American Indians

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 and their adult household members up to 133% FPL are eligible for Medical Assistance. Their children are eligible for Medical Assistance up to 283% FPL.
• Medical Assistance is a premium-free program for all qualified participants.
• American Indians and Alaska Natives do not have Medical Assistance cost sharing if they currently receive or have ever received care from an I/T/U provider or a referral from an I/T/U to a non-Indian provider. Any 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 Indians who enroll in managed care Medical Assistance, whether or not they live on a reservation, have direct access to I/T/U facilities, even if the provider is not in network.

MinnesotaCare

• Adult American Indians, Alaska Natives and their adult household members up to 200% FPL are eligible for MinnesotaCare.
• American Indians, Alaska Natives and their household members are not required to pay MinnesotaCare premiums.
• American Indians who are members of a federally recognized tribe are not subject to cost sharing for any covered services, regardless of where they receive care.
• American Indians do not have MinnesotaCare 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. This is true regardless of whether the person is a member of a federally recognized tribe.
• Non-Indian members of American Indian households are not required to pay MinnesotaCare premiums, but are responsible for cost sharing.
• American Indians and Alaska Natives eligible for MinnesotaCare must enroll in a managed care plan.

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 Health Coverage 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 qualify for a health coverage exemption. You can claim this exemption when you file your federal income tax return.

Information for claiming an individual exemption through the IRS can be found on the IRS website.

1. Claim this exemption when you file your federal income taxes. Most people file their taxes in April of the following year.
2. On Form 8965, enter code "E" in Part III, column (c). Identify the months this exemption applies or select (d) for the full year.
3. Include Form 8965 when you file your tax return.

For more information on the tribal exemption, visit the exemption page at Healthcare.gov.

Resources

• MNsure Tribal Consultation Policy (PDF)
• MNsure American Indian Health Coverage Continuum (PDF)
• Frequently asked questions