the affordable care act (aca) which permanently reauthorizes the indian health service (ihs) makes several changes for the health care coverage of native americans. anyone with tribal membership is exempt from the “individual mandate”—the requirement to purchase insurance or pay a penalty. for those who choose to purchase insurance several options are now made available to native americans. american indians and alaskan natives may choose to receive coverage through ihs (as occurred before the aca); through medicare medicaid and chip (where eligible); or through health insurance exchanges. the aca allows tribes and tribal organizations to pay premiums on behalf of covered individuals in the exchanges. it prohibits cost sharing for native americans who earn below 300 percent of the federal poverty level ( $34 470 for one person and $70 650 for a family of four in 2013). any benefits paid for by tribes or ihs on behalf of an individual cannot be taxed as part of the individual’s income. any spending by ihs or a tribe on prescription drugs counts towards the individual’s medicare part d out-of-pocket threshold.
what coverage is available to native americans under the affordable care act?