Enhancements to the Affordable Care Act
General Resources
Enrollment Resources
Medical Assistance and MinnesotaCare
No. None of your access rights to I/T/U services have been changed by the Affordable Care Act or MNsure.
Under the ACA, plans within MNsure may require the payment of deductibles or co-pays. To increase access to care, American Indians have some unique protections and benefits. Enrolled American Indians and their descendants who are IHS-eligible do not have to pay for services they receive from an IHS, tribal or urban Indian Health care facility.
Zero-cost-sharing plans: American Indians enrolled in a U.S. federally recognized tribe who are above 200% of the federal poverty guidelines but below 300% and who enroll in a qualified health plan (QHP) through MNsure will have to pay premiums, but will not have to pay out-of-pocket costs (such as deductibles, co-pays and co-insurance) regardless of where they receive care.
Limited cost sharing: American Indians enrolled in a U.S. federally recognized tribe who are above 300% FPL but below 400% FPL and who enroll in a QHP through MNsure will have to pay for premiums and may have to pay cost sharing if they get service outside of an I/T/U facility. IHS/Tribal Contract Health Services funds may pay for cost sharing for CHS-eligible American Indians if CHS rules are followed.
Yes. Indian tribes, tribal organizations, and urban Indian organizations can be navigators, along with state or local human service agencies.
Benefits coordinators understand the health needs of their communities and, with appropriate training, would be well-equipped to help tribal members determine their best coverage options, including qualified health plans through MNsure or other available programs. The tribe chooses which employees would receive the navigator training.
Tribes and other Indian health care providers also believe that they should be allowed to have navigators who serve only American Indians without running into conflict of interest. This does not prevent other navigators from serving American Indians, but rather acknowledges that tribes and IHS are prohibited from serving non-Indians in their federally funded programs.
Minnesota supports tribal sponsorship which means that Indian tribes, tribal organizations and urban Indian organizations can elect to pay premiums on behalf of American Indians who obtain health insurance through MNsure. Questions regarding sponsorship should be directed to I/T/U health care facilities.
If you have health insurance through your employer or have health care through a government-sponsored program, for example, Medicare, Medical Assistance, MinnesotaCare, or other programs such as VA or TRICARE, there is nothing you need to do—you are covered.
Yes. Access to coverage through your employer does not bar your family members from enrolling in coverage through MNsure. Family members who have access to employer-sponsored coverage might be eligible for premium tax credits if the employer-sponsored plan does not meet the minimum value or affordability test provided in the ACA.
Yes. Generally, loss of employer-sponsored coverage is a qualifying life event for a special enrollment period. See more information on life events here.
Yes. If you are not eligible for Medicare and are over 65 years of age, you might be able to purchase coverage through MNsure. For questions related to Medicare eligibility and your coverage options, contact the Senior LinkAge Line at 1-800-333-2433.
No. Gaming per capita payments are taxable and must be included in your MAGI.
Many American Indians in Minnesota are covered by Contract Health Services/Purchased or Referred Care (CHS/PRC) through their IHS/tribal health care program. All rules regarding referrals must be followed for payment to be made. Those American Indians who do not have access to CHS/PRC will be financially responsible for services they receive unless they are insured through either a public or a private health care plan.
Certain categories of income are treated differently depending on which program you are eligible for. For purposes of Medical Assistance and MinnesotaCare, the following categories of income may be excluded from an Indian's MAGI:
Yes. Though non-tribal members are not eligible for this monthly SEP on their own, effective October 1, 2015, MNsure allows family members who apply for coverage with a qualifying tribal member to take advantage of the monthly SEP along with the qualifying tribal member. If you, as a qualifying tribal member, choose to enroll in a qualified health plan or change plans using the monthly SEP, then your family members can enroll in or change plans as well.
Effective October 1, 2015, MNsure allows family members who apply for coverage with a qualifying tribal member to enroll in or change QHP in any month that the qualifying tribal member exercises the monthly SEP by enrolling in or changing QHPs. Remember, during open enrollment all household members can enroll or change plans for the coming coverage year.
No. In order to continue your 100% CSR benefit you cannot enroll a non-tribal member on your plan. You can enroll your non-tribal dependent in their own QHP and they can still receive any CSR benefit they may qualify for themselves. Please call the MNsure Contact Center for more information about this option.
Mixed-tax households have complicated eligibility determinations that need to be carefully considered. Spouses and children of mixed-tax households might benefit from various levels of public assistance. Questions may be directed to navigators or certified application counselors who are familiar with American Indian issues, or to the American Indian specialist at the MNsure Contact Center.
No, Starting January 1, 2019, the requirement to have health insurance ("individual mandate") is no longer in effect.
Up until this date, members of federally recognized tribes and AI/ANs and their descendants who are eligible to receive health care at an IHS/tribal facility were exempt from this requirement.
Yes. An exemption from the shared responsibility rule does not prevent AI/ANs from enrolling in a qualified health plan through MNsure, Medical Assistance, or MinnesotaCare, and they might qualify for certain protections under Medical Assistance or MinnesotaCare, or might qualify for tax credits and cost-sharing reductions, if eligible. (Note that the shared responsibility rule is no longer in effect starting 2019, therefore, you will not need to apply for an exemption for 2019 coverage.)
You may be eligible for special benefits through Medical Assistance and/or MinnesotaCare if you qualify for one of these programs.
Yes. If you enroll in a plan that does not list your I/T/U clinic as a provider, you can continue to go to your local Indian health provider. Tell your clinic about your insurance and show them your insurance card.
If you have a limited cost-sharing plan, then you need to get a referral from your Indian health clinic so you will not have to pay co-pays or deductibles when you go somewhere else. If you have a zero cost-sharing plan, you do not need a referral from your Indian health clinic, and you may go to any provider without having co-pays or deductibles.
Enrolled members of U.S. federally recognized tribes must be able to verify their enrollment {Source: 45 CFR section 155.350 (c)}. Enrolled members can provide MNsure with a copy of one of the following documents to verify their tribal enrollment.
To verify status as an I/T/U beneficiary, descendants will be required to provide proof from an I/T/U health care facility.
