Are you exempt from the Affordable Care Act because you are a citizen of a federally recognized tribe?


February 10 2014

Written by LCDR Amy Eden, Muscogee (Creek) Nation, Department of Health


The Affordable Health Care Act Health Care Coverage for the American Indian and Alaska Native

OKMULGEE, Okla. – Health Insurance coverage has not always been a familiar term within Indian Health Country.  The unfamiliarity could be linked back to treaties made in 1787 between federally recognized Tribes and the United States Government.  The treaties obligated the United States Government to provide health care services to Tribal members at no cost to the patient, in exchange for land that belonged to the Tribes.  Due to this obligation, there was no apparent reason for an American Indian or Alaska Native to purchase any additional health insurance coverage.

Over the years, Indian Health has significantly grown along with the rest of the health care industry; and unfortunately the U.S government has not always been able to provide the appropriate amount of funding that is needed.  In 1998, the Indian Health Care Improvement Act, P.1.94-437, authorized the Indian Health Service, Tribal Health and Urban Indian Health, (I/T/U) the ability to bill and collect third party reimbursement for the services provided to the patient.  This reimbursement from insurance companies has created a dependable, sustainable revenue stream, which is directly placed back into the Muscogee (Creek) Nation health care system; which helps pay for additional equipment and services for the patient population.

Since ITU’s have had the ability to bill, they highly encourage their patient load to apply for health care Insurance coverage.   Although, before now, due to either the high financial expense or a pre-existing condition, the percentage of patients that carry health insurance coverage has been minimal in comparison to the patient population.

The Affordable Health Care Act also known as Obama Care, is a law that is intended to reform the health care industry as we know it.  It provides the American population affordable options when purchasing a health care coverage plan.  It also provides the American Indian/Alaska Native population the option of using a health care coverage plan rather than using the Contract Health Service; which could potentially run low on funding and not be available to cover health care service charges, which would mean that the charges would then become the patients’ responsibility.

There are special provisions for the American Indian and the Alaska Native population when they enroll in health insurance coverage through the marketplace, such as;

  • No out of pocket costs like deductibles, copayments and coinsurance if the income is around $70,650 for a family of 4 ($88,320 in Alaska).
  • Can enroll in Marketplace health insurance any month, not just during the yearly open enrollment period.
  • Can begin and continue to receive health care services at any Indian Health Service including Tribal Health or Urban Indian Health Facilities.
  • Can get services from any providers listed on the Marketplace Insurance Plan
  • The Affordable Health Care coverage plans can be found on a web based portal called the Marketplace.  There are four ways to apply for a Marketplace health care coverage;
  • On-line at
  • Telephone at 1-800-318-2596; available 24 hours a day 7 days a week

Can download and print the application at and mail to

Health Insurance Marketplace
Dept. of Health and Human Services
465 Industrial Blvd.
London, KY 40750-0001


Although the Affordable Health Care Act provides affordable health care coverage, there are still some that prefer not to enroll into a health care coverage. For the American Indian/Alaska Native population there is an exemption from having to obtain health care coverage, it is based upon Tribal citizenship. There are two ways that a Federally Recognized American Indian can file for exemption.

Claim the exemptions when you fill out your 2014 federal tax return, which is due by April 15, 2015 (make sure you have your CDIB or your Tribal Citizenship Card available, they need the information from one or the other)

Fill out an exemption application in the Health Insurance Marketplace (if you would like to fill this application out, you can download it from, or you can call Amy Eden at (918)756-4333 ext. 315 and request an application be mailed to you)

The State Recognized American Indian population is required to file for this exemption only by filling out the application; they do not have the option of waiting until they file their 2014 Income Taxes.

If there is anyone that would like assistance with filling out the exemption application or just have any questions in general, you can contact any of the Patient Benefit Coordinators at any of the Muscogee (Creek) Nation health facilities.  You can also contact LCDR Amy Eden at (918)756-4333 ext. 315.

Get your exemption form HERE.