Native Americans and Alaskan Natives have access to health coverage through the Indian Health Services or IHS. IHS has facilities in 36 states and is a healthcare advocate for both Alaskan Natives and Native Americans.

What most don’t realize is that IHS is not medical insurance, and you can only receive care from an Indian Health Services facility. This means you should also have some form of health insurance to have complete coverage.

Today we’ll discuss what Indian Health Services does and how Medicare and its options can work with it. Then we’ll discuss the costs associated and what’s covered. Finally, we’ll discuss IHS and Medicare eligibility, answer a few common questions, and show you how to get help with your healthcare options.

Indian Health Services

First, we’ll take a few minutes to go over what exactly IHS is and how it works.

IHS provides free health care and medical treatments to members that are registered to federally recognized Alaskan Native and Native American tribes. Indian Health Services is administered by the Department of Health and Human Services.

Indian Health Services facilities include hospitals, health clinics, and health centers.

As mentioned above, IHS isn’t insurance. It can be used anywhere that has an Indian Health Insurance facility. You will have no coverage if you seek care at any location that is not deemed an IHS facility.

It’s also important to understand that not all medical services can be obtained in an IHS facility. Only about 60% of healthcare is covered. This is why enrolling in additional health insurance that can be used alongside IHS coverage is important.

Medicare and Indian Health Services

All Indian Health Services facilities accept Medicare. This allows you to continue seeing the providers you’re familiar with. Once you add Medicare, you can receive services that aren’t included in your IHS coverage. It will also add protection when you are not close to an IHS facility and need health care services.

Medicare Part A, Medicare Part B, and Indian Health Services

Medicare Part A is the hospital insurance and inpatient services of Medicare. This will provide you coverage nationwide for these services. Medicare Part B is your doctors, outpatient, and medical services.

When using Medicare at an Indian Health Services provider, Medicare pays them. That saves the IHS money that can be used for other tribal services.

Medicare Part C and Indian Health Services

Medicare Part A is called Medicare Advantage. These plans combine the benefits from Medicare Part A, Medicare Part B, and in most cases Part D into a convenient all-in-one plan. They often include additional benefits not covered by Medicare, such as dental, vision, and hearing coverage.

The benefits of Medicare Advantage plans will vary based on where you live and which plan you choose. These are network-based plans. You can see any doctor in the network. Some plans allow you to see out-of-network providers as well.

Since these are network-based plans, you should speak to your IHS doctor and facility to find out which plans they take. You can see other providers outside of the IHS with a Medicare Part C plan.

Medicare Part D and Indian Health Servies

Medicare Part D is your prescription drug coverage for drugs you get from the pharmacy. You can get your scripts from any participating pharmacy, including your IHS pharmacy.

You should check with your IHS pharmacy to see which plans they take. This way, the Part D plan can pay them, saving the IHS funds that can be allocated elsewhere.

Medicare Supplements and Indian Health Services

Medicare Supplement plans offset your cost-share associated with Original Medicare. These plans are also called Medigap. While these plans won’t do much for you at an IHS facility, They help immensely with the out-of-pocket costs left to you from traditional Medicare outside of the Indian Health Services.

The Federal government standardizes these plans and the coverage will be the same regardless of the insurance company you choose or where you live. These plans are the most comprehensive and thus the most expensive.

Costs of Medicare at an Indian Health Services Facility

Medicare or your Medicare Advantage plan will cover your costs at an Indian Health Services facility. You shouldn’t be paying any costs at the IHS facility, such as copays, coinsurance, or deductibles. Some Medicare insurance plans have monthly premiums associated with them.

Many people that qualify for IHS coverage also qualify for Medicare Savings Programs. These programs help with some of the costs of the different parts of Medicare. Some examples include your Medicare Parts B, C, or D premiums, copays, coinsurance, and Part D deductibles.

Medicare Savings Programs are based on income. Listed below are certain incomes for Native Americans and Alaska Natives that don’t count as income for qualification purposes:

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

Eligibility for Medicare and Indian Health Services

To be eligible for Indian Health Services you must show you’re a member of a federally recognized tribe. There are a few ways you can show this documentation.

  • Actively participate in tribal life.
  • Living on tax-exempt land or your restricted property.
  • Have a membership or are enrolled in a federally recognized tribe or group under federal supervision.
  • Any other reasonable factor that proves Native American or Alaskan Native descent.

If you are eligible, certain family members will also be. This includes children, including adopted children and step-children age 19 or under, and your spouse.

Pregnant women can be covered during their pregnancy if they’re pregnant with the child of an individual eligible for Indian Health Services. If an infectious disease is present in the household, any person living in a household with IHS is eligible.

Medicare eligibility is the same as it is for non-IHS members.

You’re eligible for Medicare when you turn 65 years old or under 65 diagnosed with a disability that gives you eligibility for Social Security disability for at least two years. You can also qualify for certain health conditions such as end-stage renal disease or amyotrophic lateral sclerosis.

Enrolling in Indian Health Services

Once you have verified you meet the eligibility requirements for Indian Health Services, you need to contact your patient registration office.

They will assist in your registration and let you know if there are any additional documents you need to get started with your Medical records. Once that’s completed, they’ll assist you in scheduling your first appointment.

You should be prepared to visit the Patient registration office in person. You’ll be expected to provide proof that you’re a member of a federally recognized tribe.

Enrolling in Medicare

Most people will be on Indian Health Services before starting Medicare.

Your Medicare will start automatically if you are already drawing Social Security the month you turn 65. If you’re on Social Security disability, your Medicare should start on the 1st day of your 25th month on disability. With Lou Gehrig’s disease, your Medicare will also start automatically.

If you’re not drawing social security benefits or have end-stage renal failure, you should apply online at Social Security’s website.

5 Facts about Indian Health Services

  1. IHS is not health insurance coverage – IHS is a federal government organization that provides health care to American Indians and Alaska Natives. It also provides funds for Indian urban and Tribal healthcare programs.
  2. People with IHS need additional Health Insurance – Indian Health Services doesn’t cover all medical needs. For example, coverage for specialists or coverage outside of IHS services.
  3. Your costs are little to nothing. Many American Indians and Alaskan Natives have income that allows them to have additional health coverage at little to no cost.
  4. Keep your same doctors — with IHS and a Medicare Plan, you’ll be able to receive care both at IHS facilities and at non-IHS facilities.
  5. Indian Trusts won’t keep you from qualifying for Medicaid, Extra Help, or Medicare Savings Programs. Income from selling basketwork, culturally significant jewelry, and payments from farming, fishing, and natural resources on Indian trust lands.

FAQs

How does IHS work with Medicare?

Yes, at Indian Health Service facilities and health care providers. If you have Medicare and IHS, you should have no costs with using IHS facilities. Medicare will pay the facility allowing Indian Health Services to use its funds in other places.

Who pays for Native American healthcare?

The Federal government funds the IHS health insurance program.

Is tribal drug coverage creditable for Medicare?

Indian Health Services is creditable drug coverage for Medicare Part D.

What is the process for getting IHS services?

Once you verify your eligibility, contact the Patient Registration Office. They can assist in enrollment in your IHS health plan.

What is the Indian Health Service?

Indian Health Services is health coverage for American Indians and Alaska Natives. If you are a member of a federally recognized tribe, you can qualify. You can only use this coverage at Indian Health Services facilities and providers.

What is the difference between Medicare and IHS?

Medicare is for Americans aged 65 or under 65 for certain health conditions. IHS is for Native Americans and Alaskan Natives of any age.

What are the benefits of IHS?

If you qualify for Indian Health Services, you will be able to receive Medical care from any IHS hospital, healthcare center, or healthcare clinic.

What are some of the benefits of tribal health benefits?

Indian Health Care services cover the following benefits:

  • Ambulatory
  • Audiology
  • Behavioral Health
  • Alcohol Abuse
  • Substance Abuse
  • Mental Health
  • Dental
  • Diabetes Management
  • Elder Care
  • Health Education
  • Immunizations
  • Inpatient Care
  • Laboratory
  • Optometry
  • Outpatient Care Pediatrics
  • Pharmacy
  • Physical Rehabilitation
  • Physical Therapy
  • Occupational Therapy
  • Speech-Language Pathology
  • Audiology
  • Prenatal Care
  • Radiology
  • Rehabilitation

Can you be eligible for both Medicare and Indian Health Services?

Yes! To be eligible for both, you must meet the eligibility requirements for both the Indian Health Services and Medicare.

To be eligible for IHS, you must:

  • Be a member of a tribe receiving federal recognition.
  • Be a spouse or child of a member of a federally recognized tribe
  • This includes adopted children under the age of 19
  • If you’re pregnant with a child of someone with IHS, the pregnancy receives coverage.
  • If an infectious disease is present in the household of an IHS member and you live there.

Getting Help with Medicare and Indian Health Services

We can assist you in choosing the right plan that works with your IHS benefits. Our agents can access your current needs and situation and provide comprehensive and affordable options to provide complete coverage for your needs.

There is no cost for our services, and our agents are experts in Medicare. They’ll listen intently to make sure you get what you want.

So give us a call, or fill out our online request form to find out more today!

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by Lindsay Malzone, Lindsay Malzone is the Medicare expert for Medigap.com. She's been contributing to many well-known publications as an industry expert since 2017. Her passion is educating Medicare beneficiaries on all their supplemental Medicare options so they can make an informed decision on their healthcare coverage.