How Medicare works at Indian health providers
CMS's Medicare basics for American Indians and Alaska Natives says you can keep using your Indian health care provider, or see a non-Indian provider, and either way the provider bills Medicare for you. With Original Medicare, CMS's tribal guide says your Indian health provider will be paid for Medicare-covered services.
| Coverage | At your IHS or tribal clinic | At other providers |
|---|---|---|
| Original Medicare | Clinic bills Medicare; no deductible, coinsurance or copay for covered services | Any provider in the U.S. that takes Medicare; usual Medicare costs unless Purchased/Referred Care or another program helps |
| Medicare Advantage | You can still be seen, but if the clinic is out of network the plan may not pay it | Generally the plan's network |
Where this applies in Oklahoma
- IHS facilities in the IHS Oklahoma City Area, such as Lawton Indian Hospital and Indian health centers in towns including Anadarko, Clinton, El Reno, Pawnee, Watonga and Wewoka.
- Tribal health systems run by nations including the Cherokee Nation, Chickasaw Nation, Choctaw Nation of Oklahoma and Muscogee (Creek) Nation.
- Urban Indian clinics: the Oklahoma City Indian Clinic and the Indian Health Care Resource Center of Tulsa.
Eligibility for each one is set by IHS and the nation that runs it, not by Medicare.
Referrals and Purchased/Referred Care
When your clinic refers you to an outside specialist or hospital, Medicare pays first. IHS is the payer of last resort, so Purchased/Referred Care may then help with what's left if you qualify. CMS also points out that with insurance such as Medicare, you can get covered care without waiting for a PRC authorization.
Before your next visit
- Update your registration. Bring your Medicare card and any plan card to the front desk or benefits office.
- Ask about networks. If you're considering Medicare Advantage or a Part D plan, ask the clinic and its pharmacy which plans they contract with.
- Keep your paperwork. Save Medicare Summary Notices or plan statements in case a bill needs to be sorted out.
See our guide to tribal health and Medicare in Oklahoma and the IHS vs. Medicare comparison. To compare plans from the companies they work with, you can request a call from a licensed insurance agent.
Related questions
Does Medicare Advantage work with IHS?
What to check before you join a plan.
Do I need Medicare if I have IHS?
Why most tribal citizens sign up.
Part B penalty and IHS
Why timing matters.
Sources
- CMS — Important Facts about Medicare for American Indians and Alaska Natives
- CMS — Medicare and Tribal Medicare Beneficiaries
- CMS — 10 Important Facts about IHS and Health Insurance
- 42 CFR §423.120(a)(6) — Access to I/T/U pharmacies
- IHS Oklahoma City Area — Healthcare Facilities
- IHS — Urban Indian Organizations, Oklahoma City Area
More questions in this guide
- Can Native Americans get help paying Medicare premiums in Oklahoma?
- Do Native Americans in Oklahoma need Medicare if they have IHS?
- Does Medicare Advantage work with IHS and tribal clinics in Oklahoma?
- Will I pay a Part B late penalty if I only use IHS or tribal health care?
Part of the guide: Tribal Health Care, IHS and Medicare in Oklahoma · All questions
Frequently asked questions
Should I show my Medicare card at my tribal clinic?
Yes. Give your Medicare card, and any plan card, to registration or the benefits office so the clinic can bill Medicare. Billing doesn't cost you anything for covered services there, and the payment helps the clinic serve your community.
Can my IHS or tribal pharmacy bill my Part D plan?
Usually. Federal rules require every Part D plan to offer standard contract terms to all IHS, tribal and urban Indian pharmacies in its service area. Ask your pharmacy which plans it has contracts with before you choose one.
Does having Medicare make me eligible for IHS?
No. Medicare doesn't change who can use IHS or a tribal health system. That depends on IHS rules and each nation's own eligibility rules, such as citizenship and where you live.
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