Indian Health Services and Medicare

Written by:

Jason Kolkey

Reviewed by:

Amy Tran

7 min read

Key Takeaways

The Indian Health Service (IHS) provides healthcare to American Indian and Alaska Native communities at hundreds of facilities across the U.S.
If you regularly visit an IHS location, you can still benefit from having health insurance for certain services and for accessing care while away from home.
People who are over 65 or have certain disabilities can enroll in Medicare. Based on your individual needs, you may choose federally administered Original Medicare or a Medicare Advantage plan.
Some of the decisions you may need to make include applying for financial assistance to help with the costs of coverage and enrolling in Medicare Part D prescription drug coverage.

According to census data, there were 9.7 million American Indians and Alaska Natives (including those who also identified as other races) living in the U.S. as of 2020. More than one in 10 are 65 or older, which means they’re eligible for Medicare, the health insurance program for older adults and people with certain disabilities.

If you’re one of the millions of American Indians and Alaska Natives who access free healthcare through Indian Health Service facilities, you can also benefit from Medicare coverage. Let’s look at how the Indian Health Service and Medicare work together to provide essential healthcare for members of tribal communities.

How the Indian Health Service Provides Care

The members of 574 federally recognized tribes — and other eligible people such as the spouses and children of members — can receive healthcare through the Indian Health Service (IHS) in 37 states. IHS facilities include more than 600 health clinics, hospitals, and health centers, each providing a range of medical services such as:

Immunizations
Lab tests
Diabetes management
Pediatrics
Pharmacy
Radiology
Dental
Hearing
Vision
Physical rehabilitation
Behavioral health

IHS is not an insurance program and only provides specific types of care at designated locations. Facilities don’t generally have specialists or surgeons on staff. So, even if you get many routine services from IHS, health insurance makes a big difference when you need an outside doctor or hospital.

Ready for a new Medicare Advantage plan?

Enrolling in Medicare

Over 67 million U.S. adults (including more than a quarter of a million American Indians and Alaskan Natives as of 2023) get their health coverage through Medicare. Most become eligible during their Initial Enrollment Period, which generally lasts for seven months: three months before and three months after the month you turn 65. During this time, you can:

Enroll in Original Medicare, the public health insurance program that consists of Medicare Part A (hospital insurance) and Part B (medical insurance).
Add prescription drug coverage with a Medicare Part D plan from a private insurance carrier.
Add a Medicare Supplement plan (also called Medigap) to help with the out-of-pocket costs of Original Medicare.
After enrolling in Original Medicare, switch to one of the Medicare Advantage plans (also called Medicare Part C) offered by private insurance companies in your area. These plans substitute for Original Medicare and may feature additional benefits.

Later, you have other opportunities to change your Medicare coverage, such as the Annual Enrollment Period, which runs from October 15 to December 7. You may qualify for Special Enrollment Periods under certain circumstances, like losing health insurance from another source.

Medicare Costs

Unlike IHS, Medicare is not free. People who have paid Medicare taxes while working for at least 10 years don’t pay a monthly premium for Medicare Part A, but they are charged monthly for Medicare Part B. For both parts, you must meet a deductible before insurance starts to pay, and there’s a copay or coinsurance when you use most services. Copays are flat fees paid at every doctor visit or prescription refill. Coinsurance is the percentage of the entire service cost you cover out of pocket.

However, you may qualify for a Medicare Savings Program through your state if you have a low monthly income and limited financial resources. These programs can pay your Part A and Part B deductibles, coinsurance, and copayments. Keep in mind that the income calculation doesn’t include certain payments you might receive, such as from benefit programs provided by tribal governments, through individual interests in trusts or restricted lands, or from natural resources (like hunting or fishing). Contact your state Medicaid agency to find out if you qualify for a Medicare Savings Program.

Medicare Advantage

The majority of people on Medicare have now opted to switch from Original Medicare coverage to a Medicare Advantage plan. Most Medicare Advantage plans include Medicare Part D prescription drug coverage and may feature other benefits like dental, vision, and hearing. Unlike Original Medicare, these plans set an out-of-pocket maximum to limit how much you spend each year. On the other hand, you will likely need to visit doctors and pharmacies in your plan’s provider network to make full use of your coverage.

Depending on your ZIP code and individual situation, you may be able to choose from several Medicare Advantage plans. That could include Special Needs Plans (SNPs) geared toward specific populations, such as people who also qualify for Medicaid (the public insurance program for people with low incomes and limited resources) or those with certain chronic conditions. SNPs all provide prescription drug coverage and may offer additional benefits like credit to help pay for healthy food and over-the-counter items.

Explore your options to determine what Medicare coverage is the best for your specific healthcare needs and financial situation.

Using Medicare With Indian Health Services

Enrolling in Medicare allows you to access outside care when you’re away from an IHS facility or need services that IHS doesn’t provide. At the same time, your insurance coverage supports the IHS facilities in your community: If you receive covered services, your insurer reimburses IHS. Those reimbursements can be vital since the agency estimates that federal funding only pays for about 60% of eligible healthcare for American Indians and Alaska Natives.

For example, Original Medicare and Medicare Advantage plans fully cover preventive care, including:

Vaccinations
Yearly wellness visits
Bone density tests
Cardiovascular disease screening
Colorectal cancer screening
Hepatitis screening
Alcohol misuse screening and counseling
Depression screening
Diabetes screening and self-management training
Glaucoma tests
HIV screening
Mammograms
Medical nutrition therapy services
Pap tests and pelvic exams
Prostate cancer screenings
Sexually transmitted infections screening and counseling
Tobacco use cessation

Ready for a new Medicare Advantage plan?

Prescription Drug Coverage

You can pick up a variety of medications at no cost from the pharmacy services at IHS facilities, but the list of available drugs varies by location. While certain prescriptions are in the IHS National Core Formulary, which sets a basic nationwide standard, individual pharmacies may otherwise tailor their selections based on local needs.

Will an Indian healthcare resource center fill outside medications? In some cases they will. However, since the policies and formularies of individual IHS facilities differ, you may not always be able to pick up an outside prescription.

Prescription Costs

When you’re away from your IHS location or a drug isn’t carried at your local facility, filling prescriptions can be costly without insurance coverage. People on Original Medicare get coverage by signing up for a standalone Medicare Part D prescription drug plan from a private insurance carrier. Most Medicare Advantage plans include Part D coverage.

If you’re considering a Part D plan or a Medicare Advantage Prescription Drug plan, confirm that any drugs you’re taking are included on the formulary and learn what you’ll pay for a regular supply. Part D formularies are divided into tiers with higher costs for specialized, brand-name drugs.

The federal government has set an out-of-pocket maximum for spending on drugs covered by Part D: As of 2025, you’ll spend no more than $2,000 annually. In addition, there’s a limit of $35 on a monthly supply of insulin to manage diabetes. Look into whether you’re eligible to receive Extra Help, also known as the Low Income Subsidy (LIS), a program that reduces out-of-pocket costs for people with limited incomes and resources.

Usually, people on Medicare have to pay a late enrollment penalty if they go without drug coverage for at least 63 days and then later sign up for Part D. However, the Centers for Medicare and Medicaid Service (the federal agency that administers Medicare) considers IHS prescription drug coverage “creditable.” That means you won’t be penalized if you hold off on signing up for Medicare Part D prescription drug coverage when you first enroll in Medicare.

The Indian Health Service is an essential resource for communities across the U.S. Adding Medicare coverage can fill the gaps in the services that IHS provides and help the agency receive the funds it needs to continue providing care.