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The Affordable Care Act/PPACA includes provisions designed to help improve health care for Native Americans across the United States. The Affordable Care Act and Marketplace proposed regulations provide some special arrangements for Native Americans, including the following:
Exemption from individual mandate penalty
Native Americans are exempt from the individual mandate penalty for failure to comply with the shared responsibility requirement to maintain minimum essential coverage. The Marketplace Exchange must verify Native American status and must certify Native Americans as qualifying for the individual mandate exemption.
SEP/Special enrollment period
A Native American may enroll in a qualified health plan (QHP) or change from one QHP to another one time per month.
Tribes and organizations
The Marketplace may permit Indian tribes, tribal organizations and urban Indian organizations to pay QHP premiums on behalf of qualified individuals, subject to terms and conditions determined by the Marketplace. Each Marketplace must consult regularly, on an ongoing basis with federally recognized tribes located within the Marketplace’s geographic area. Indian tribes, tribal organizations, and urban Indian organizations may be eligible to serve as marketplace/exchange navigators.
Health Plan Cost-sharing subsidies
The Affordable Care Act and Exchange proposed regulations specify that a QHP issuer may not impose any cost sharing on a Native American who has household income at or below 300 percent of the federal poverty level and is enrolled in a QHP on the individual market Exchange at any metal level of coverage. HHS will pay the QHP issuer the amount necessary to reflect the required increase in actuarial value.
Special cost-sharing rule Independent of income for Native Americans
If a Native American is enrolled in a QHP, a QHP may not impose any cost-sharing for services provided by the Indian Health Service directly, an Indian tribe, tribal organization, urban Indian organization or through referral for contract health services. This provision applies regardless of the individual’s income or metal level of coverage.