Health Reform/Affordable Care Act
What is the Affordable Care Act?
Alaska Native and American Indian people have special protections and benefits when it comes to the Affordable Care Act (ACA).
Exemption from the requirement to have health care coverage:
The ACA requires that most Americans have health care coverage. If you don’t have health care coverage for you and your family, you could be assessed a tax penalty. You may have heard the term “Individual Mandate.” Alaska Native and American Indian people are exempt from this requirement, but, you must apply for this exemption.
One of the most important things for Alaska Native and American Indian people to know about the ACA is, even if you don’t buy insurance, you and your family will still be able to get health care services at your Tribal health facility. The health care services provided at IHS/Tribal health facilities are not changing.
Special Benefits for Alaska Native and American Indian people who want to purchase health care coverage:
There are special benefits in the ACA for Alaska Native and American Indian people who choose to purchase health care coverage. For instance, a family of four with income up to $89,460 who purchases coverage at www.healthcare.gov, won’t have to pay out-of-pocket costs like deductibles, co-payments, and coinsurance even if you don’t get your care at a Tribal health facility. The federal government pays those costs for you. And, no matter how much you earn, if you purchase a plan at healthcare.gov, the federal government will always pay these costs when you are seen or referred by Tribal Health facilities.
We have heard from many Alaska Native and American Indian people who are interested in health care coverage for different reasons:
- People who don’t live near a Tribal health facility,
- People who travel away from their Tribal health facility,
- Parents with children going to school out-of-state, or
- People who want more health care options
For lots of reasons, Alaska Native and American Indian people may want to know more about these special benefits. And, you can use this and all other types of health care coverage — Medicaid, Veteran’s Benefits, Denali KidCare, Medicare or insurance provided by your employer — at Tribal health facilities. Your local Tribal health facility can bill insurance to help build an even stronger Tribal health system for generations to come.
What if I have insurance?
- My employer provides insurance
- I am enrolled in Medicare
- I am enrolled in Medicaid
- I am enrolled in Denali KidCare
- I am enrolled in Veteran Benefits
- Veterans Health Care Program
- TRICARE
- VA Civilian Health and Medical Program (CHAMPVA)
- Spina bifida health care benefits program
If any of the conditions above apply to me, then I have satisfied the“Individual Mandate” and do not need to purchase additional health care coverage to avoid the tax penalty.
Indian Exemption
Under the Affordable Care Act (ACA), every American must have health care coverage, but there are special exemptions that exist for Alaska Native and American Indian people. Alaska Native and American Indian people are exempt from the requirement to purchase insurance if they can show evidence of:
- Enrollment in a federally recognized Tribe;
- Alaska Native Claims Settlement Act (ANCSA) shareholder status (village or regional), or;
- Eligibility to receive services from a Tribal health clinic or IHS Facility.
The ANTHC Health Reform Team recommends claiming the Indian Exemption when you file your taxes.
IRS Tax Form 8965, titled “Health Coverage Exemptions,” can be used to claim the Indian Exemption.
The Alaska Native Tribal Health Consortium’s (ANTHC) Health Reform team has been assisting people with the Indian Exemption application. The applications sent to the federal government for processing have faced numerous issues. Due to the ongoing issues with the paper application process, the ANTHC Health Reform Team recommends claiming the Indian Exemption when you file your taxes, for those who still need an exemption to avoid the tax penalty for not having health care coverage.
Documents:
- Instructions for Form 8965 [PDF]
- Form 8965 [PDF]
Frequently asked questions about the ACA:
Q: What if I already have health care coverage?
A: If you have health care coverage through Medicaid, Medicare, Denali KidCare, Veteran’s Benefits or your employer-provided health insurance, you have met the requirements of the Individual Mandate and do not need to purchase additional health care coverage to avoid the tax penalty. You do not need to complete the Indian Status Exemption paperwork if you have health care coverage. However, the Indian Exemption is a lifetime exemption and can be used anytime you have a gap in health care coverage.
Q: What if I already received a response with my Exemption Certificate Number?
A: Keep the letter with the Exemption Certificate Number (ECN) for you and/or your family in a safe place. You will need to report this number on your taxes. When filing taxes, you will report an exemption certificate number on IRS Tax Form 8965, titled “Health Coverage Exemptions.”
Q: What if I sent in my exemption application but haven’t heard anything on it yet?
A: Keep a look out for a letter from the “Health Insurance Marketplace.” It could still arrive. If you don’t receive a letter with an Exemption Certificate Number, you can claim the Indian Exemption on IRS Tax Form 8965, titled “Health Coverage Exemptions,” with your taxes.
Q: What if I lost the letter with my Exemption Certificate Number?
A: If you received your Exemption Certificate Number in the mail and misplaced the letter, you can claim the Indian Exemption on IRS Tax Form 8965, titled “Health Coverage Exemptions,” with your taxes.
Q: If I don’t buy insurance, will I still be able to get health care services at my IHS/Tribal health facility?
A: Yes, you will still be able to get care at your IHS/Tribal health facility. The health care services provided at IHS/Tribal health facilities are not changing; however, you will need to apply for an exemption to avoid the tax penalty.
What if I need help or have questions?
Email: healthreform@anthc.org
Phone: (907) 729-7777
Certified Application Counselors and Brokers/Agents are also available to assist.
Find a resource near you: https://localhelp.healthcare.gov
