2025 Medicare Costs for American Indian and Alaska Native Communities: Essential Guide & Pricing

Medicare assistance programs have eligibility criteria and premium costs influenced by your income and assets. For American Indian and Alaska Native individuals, special income rules apply, along with additional provisions tailored to their communities.

If you identify as Native American or Alaska Native, you can access healthcare services through the Indian Health Service (IHS), which offers many—but not all—medical services.

Older adults eligible for IHS may also qualify for Medicare, providing broader healthcare coverage, including preventive services.

When eligible for both, you can coordinate benefits from Medicare and IHS for comprehensive care.

Medicare Eligibility for American Indian and Alaska Native Individuals

Medicare eligibility requirements remain consistent for those who use IHS and those who do not.

IHS Eligibility Criteria

• Be an American Indian, Alaska Native, or both.
• Be enrolled in or a member of a federally recognized tribe.
• Reside on, or own tax-exempt or restricted land.

Additional eligible groups include:

• Dependent children under 19 of eligible individuals.
• Spouses of eligible individuals.
• Pregnant individuals with an American Indian or Alaska Native co-parent.

Medicare Eligibility Requirements

• Age 65 or older.
• Diagnosis of End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS).
• Under 65 with a qualifying disability and at least two years of disability benefits.

Combining IHS and Medicare Benefits

Since IHS is not comprehensive health insurance and may not cover all needed treatments, Medicare can fill coverage gaps. Enrolling in Medicare upon eligibility ensures access to expanded healthcare options.

Scope of IHS Coverage

IHS provides a wide range of services, though availability varies by facility. Covered services typically include:

• Inpatient hospital care exceeding 24 hours.
• Outpatient hospital care under 24 hours.
• Pharmacy services.
• Radiology such as X-rays.
• Laboratory testing.
• Dental care.
• Vision services.
• Hearing care.

Medicare Coverage Overview

Original Medicare consists of Part A (inpatient care) and Part B (outpatient services).

Part D offers prescription drug coverage through standalone plans administered by private insurers.

Medicare Advantage (Part C) plans, also managed by private insurers, combine Parts A and B benefits, typically including Part D drug coverage plus extras like dental, vision, hearing, and fitness benefits.

Costs Associated with IHS and Medicare

IHS services are free of premiums, deductibles, copayments, and coinsurance.

Original Medicare Part A may be premium-free based on your work and tax history; otherwise, premiums range from $285 to $518 per month.

Part B premiums start at $185 monthly but may increase based on income.

Costs for Medicare Part D and Medicare Advantage plans vary by provider and location, with many plans offering $0 premiums.

Understanding Income Calculations: Indian Trust Income and MAGI

Medicare premium costs often depend on your Modified Adjusted Gross Income (MAGI) from two years prior, which determines your Income-Related Monthly Adjustment Amount (IRMAA).

MAGI includes income sources such as wages, capital gains, Social Security, pensions, self-employment income, and more.

However, American Indian and Alaska Native individuals benefit from special MAGI rules that exclude certain income types, including:

• Payments from Alaska Native Claims Settlement Act (ANCSA) corporations and trusts.
• Income from trust or reservation properties.
• Revenue from hunting, fishing, and natural resource rights.
• Proceeds from cultural or subsistence property sales.
• Income exempt under the IRS General Welfare Doctrine.
• Other federally non-taxable income.

For detailed guidance on exempt income, contact your tribal authority.

Financial Assistance for Medical Costs

If your income and resources are limited, you may qualify for Medicare Savings Programs (MSPs), which help cover premiums, deductibles, and other out-of-pocket costs. MSP options include:

• Qualified Medicare Beneficiary (QMB) Program.
• Specified Low-Income Medicare Beneficiary (SLMB) Program.
• Qualifying Individual (QI) Program.
• Qualified Disabled & Working Individual (QDWI) Program.

Most MSP participants also qualify for Extra Help, which reduces prescription drug costs.

You can also qualify for Extra Help independently, provided your income and assets fall below set limits:

Extra Help Eligibility for American Indian and Alaska Native Communities

Certain income and resources are excluded when determining eligibility for Extra Help, including:

• Funds received from Alaska Native Regional and Village Corporations.
• Land held in trust by the U.S. government.
• Trust funds allocated per capita by the Secretary of the Interior.
• Up to $2,000 annually from interests in trusts or restricted lands.
• Federally authorized payments to tribe members.

Native American Medicare Exemption Explained

Since January 2019, many individuals no longer require an exemption certificate to avoid healthcare coverage penalties, but state rules vary.

Previously, those with only IHS coverage needed to apply for exemptions to avoid tax penalties unless covered by other insurance such as employer plans, Marketplace coverage, Medicare, Medicaid, or Veterans Affairs.

Check with your state tax office or tax preparer to confirm current requirements.

Summary

While IHS provides essential healthcare services, it may not cover all needs. Combining IHS with Medicare ensures broader access to care.

Special income rules for American Indian and Alaska Native communities influence Medicare costs and eligibility for assistance programs.

Depending on your coverage and state, you may need to apply for exemption certificates to avoid penalties.

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