888-765-5400The ACA and American Indians & Alaska Natives
Executive Brief
Prepared by BCBSNC Health Policy Office
Overview
The Affordable Care Act (ACA) changes the very foundation of the way health insurance is purchased with the introduction of public health insurance Exchanges, a standardization of health insurance plans, and the creation of new financial assistance programs call subsidies. Each American may have a different experience with many of the reforms depending on factors such as their income, health status, and how they currently obtain their insurance. One group that received special attention under the ACA are American Indians and Alaska Natives (AN/AIs). Of particular note to health insurance issuers is the fact that these groups will have unique rules regarding subsidies and enrollment.
Subsidies
Two types of subsidies exist under the ACA: premium tax credits and cost-sharing reductions. Only available through the public Exchanges, the premium tax credits reduce the cost of the premium to individuals and families while the cost-sharing reductions reduce the out-of-pocket costs once a member has enrolled. For AI/ANs, the premium tax credits are applied just like anyone else who qualifies on the Exchange. However, the cost-sharing reductions have been modified for AI/ANs. For most individuals without access to other affordable coverage, the cost-sharing reductions are available on a sliding scale for low-income people only through the second tier of plans on the Exchange (called “Silver”). However, for AI/ANs, the cost-sharing reductions are available for a slightly broader group, income-wise, and reduce the out-of-pocket costs for in-network services for essential health benefits (the standard package of benefits in a given state) to zero. They are also available on any plan at any tier on the Exchange (not only the Silver).
In the case of AI/ANs who fall above the income threshold for no cost-sharing responsibility, they may enroll in any standard plan offered on the Exchange and receive standard benefits in-network. However, if any AI/AN goes to certain Indian health programs (IHS, tribal, and urban) to receive services, those services will be provided at no cost-share to the AI/AN member.
Enrollment
Another difference for AI/ANs is when they can enroll in coverage. For most people, they must enroll in coverage during the annual enrollment period (AEP) or be locked out of coverage for the year. The only way an individual would qualify to enroll outside the AEP would be when a special event occurred (such as a birth, death, marriage, divorce, etc). Conversely, AI/ANs have the ability to change their enrollment up to once a month at anytime during the year.
Concluding Thoughts
It is important to remember that AI/ANs also benefit from the myriad changes in the ACA that are available to most Americans, including covering certain preventive screenings at no cost-share, removing annual and lifetime limits, and providing tax credits for small businesses. Yet these groups also benefit from provisions that expand many of the ACA benefits, especially in terms of subsidy applicability and enrollment processes. As such, it is recommended that AI/ANs should consider their options carefully when purchasing plans in the future.
This information has been prepared by Blue Cross and Blue Shield of North Carolina (BCBSNC) to assist our customers in understanding Health Care Reform, also known as the Affordable Care Act.
This publication is for information purposes only. It is not legal or tax advice and is not contractually binding on BCBSNC. Please consult with your attorney or tax advisor for further advice. As regulations and other interpretive guidance are published, this information may change. We will continue to work with our customers going forward to provide updates and further assistance. For specific benefits and contractual obligations, refer to the BCBSNC benefit booklet and/or contract with BCBSNC.
For more information on health insurance coverage in North Carolina, please visit our website at www.nchealthplans.com or call our toll free number 888-765-5400 and speak with one of our professional agents. Our agency provides coverage for health insurance in North Carolina through Blue Cross Blue Shield of North Carolina (BCBSNC). It would be our pleasure to help you navigate through the Health Care Reform changes in accordance with the new regulations of Obama care. Call us for details.