American Indians and the Affordable Care Act

The Act contains special provisions for American Indians and Alaska Natives.

The Affordable Care Act (ACA) has specific provisions for American Indians and Alaska Natives. Some of these benefits are effective if you are a member of a federally recognized tribe. Other benefits are available to people of Indian descent or who are otherwise eligible for services from the Indian Health Service, tribal program or Urban Indian Health Program.

If you are a member of a federally recognized tribe you are exempt from the insurance mandate. That means if you decide you do not want to purchase health insurance, you do not have to and you will not be charged a penalty. If you change your mind at any time you may enroll for coverage through the Health Insurance Marketplace during any month, not just during the annual open enrollment period. You may also opt to change your healthcare plan at any time, not just during the open enrollment period.

Members of federally recognized tribes who purchase health insurance through the Marketplace do not have to pay co-pays, deductibles or other cost-sharing, such as co-insurance if their income does not exceed 300 percent of the federal poverty level (about $70,650 for a family of four).

There are special cost and eligibility rules for American Indians, Alaska Natives and others who are eligible for services through the Indian Health Service or an Urban Indian Health Program. These special provisions make it easier for these individuals to qualify for Medicaid and the Children’s Health Insurance Program (CHIP), which is called MIChild in Michigan.

If you are American Indian or Alaska Native and you decide not to enroll in health insurance you are exempt from paying the fee that will be charged to most other people who decide to opt out of health insurance.

The ACA has also reauthorized the Indian Health Care Improvement Act permanently. This act, which was originally enacted in 1976, authorized Congress to fund healthcare services for American Indians and Alaska Natives through the Indian Health Service. New programs will also be added to Indian Health Service as a result of the ACA.

To learn more about these unique provisions of the ACA, go to or call 1-800-318-2596 (TTY 1-855-889-4325).

Michigan State University Extension offers consumer education about making healthcare choices in the Health Insurance Marketplace. Through Smart Choice Health Insurance participants will determine what they want from health care providers, compare healthcare plans, determine the cost of the plans and will apply what they learn to make the right choice in healthcare plans for them. For more information visit

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