ELDERS

IF YOU HAVE MEDICARE, THERE IS NOTHING YOU NEED TO DO.

Most people over 65 years old have Medicare. If you have Medicare Part A, you meet the insurance requirements under the Affordable Care Act (ACA). You will not have a tax penalty. There’s nothing you need to do.

IF YOU HAVE OTHER HEALTH INSURANCE, THERE IS NOTHING YOU NEED TO DO.

If you do not have Medicare Part A, you can still meet the insurance requirements under ACA if you have Medicaid, employer-sponsored insurance, and most types of Veteran’s Administration (VA) insurance. You will not have a tax penalty. There’s nothing you need to do.

 

IF YOUR INCOME IS TOO LOW TO PAY TAXES, THERE IS NOTHING YOU NEED TO DO.

Some elders have income so low that they do not have to pay federal income tax. If you do not need to pay federal income tax, you will not have a tax penalty for not having insurance. There is nothing you need to do.

IF YOU HAVE ONLY INDIAN HEALTH CARE AND NO OTHER INSURANCE, YOU NEED TO APPLY FOR AN EXEMPTION FROM THE TAX PENALTY.

If your income is high enough to pay taxes and you do not have insurance, you need to get an exemption from the tax penalty for not having insurance. There are two types of exemptions from the tax penalty for American Indians and Alaska Natives:

1. Indian Exemption
The Indian Exemption is for people who are enrolled members of federally-recognized Tribes or shareholders in an Alaska Native Regional or Village Corporation. You can claim the Indian exemption when you file your federal income tax at the end of the year, or you can get a certificate of exemption from your state Marketplace.

2. Hardship Exemption for IHS Beneficiaries
This hardship exemption is for people who use, or are eligible to use, the Indian Health Service, a tribally-operated clinic, or an urban Indian clinic (called I/T/U). You must apply through the Marketplace in your state for a certificate of exemption.

CONFUSED BY THE MAIL YOU ARE GETTING ABOUT HEALTH INSURANCE?

Both Medicare and the Marketplaces have open enrollment periods that start on October 1. Open enrollment periods occur near the end of the year when people pick their health insurance plans for the following year. Many insurance companies advertise their Medicare Advantage plans (Medicare Part C) during this time. This is not the same as the Marketplaces created by the Affordable Care Act.

Medicare

Medicare is a federal health insurance program for people over 65 years old. There are four parts of the Medicare program:

Part A -
hospital services

Part B -
doctors and other services provided outside hospitals

Part C -
Medicare Advantage, a managed care plan that includes Parts B and D.

Part D -
Prescription drug benefits

Medicare Part A does not have any premium. Parts B, C and D have premiums. All of the Medicare parts have some form of cost sharing, such as deductibles, co-pays or co-insurance. Medicaid programs for low income Elders can help pay the premiums and cost sharing in Medicare.

SOME PEOPLE DO NOT QUALIFY FOR MEDICARE.

Some American Indian and Alaska Native Elders do not qualify for Medicare because they have not worked in jobs that paid into Medicare. Some Tribes consider people to be Elders who are younger than 65 years old and Medicare coverage starts after 65 years old.

If you do not qualify for Medicare and you want health insurance, you may have some options. The single application on the Marketplace will let you know if you qualify for Medicaid. The traditional Medicaid program covers low income elders. (Medicaid Expansion, the new program under ACA for adults, does not cover people over 65 years old.)

Elders who do not qualify for either Medicare or Medicaid may purchase insurance in the Marketplace and they will be eligible for the tax credits that help pay the premiums. Also, you will be eligible for zero cost sharing plans or limited cost sharing plans if you are a member of a federally-recognized Tribe or a shareholder in an Alaska Native regional or village corporation.

SHOULD I DROP MEDICARE AND ENROLL IN AN INSURANCE PLAN ON THE MARKETPLACE?

No. People who drop Medicare cannot get the tax credits or cost sharing reductions available to others in the Marketplace. It would cost you more to get insurance in the Marketplace if you are already enrolled in Medicare. Medicare is the way the federal government subsidizes health care for Elders. Marketplaces are the way the federal government makes health care affordable for other people who do not have insurance.

CONTINUE TO SEE YOUR INDIAN HEALTH PROVIDER.

Your Indian health clinic will always be there for you. You do not need to purchase insurance. If you do have insurance, let your clinic know. They can bill Medicare, Medicaid and Marketplace plans for the services they provide. This will mean more health care dollars to fund services for your entire community.