Does Indian Health Service coverage meet the requirements of the individual mandate?

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indian-health-services-seal-200pxBy Michelle Andrews

Q. If our son is able to get healthcare from the local Indian Health Clinic, is he still required to get Obamacare insurance?

A. He may not be. Starting in January, most people have to have health insurance that qualifies as “minimum essential coverage” under the law or face a penalty.

Job-based health insurance, Medicare Part A, Medicaid and Tricare, the health program for members of the military and their families, all meet the standards for minimum essential coverage under the health law.

About 2 million American Indian and Alaskan Native tribe members receive health care at 600 Indian Health Service facilities around the country. But IHS services aren’t health insurance, nor do they meet the standards for minimum essential coverage.

However, members of federally recognized tribes are one of several groups exempt from the penalty for not having insurance. Others include people who can’t afford coverage or are experiencing a hardship, or those who have a short gap in coverage of less than three months.

In 2014, the penalty for not having insurance will be $95 or 1 percent of family income, whichever is greater. That amount will increase to $695, or 2.5 percent of income in 2016.

Members of Indian tribes who qualify can complete a form to apply for an exemption from the requirement to have insurance. The form is currently under development, according to an IHS spokesperson.

Please send comments or ideas for future topics for the Insuring Your Health column toquestions@kaiserhealthnews.org. We regret that we can’t respond to individual requests for health insurance advice or information. Please visit healthcare.gov to locate a health insurance expert in your area.

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

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