Native American Community Services of Erie & Niagara Counties, Inc.


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What is the “The Affordable Care Act”
submitted by: Carmen Brown, Economic Self-Sufficiency Specialist

The Affordable Care Act (ACA), or “Obamacare”, is a relatively new law aimed at reforming the American health care system. It’s focus is on providing more Americans with access to low cost health insurance, improving the quality of health care and health insurance, watching over the health insurance industry, and lowering health care spending in the US. There is a lot involved in passing and putting into effect the ACA, a unique portion of which involves Native Americans. Throughout this article, we will cover the special affect the ACA has on the people of Turtle Island.

There has been a lot of talk about the Marketplace, or the exchange as it is sometimes called, especially relating to getting your taxes filed this year. The Shared Responsibility Payment is what some people who did not have health care coverage in 2014 will have to pay, though we will come back to that later on.

The Marketplace is a resource where individuals, families, and small businesses can go to learn about their health coverage options, a resource where they can compare health insurance plan costs, benefits, and other important features. The Federal government has a Marketplace at: www.healthcare.gov. New York State chose to do their own website so visit: www.nystateofhealth.ny.gov.

With putting the ACA into use, came the expansion of Medicaid and Children’s Health Insurance Program (CHIP). If you are not receiving health insurance from your employer, visit these websites to apply for either private insurance, or to apply for Medicaid and/or CHIP. However, the option of applying for health coverage over the phone, or by paper application is also available.

The deadline to have health coverage ended February 15 th of this year, marking the close of open enrollment for many Americans. However, the Indigenous people of America were exempt from this deadline, and can enroll in private health coverage any time of the year they choose, though limited to changing plans once a month. Medicaid has open enrollment, for anyone needing to apply, throughout the year.

Native Americans who are a member of a federally recognized Tribe, Alaskan Natives, or people otherwise eligible for services from an Indian health care provider through IHS are not required to have health insurance, and are exempt from having to pay the Shared Responsibility Payment when filing their taxes. You are able to use this exemption for the whole year, and qualify for an exemption for any month you had any of these statuses for at least 1 day or for the full year if you had the status all year. You can claim this exemption for yourself or anyone else on your federal tax return who qualifies.

A noteworthy portion of people included by this exemption I’d like to specifically talk about for a moment, are people eligible for services from IHS. This includes, but is not limited to, nonstatus or non-enrolled Indigenous people who are able to receive, or are receiving services from IHS.

Depending on where you go to file your taxes this year, you should have an exemption form filled out to make sure all your bases are covered. When filing at places like the free tax preparation sites run by volunteer income tax assistance (VITA) preparers, the systems they use already come pre-loaded with the correct exemption forms. You would just have to bring proof of Tribal affiliation for yourself, and people you are claiming. Visit: https://www.healthcare.gov/exemptio ns-tool/#/results/details/tribal to attain the forms necessary for filing, and answers to other tax specific questions.

All that said, if you had health insurance coverage for the entire year, you do not have to go through the process of applying your exemption, unless you would like to. Those who enroll in health insurance through the Marketplace, be it private or Medicaid, can continue to receive health care from Indian Health Service (IHS), tribes or tribal organizations, or urban Indian organizations (ITUs). Enrolling in the Marketplace adds to the pool of services available to you, and adds to the pool of resources available to the community. Indian health care providers can bill Marketplace health plans, referred to as Qualified Health Plans (QHP), or Medicaid for services provided to their patients and the reimbursements collected benefit the entire tribal community.

All QHP through the Marketplace offer a comprehensive package of items and services, known as essential health benefits (EHB):

  • Outpatient care you get without being admitted to a hospital (ambulatory patient services)
  • Visits to the emergency room
  • Hospitalization
  • Maternity and newborn care
  • Mental health, behavioral health, and substance abuse treatment
  • Prescription drugs
  • Rehabilitative and habilitative services and devices (such as physical, occupational, or speech therapies that help improve skills for daily living)
  • Laboratory services
  • Preventive and wellness services and chronic disease management (such as screenings, check-ups, and monitoring and coordinating treatment)
  • Pediatric services (including oral and vision care)

Qualified Health Plans come in four different “metal” levels: Bronze, Silver, Gold, and Platinum. Each plan will pay a different amount towards the total costs of your care.

A special protection that Native Americans can apply for is zero cost sharing or limited cost sharing when enrolling in a Qualified Health Plan. If your income is at or below 300% of the federal poverty level (see table provided), you could qualify for zero cost sharing. If you are above 300% of the federal poverty level, you could qualify for reduced cost sharing.

That would mean that you pay no out of pocket costs like copays, deductibles, and co-insurance. Due to this, Bronze and Silver level plans might be most beneficial to Natives because they have the highest out of pocket expenses, expenses that Natives can be exempt from paying.

However, this exemption from paying out of pocket costs does not apply for premiums, or the fees paid for coverage of medical benefits over a given timeframe. When applying for private health insurance through the Marketplace, you are responsible for paying the premiums. Based on your income, you might be able to apply for Advanced Premium Tax Credits (APTC) that can help pay part or all of your premium costs. Some Nations have elected to pay the premiums on behalf of their members, contact your Nation to see if that is something they will do.

This new legislation is a lot to take in, though we have not even touched on Medicare or CHIP yet! There are more articles to come in the future covering these largely confusing topics. However, if in the meantime you have any questions, please feel free to contact us here at NACS!

A great deal of the information gathered in this article comes from: http://obamacarefacts.com/, http://www.cms.gov/index.html, and http://www.ihs.gov/aca/.