 [ Symptoms ] what coverage is available to native americans under the affordable care act [ Disease ] 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 is income any spending by ihs or a tribe on prescription drugs counts towards the individual is medicare part d out of pocket threshold