Choctaw Nation of Oklahoma

The Great Seal of the Choctaw Nation

Affordable Care Act, Medicare and Medicaid and How It Affects You


There are more than 50 million Americans in the United States that do not have any form of insurance and tens of millions of Americans that are underinsured. Due to this dilemma, on March 2010 President Obama signed into law the Affordable Care Act. It mandates that every American have health insurance coverage or face a new health tax penalty for not obtaining insurance beginning January 1, 2014.

There are exemptions within the law that would allow some to be exempt from the mandatory insurance requirement/health tax penalty. The first exemptions include individuals that already have health insurance coverage such as: employer-sponsored coverage, Medicare and/or Medicaid, Veterans health benefits and/or TRICARE. The next types of exemptions are for individuals who cannot afford insurance coverage based on federally determined poverty level calculations; those incarcerated; or members of recognized religious sects. The last exemption is very important to know and understand for OUR tribal members; members of federally recognized Indian tribes. In order to be federally recognized, you and all members of your family MUST obtain a CBID card as well a tribal membership card prior to January 1, 2014. Some Native Americans (those without a federally recognized tribal membership and only possess a CDIB card) will have to request a hardship waiver as “proof” of Native American ancestry in order to be considered exempt from the mandatory insurance requirement and prevent future health tax penalties on future income tax returns.

The Affordable Care Act will provide many services to include the following:
• Creates the Health Insurance Marketplace, a new way for individuals, families, and small businesses to get health coverage,
• Requires insurance companies to cover people with pre-existing health conditions,
• Holds insurance companies accountable for rate increases,
• Makes it illegal for health insurance companies to arbitrarily cancel your health insurance just because you get sick,
• Protects your choice of doctors,
• Covers young adults under 26,
• Provides free preventive care,
• Ends lifetime and yearly dollar limits on coverage of essential health benefits,
• Guarantees your right to appeal.

When you get health insurance coverage in the Marketplace, you may be able to get lower costs on monthly premiums. This depends on your income and family size. Enrollment will begin October 2013 and ends March 2014. The Marketplace Exchange can be very beneficial as it can give tribal members a safety net back-up plan for services Choctaw Nation Health Services are unable to provide to include certain surgeries or medications. The best part is that certain tribal members who purchase health insurance through the Marketplace Exchange do not have to pay co-pays or other cost-sharing if their income is under 300 percent of the federal poverty level, which is roughly $66,000 for a family of four (83,000 in Alaska). For those who choose not to enroll or provide membership of a federally recognized tribe will face tax penalties that in 2014 will be $95 per family member and by 2016 will be $695 per family member. Do not delay so you will not have to pay unnecessary tax penalties.

Medicaid offers free insurance to those that qualify by age, blind and/or disabilities, pregnant women and children based on state income and resource guidelines. Often patients believe they might not qualify for this health care coverage and never apply. Each Choctaw Nation health facility has trained personnel that can assist with most types of enrollment and patients can know immediately see if they meet the requirements for this benefit. Patients should speak with a Benefit Coordinator and see if this free health insurance is available for them!

Medicare open enrollments are just around the corner based on eligibility. To be eligible for Medicare one must be a US citizen that is 65 or older, under age 65 and disabled or any age with ESRD. There are four parts of Medicare: Part A covers hospitalization, skilled nursing facilities, home health and hospice. Part B covers physician services, ambulance, durable medical equipment/supplies and other services not paid under Part A. Part C replaces the traditional Part A/Part B Medicare and is ran by private insurance companies and finally Part D covers pharmacy prescription drugs. Penalties are charged to patients for not enrolling in Medicare coverage when they first become eligible, so do not delay and speak any of our Benefit Coordinators at your local Choctaw Nation Clinic or our Medicare or Medicaid Specialist with any questions or concerns you may have.

Open enrollment for Medicare Part D begins October 15th-December 31st. Patients can sign up for Medicare Part C from October 5th- December 31st if they already have Medicare benefits and want to change from ‘traditional’ Medicare to a private insurance plan acting as Medicare. A second open enrollment runs January 1-February 14 which allows those on a Part C plan that want to make changes and/or go back to ‘traditional’ Medicare coverage. If you didn’t sign up for Part A and/or Part B when you were first eligible, you can sign up during the general enrollment period between January 1– March 31 each year.

Many of the changes will not only affect our elders, but our younger working age and children tribal members. We need your help, by being informed of all the health care changes you can discuss and advise your family members and friends so that all of our tribal members can make informed important health care decisions in the upcoming months!