Giving access to care for our clients by building comprehensive plans requires that we look at any benefits that they may have access to and any ways we can assist them. If you have American Indian or Alaska Native clients, Medicare can be a confusing topic because of the benefits offered to them by the Indian Health Service.
The Indian Health Service (IHS), an agency inside the Department of Health and Human Services, is responsible for delivering federal health services to American Indians and Alaska Natives. Due to the special relationship between the federal government and Indian Tribes, CMS often has special rules working with the Indian Health Service, Tribes and Urban Indian programs (I/T/Us). The IHS provides a comprehensive health service distribution system for over two and a half million American Indians and Alaska Natives who belong to 574 federally recognized tribes. (https://www.ihs.gov/aboutihs/)
The IHS does not have a health plan or a set package of benefits. Instead, they offer access to programs of care. They are generally limited to primary care physician care only and other limited services. The services may be sufficient to address some medical conditions, and they may not manage others. Without Medicare and supplemental coverage, Medicare beneficiaries are exposed to Medicare’s out-of-pocket cost-sharing requirements unless receiving services from Indian Health Service, tribal entities, or Urban Indian Health Programs or through a Purchased/Referred Care referral.
Those who enroll in both the IHS and Medicare could be benefited by:
- Access to a broader range of healthcare within their community.
- Access to Medicare-approved care without having prior IHS authorization.
- Continued access to IHS pharmacies even if an individual purchases a Medicare Part D prescription drug plan.
- Additional Medicare-covered services not available through the IHS
- Access to healthcare when traveling.
- Continued access to all of the free IHS healthcare.
Detailed information, brochures, and fact sheets are on cms.gov at https://www.cms.gov/Outreach-and-Education/American-Indian-Alaska-Native/AIAN/Outreach-and-Education/medicare-for-american-indians-alaska-natives