Equal Opportunity for Quality Health Care

• The Affordable Care Act promotes the opportunity for all Americans, including American Indians and Alaska Natives, to access quality health care by providing them with more health care choices.

• The law holds insurance companies more accountable and lowers health care costs. It is easier to access affordable health insurance.

• The Affordable Care Act also permanently reauthorizes the Indian Health Care Improvement Act, which makes possible new programs and services within the Indian Health Service.

More choices to access insurance coverage

• use the Indian Health Service if eligible and accessible

• access coverage through Medicare, Medicaid, CHIP, if eligible

• purchase affordable, quality coverage through Health Insurance Exchanges

• In many states, Medicaid eligibility is expanded to individuals with incomes up to 133% of poverty level. (approx. $15,654/year for a single adult)

Benefits for American Indians and Alaska Natives

• Special monthly enrollment periods for eligible American Indians and Alaska Natives to sign up for Health Insurance Exchange coverage every month (no waiting for open enrollment).

• No cost-sharing for eligible American Indians and Alaska Natives who receive care through the IHS, Tribal health programs, or Urban Indian health programs.

• No cost-sharing for eligible American Indians and Alaska Natives earning less than 300% of poverty level who receive care at any health care facility,

• Many American Indians and Alaska Natives are exempted from the tax penalty that would otherwise apply to individuals who do not obtain health insurance coverage.

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Requires insurance companies to cover people with pre-existing health conditions

• Health insurance plans can't charge you more or turn you down because you're sick or have a health condition. They also can't charge women more than men. The only exception is for grandfathered individual health insurance plans.

Helps you understand the coverage you are getting

• You have the right to get an easy-to-understand summary about a health plan's benefits and coverage. Insurance companies and group health plans must provide you with: a Uniform Glossary of terms used in health coverage and medical care as well as a Summary of Benefits and Coverage (SBC).

Holds insurance companies accountable for rate increases

• Rate Review: helps protect you from unreasonable rate increases. Insurance companies must now publicly justify any rate increase of 10% or more before raising your premium. This does not apply to any grandfathered plans.

• 80/20 Rule: ensures that insurance companies to spend at least 80% of the money they take in on premiums on your health care and quality improvement activities instead of administrative, overhead, and marketing costs. This is also referred to as the Medical Loss Ratio (MLR).

Makes it illegal for health insurance companies to arbitrarily cancel your health insurance just because you get sick

• It's now illegal for insurance companies to cancel your coverage simply because you made an honest mistake or left out information that has little bearing on your health.

• You will be given at least 30 days' notice prior to cancelling your coverage.

Protects your choice of doctors (does not include grandfathered plans)

• You have the right to choose the doctor you want from your health plan's provider network. You also can use an out-of-network emergency room without penalty.

• Insurance plans cannot require higher co-payments or coinsurance if you get emergency care from an out-of-network hospital. They also can't require you to get prior approval before getting emergency room services from a provider or hospital outside your plan's network.

• You can choose any available primary care provider in your insurance plan's network. You can choose any available network pediatrician as your child's primary care doctor.

• You don't need to get a referral from a primary care provider before you can get obstetrical or gynecological (OB-GYN) care from a specialist.

Covers young adults under 26

• If you're under 26 years old, you may be able to get insured under a parent's plan. You can join, remain, or return to a parent's plan even if you're married, attending school, not living with your parents, eligible to enroll in your employer's plan, or financially independent.

Provides free preventive care

• You may be eligible for free preventive screenings, like mammograms, colonoscopies, blood pressure, and cholesterol tests. This does include coverage for vaccines and new preventive services for women.

Ends lifetime and yearly dollar limits on coverage of essential health benefits

• Insurance companies can't set a dollar limit on what they spend on essential health benefits for your care during the entire time you're enrolled in that plan. These are often referred to as lifetime limits.

• Yearly dollar limits are not allowed on essential health benefits.

Guarantees your right to appeal

• Internal Appeals: You can ask your insurance company to reconsider its decision to deny payment for a service or treatment. It must review its decision.

• External Review: If your insurance company still denies payment, the law allows you to have an external review. The review will be done by an independent organization that will decide if the insurance company should pay or not.

• Under the Affordable Care Act, insurance companies may not deny coverage to you based on a pre-existing condition. For individuals under the age of 19, this began on September 23, 2010.

• If you have private health insurance, you have better access to and a greater choice of health care providers.

• If you are enrolled in a health plan that requires that you designate a specific primary care provider, you are guaranteed the right to choose that doctor.

• You have the right to designate a pediatrician as your child's primary care provider.

• Women can see an OB/GYN without prior authorization from the health plan or a referral.

• No health plan can require you to get preauthorization for emergency services

• No health plan can charge you higher copayments or co-insurance for out-of-network emergency services than you are charged for in-network emergency services

• No health plan can limit its coverage for out-of-network emergency care more than would limit its coverage if that care were to be received in-network.

• An insurance company can only rescind your health plan if you (or someone you have authorized to represent you) commit fraud.

• No insurance company can rescind your insurance if you forgot to mention something minor in your medical history or if you didn't understand that a piece of information was relevant to your health plan.

• Insurance companies are not able to set dollar limits on health benefits that they cover in a single year or in the course of a lifetime.

• Health insurance plans are required to provide coverage for certain preventative health services and are prohibited from charging cost-sharing for them.

• If you disagree with your plan's refusal to pay for care, the plan must review its decision. If you are still not satisfied, you have the right to appeal that decision to an independent reviewer that is outside of the health plan.

• Uninsured Americans under the age of 26 have the right to stay on a parent's health plan if they meet certain eligibility criteria.

If you would like to learn more about the rights protected and created under the Affordable Care Act, click here.

Within the Affordable Care Act (ACA), the Indian Health Care Improvement Act (IHCIA) was re-authorized. It helps American Indians and Alaska Natives. The IHCIA, which authorizes health care services for American Indians and Alaska Natives through the Indian Health Service (IHS), was first approved by Congress in 1976 and last reauthorized in 2000. The ACA makes the re-authorization of this law permanent and authorizes new programs within the IHS to ensure it is more equipped to meet its mission to raise the health status of American Indians and Alaska Natives to the highest level.

Here are some of the newly created functions under the IHCIA:

• The law gives IHS the authority to established expanded services such as behavioral and mental health treatment and prevention, long-term care services, dialysis services, care for Indian veterans and urban Indian health programs.
• A health care professional employed by a tribally operated health program is exempt from state licensing requirements if the individual is licensed in any state. It also aims to have them join or continue in an Indian health program.
• A tribe or tribal organization that carries out a program under the Indian Self-Determination and Education Assistance Act and an urban Indian organization carrying out a program under Title V of IHCIA to purchase coverage for its employees through the Federal Employees Health Benefits Program (FEHB).