qualify and have MNsure process their enrollment.

Get Help Paying for Health Insurance

Many individuals or families, even those who are working, can get financial help to purchase a plan.

Household Size Maximum Yearly Income
1 $47,520 
2 $64,080
3 $80,640
4 $97,200
5 $113,760
6 $130,320

Cost-Sharing Benefits

There are three ways cost-sharing may be reduced for American Indians who enroll in a qualified health plan through MNsure.

  1. Zero cost-sharing plans: American Indians enrolled in a U.S. federally recognized tribe who have a household income at or below 300% of the federal poverty level (FPL) and who enroll in a qualified health plan (QHP) through MNsure will have to pay premiums, but will not have cost-sharing (such as deductibles, co-pays and co-insurance) regardless of where they receive care.
  2. Limited cost-sharing plans: American Indians enrolled in a U.S. federally recognized tribe who have a household income above 300% FPL and who enroll in a QHP through MNsure will have to pay for premiums and may have to pay cost-sharing if they get service outside of an I/T/U facility. IHS/Tribal Contract Health Services (CHS) funds may pay for cost-sharing for CHS eligible American Indians if CHS rules are followed.
  3. Reduced cost-sharing: descendants of enrolled members of a federally recognized tribe who are below 250% FPL, who are enrolled in a silver level QHP through MNsure, will have reduced cost-sharing (such as deductibles, co-pays and co-insurance) when services are provided by a non-Indian health care provider.

Other Benefits

  • American Indians enrolled in a U.S. federally recognized tribe may enroll in or change their enrollment in a QHP monthly. (See FAQ for American Indians)
  • American Indians enrolled in a U.S. federally recognized tribe and their descendants (IHS/Tribal eligible) are exempt from the mandate to purchase health insurance.

Special Rules for American Indians in Medical Assistance, MinnesotaCare and Medicare

Medical Assistance

  • Adult American Indians enrolled in a U.S. federally recognized tribe and their descendants (IHS/Tribal eligible) and their household members up to 133% FPL are eligible for Medical Assistance.
  • Medical Assistance is a premium-free program for all qualified participants.
  • All enrolled and non-enrolled American Indians who are beneficiaries of I/T/U services do not have cost-sharing if they receive care at I/T/U facilities or if they have a referral from an I/T/U facility when they receive covered services from other health care providers. Their non-Indian household members will be responsible for cost-sharing.
  • American Indians who qualify for Medical Assistance and live on a reservation are excluded from mandatory enrollment in managed care and will be covered on a fee-for-service basis. However, they may choose to enroll in managed care on an individual basis regardless of residence on a reservation. American Indian Medical Assistance recipients, living on or off a reservation, have direct out-of-network access to I/T/U facilities.

MinnesotaCare

  • Adult American Indians enrolled in a U.S. federally recognized tribe and non-enrolled American Indians who are beneficiaries of I/T/U services and their household members are not required to pay MinnesotaCare premiums.
  • Adult American Indians enrolled in a U.S. federally recognized tribe have no cost-sharing for any covered services regardless of where they receive care.
  • Non-enrolled American Indians who are beneficiaries of I/T/U services do not have cost-sharing if they receive care at I/T/U facilities or if they have a referral from an I/T/U facility when they receive covered services from other health care providers.
  • Non-Indian members of American Indian households are not required to pay MinnesotaCare premiums, but are responsible for cost-sharing.

Medicare

  • Individuals on Medicare may qualify for Medical Assistance or for help paying Medicare premiums and co-pays. Medicare beneficiaries may apply directly through their local county or tribal agency. Individuals who are eligible for free Medicare Part A, even if not enrolled, or are enrolled in a Part B or Premium Part A cannot purchase a QHP on MNsure and are not eligible for MinnesotaCare.
  • Individuals who become eligible for free Medicare Part A or enroll in Part B or Premium Part A after purchasing a QHP can stay enrolled in the QHP but are not eligible for Premium Tax Credits or cost-sharing reductions.
  • Medicare beneficiaries who are looking for health coverage through MNsure should contact the Senior Linkage Line at 1-800-333-2433 to speak with a Medicare specialist before enrolling in a QHP.

Tribal Sponsorship

Some Minnesota tribes are supporting qualifying members by paying their insurance premiums. Contact your tribal clinic for more information.

How to Apply for an American Indian Shared Responsibility Payment Exemption

American Indians enrolled in a U.S. federally recognized tribe and non-enrolled American Indians who are beneficiaries of I/T/U services may be exempt from the Affordable Care Act's shared responsibility rule. There are two ways to apply for the American Indian exemption.

  1. Go to healthcare.gov to download the application for the tribal membership exemption and application instructions. The completed form and any supporting documents should be mailed to the address on the application.
  2. In addition to the above-listed applications for exemption, you can apply for certain categories of exemptions when you file your federal income tax return. Information for applying for an individual exemption through the IRS can be found on the IRS website.
For more information on the tribal exemption, visit the exemption page at Healthcare.gov.

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