The Indian Health Service (IHS) provide healthcare free of charge to Alaska Native and American Indian people. The agency offer a range of programs, such as physical rehabilitation, health education, and immunizations.
Although IHS benefits are relatively broad, they may not address the health conditions of every person.
Because of this, an individual may wish to enroll in Medicare to receive help paying for services not included in IHS coverage.
This article provides an overview of the IHS, explains how to enroll, and examines how the agency work with Medicare. It also provides an overview of Medicare, information on how to get help with costs, and instructions on how to register.
It also offers resources that may be of interest to Alaska Native and American Indian people.
We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:
- Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
- Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
- Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
The IHS fall under the Department of Health and Human Services. They are the primary federal agency offering healthcare to Alaska Native and American Indian people.
Around 2.6 million people who are members of 574 federally recognized tribes are beneficiaries of the IHS, and healthcare facilities are on or near reservations.
The IHS also contract with different healthcare providers to ensure that a broad range of care is available to those eligible for coverage. A person who receives healthcare through the IHS will generally pay nothing for it.
The IHS do not have a health plan or a set package of benefits. Instead, they offer access to programs that include:
- diabetes management
- behavioral health
- laboratory tests
- dental care
- health education
- physical rehabilitation
- prescription drugs
It is important to note that some services are limited. For example, primary care doctors, but not specialists, are available at IHS facilities. Surgery, skilled nursing care, and hospice care are also rarely available.
To be eligible for IHS healthcare, a person should:
- be able to show proof that they are part of a federally recognized tribe
- own restricted property or live on tax-exempt land
- be married to an eligible American Indian person
- be under the age of 19 years and a child of an American Indian person
- actively take part in matters relating to their tribe
An IHS healthcare provider will not deny individuals in need of urgent care should they not immediately be able to prove their eligibility. If a person is later unable to show eligibility, they may be responsible for all care costs.
A person who is interested in receiving healthcare from one of the clinics or hospitals within the IHS should first discuss their needs with their tribe and contact their chosen facility’s registration department with proof of eligibility.
The facility will let the person know if they should provide additional documents for registration, such as a medical record.
After an individual enrolls, they may schedule a medical appointment. They may also receive care through their tribal health program if their tribe has an agreement with the agency.
It is important to understand that the IHS are a healthcare provider rather than a health insurer, like Medicare.
The care that the IHS provide may not be sufficient to serve all eligible people. Also, although the services may be adequate to address some medical conditions, they may not be able to manage others.
For these reasons, an older adult who receives healthcare from the IHS may wish to consider enrolling in Medicare as well.
Individuals who enroll in both the IHS and Medicare have the following advantages:
- They have access to a broader spectrum of healthcare in their community.
- They may seek healthcare when traveling within the country.
- They may receive Medicare-approved care without having authorization from the IHS.
So, when enrolled in the IHS, a person may receive all the free healthcare they offer.
When a service is not available through the IHS, an individual may use Medicare, which pays part of the costs.
Both IHS and non-IHS providers who accept Medicare will usually bill Medicare directly, meaning that a person eligible for IHS services can visit either. People can also continue to use IHS pharmacies after purchasing a Medicare Part D prescription drug plan.
Before enrolling in Medicare, it helps to understand what the main programs cover. Below is an overview of each part:
- Original Medicare comprises Part A, which is inpatient hospital insurance, and Part B, which is outpatient medical insurance.
- Medicare Advantage, or Part C, is an alternative to original Medicare and provides parts A and B benefits. Most plans include prescription drug coverage, and some offer extra coverage, such as for dental and vision care. Private insurers administer these plans.
- Part D is a prescription drug plan that a person with original Medicare may obtain from a private insurance company.
- Medigap is Medicare supplement insurance that someone with original Medicare may buy. Private insurance companies also administer these plans.
According to the Kaiser Family Foundation, of the overall 10% of older adults with an income at or below the federal poverty level, 16% are Alaska Native or American Indian people.
However, help is available with the out-of-pocket costs associated with Medicare. For example, people can seek help through the following programs:
- Medicare savings programs help a person with limited means pay the out-of-pocket costs of original Medicare.
- Extra Help assists with Part D’s out-of-pocket costs and can save a person around $5,000 per year.
- Medicaid is a state-federal program that assists low income households with medical costs.
Aside from these programs, the IHS may help pay Part B monthly premiums for eligible individuals, and some tribes may pay parts B and D premiums for their members.
Medicare’s initial enrollment period is the 7-month period that begins 3 months before a person turns 65 years of age.
If an individual misses this enrollment period, they may sign up during the general enrollment period, which runs from January 1 to March 31, or the annual enrollment period, which runs from October 15 to December 7.
There are resources available at each step of a person’s healthcare journey.
To learn more about the IHS, a person can visit their website.
For more information about enrolling in original Medicare, a person can:
- visit their healthcare provider
- call Social Security at 800-772-1213
- visit the Social Security website
Other Medicare plans
To get more information about any Medicare program, a person can:
- visit their healthcare provider
- call Medicare at 800-633-4227
- contact their doctor, field nurse, or community health representative
Help and support
To find information or to apply for other assistance programs, a person can visit the following pages:
Older adults who are Alaska Natives or American Indians can benefit from enrolling in both the IHS and Medicare, as the two programs work well together.
Those who have both programs may use an IHS healthcare provider or a non-IHS healthcare provider.
Individuals with limited income and resources may be eligible for help from several sources. These include their tribes or certain Medicare programs, such as Extra Help or Medicaid.