How Do Indian Health Services and Medicare Work Together?

IHS is a program of the federal government and the Department of Health and Human Services that provides free medical care to registered members of federally recognized Native American and Alaskan Native tribes.

Across the country, IHS operates:

• hospitals
• health centers
• health clinics

Additionally, IHS provides funding for healthcare and acts as a healthcare advocate for Native Americans.

IHS is not insurance. You can’t use IHS care anywhere but an IHS facility. It doesn’t provide coverage for care at any other provider.

Plus, not all services can be performed at IHS facilities. According to IHS, federal funding covers about 60 percent of the care Native American and Alaskan native people need.

Fortunately, you can use other healthcare plans alongside the care you receive from IHS. If you’re eligible for Medicare, you can use it to get care beyond the services provided by IHS.

You can keep seeing the same doctors at your IHS provider when you enroll in Medicare. All IHS providers will accept Medicare.

Plus, you can use Medicare to get expanded services like specialist visits and services your IHS facility isn’t able to provide. Using Medicare can also help when you’re traveling or when you don’t live near an IHS facility.

You can choose the parts of Medicare that work best for you. The parts of Medicare include:

• Medicare Part A. Medicare Part A is hospital insurance. You can use it to receive inpatient care in a hospital or long-term care facility. You can use Part A at an IHS hospital or any other available hospital.
• Medicare Part B. Medicare Part B is medical insurance. You can use it to see a doctor, visit urgent care, get a medical test, or get medical equipment in your home. Part B will cover your costs to see your doctor at an IHS facility and see specialists when you need to.
• Medicare Part C (Medicare Advantage). Medicare Advantage plans cover everything that Medicare parts A and B do. They also often include additional coverage for things like dental care, vision care, and prescription drug coverage. Just like with parts A and B, you can use an Advantage plan to get care at an IHS facility or at a facility outside of IHS.
• Medicare Part D. Medicare Part D is prescription drug coverage. You can use it to get your prescriptions at an IHS pharmacy or another pharmacy that’s convenient for you.
• Medicare supplement (Medigap). A Medigap plan is designed to cover the costs of using parts A and B that would normally fall to you, like copayments or deductibles. Medigap plans can make getting care more affordable.

Care at an IHS facility is free if you qualify.

You can also get Medicare coverage at a low cost to you. Your costs for Medicare depend on your income.

However, many people who use IHS are eligible for Medicare savings programs. These programs can help reduce the cost of your:

• Part A premiums
• Part B premium
• Part D premiums
• Part A deductible
• Part B deductible
• any Part D deductible you have
• copayments and coinsurance amounts

In 2020, you can qualify for a Medicare savings program if you make as little as $1,084 a month as an individual or $1,457 as a married couple, depending on the program you choose or qualify for. These income amounts may change for 2021.

Several types of income that people who qualify for IHS might receive don’t count toward this income calculation. This includes:

• distributions from the Alaska Native Claims Settlement Act of 1971
• trust or reservation property distributions
• hunting, fishing, or other natural resources income
• the sale of cultural/subsistence property
• Bureau of Indian Affairs or tribal student financial aid
• income under IRS general welfare doctrine

If you don’t qualify for a Medicare savings program you’ll pay the standard amount to use Medicare alongside your IHS care. As of 2021, those costs are:

• Medicare Part A. Most people receive Part A without paying a premium. There’s a deductible of $1,484 before coverage begins. There’s no coinsurance on your first 60 days of hospital or nursing care in any benefit period but starting on day 61, you’ll pay $371 per day and after day 90, you’ll pay $742.
• Medicare Part B. There’s a premium of $148.50 for Part B. Part B also has a deductible of $203. After your deductible, you’ll pay a coinsurance of 20 percent of the Medicare-approved cost of all services you receive.
• Medicare Part C (Medicare Advantage). Medicare Advantage plans are offered by private insurance companies and overseen by Medicare. Your costs — including premiums, deductibles, and copays — will depend on the plan you chose. You can often find Medicare Advantage plans at a very low cost.
• Medicare Part D. Like Medicare Advantage plans, Part D plans have their own costs. Your costs will depend on the plan you choose. Low costs plans are available in most areas.
• Medicare supplement (Medigap). Medigap plans have premiums that are set by the companies offering them. Your costs will depend on the Medigap plan you choose and the company offering it.

You can compare costs for Medicare Advantage plans, Medicare Part D plans, and Medigap plans near you by using the Medicare website.

You’re eligible for IHS if you’re a registered member of a federally recognized Native American or Alaskan Native tribe. You can show eligibility in a few different ways, including:

• You have a membership or are enrolled in a federally recognized tribe or group under federal supervision.
• You live on tax-exempt land or own restricted property.
• You actively participate in tribal life.
• You have any other reasonable factor that proves Native American or Alaskan Native descent.

If you’re eligible for IHS, some members of your family will also be eligible. This includes:

• your children, including adopted children and step-children who are under age 19
• your spouse

IHS care is also available for pregnant women during their pregnancy if they’re carrying the child of an IHS eligible person and for household members of IHS eligible people if an infectious disease is present in the household.

Medicare eligibility is the same whether or not you use IHS. You can become eligible for Medicare in a few different ways:

• turning 65 years old
• being diagnosed with a disability makes you eligible for Social Security Disability Insurance (SSDI) benefits for at least 2 years.
• being diagnosed with end-stage renal disease (ESRD)
• being diagnosed with amyotrophic lateral sclerosis (ALS)

You can enroll in IHS by going to the patient registration office of your local IHS facility. You’ll need to present proof of your tribal membership to enroll.

You need to enroll in person at an IHS facility. There’s no option to enroll by mail or online at this time.

Your steps for enrolling in Medicare depend on how you become eligible. In some cases, you’ll be enrolled automatically. This includes when you:

• are receiving Social Security retirement benefits and turn 65 years old
• are receiving Railroad Retirement Board benefits and turn 65 years old
• have been receiving SSDI for 24 months
• are diagnosed with ESRD
• are diagnosed with ALS

You’ll receive your enrollment information automatically in the mail. You’ll also be able to choose a Medicare Advantage, Medicare Part D, or Medigap plan at this time.

You can apply through the Social Security Administration if you’re not automatically enrolled. You can do this in one of four ways:

• online
• by phone at 800-772-1213
• visiting your local Social Security office
• sending a letter to your local social security office stating your name, date of birth, and intent to enroll

You might need to provide some information when you apply.

In some cases, Social Security might already have all the information they need. In other cases, you’ll need to provide information about:

• your age
• your citizenship
• your income
• any military service you’ve had

Medicare enrollment dates

• Initial enrollment period. This is a 7-month window around your 65th birthday when you can sign up for Medicare. It begins 3 months before your birth month, includes the month of your birthday, and extends 3 months after your birthday. During this time, you can enroll in all parts of Medicare without a penalty.
• October 15–December 7 (open enrollment period). During this time, you can switch from original Medicare (parts A and B) to Part C (Medicare Advantage), or from Part C back to original Medicare. You can also switch Part C plans or add, remove, or change a Part D plan.
• January 1–March 31
  • General enrollment period. You can enroll in Medicare during this time frame if you didn’t enroll during your initial enrollment period.
  • Medicare Advantage open enrollment. During this period, you can switch from one Medicare Advantage plan to another or go back to original Medicare. You can’t enroll in a Medicare Advantage plan if you currently have original Medicare.
• April 1–June 30 (Part D enrollment/Medicare add-ons). If you don’t have Medicare Part A, but you enrolled in Part B during the general enrollment period, you can sign up for a Part D prescription drug plan.
• Medigap enrollment. This 6-month period starts after the first day of the month that you apply for original Medicare or from your 65th birthday. If you miss this enrollment period, you may not be able to get a Medigap plan. If you do get one later, you may pay higher premiums for it.

• Medicare coverage can supplement the care you receive through IHS.
• Using Medicare can allow you to see specialists, seek care outside of IHS, and get services that IHS doesn’t provide.
• You can use your Medicare coverage at an IHS facility, so you don’t have to worry about switching doctors.