july 1, 2014
FAQs regarding the Affordable
Care Act (ACA)and Skookum
Health Assistance Program
Question: What if I already have insurance through my job or am
already on Medicaid?
Answer: If you have health insurance through your employer or have
health care through a government-sponsored program, such as Medi-
care, Medicaid, CHIP, Veterans Affairs or TRICARE, there is nothing
you need to do – you are covered.
Question: I have Contract Health Services. Do I still need to apply?
Answer: Yes, if you do not have primary insurance coverage, you will
need to apply.
Question: Isn’t my Skookum Health Assistance Program an insur-
ance?
Answer: No, Skookum is not an insurance plan. Therefore, it is not
considered to be insurance by definition. You should not reference
Skookum as insurance, as it is not. It is assistance you receive from
the Tribe because you are an enrolled Tribal member.
Question: Am I required to pay for insurance through my employer?
Answer: We encourage Tribal members with alternate resources,
such as employer-sponsored insurance, to enroll in those plans and
use Skookum as a secondary coverage to pay for any balances that
are patient responsibility.
Question: I’m an American Indian/Alaska Native. What do I need to
know about the Health Insurance Marketplace?
Answer: The Health Insurance Marketplace will benefit American
Indians and Alaska Natives (AI/AN) by providing opportunities for
enrolling in affordable health coverage. You might be eligible to enroll
in a private health plan in the new Health Insurance Marketplace, or
you might be eligible for Medicaid or the Children’s Health Insurance
Program (CHIP). There will be one application to determine whether
you are eligible for a marketplace health plan, Medicaid or CHIP.
Question: What are the special protections for AI/ANs who enroll in
the Health Insurance Marketplace?
Answer: Members of federally recognized Tribes with a household
income at or below 300 percent of the federal poverty level (roughly
$70,650 for a family of 4 in 2013 or $88,320 for the same family in
Alaska) who are also eligible for the tax credit won’t have any out-of-
pocket costs like co-pays, co-insurance or deductibles for services
covered by their Marketplace health plan.
Question: How can I apply for an exemption from the shared respon-
sibility payment?
Answer: To get an exemption, members of federally recognized Tribes
may apply through the Marketplace or provide the appropriate informa-
tion when they file their federal income tax return. AI/ANs who aren’t
members of federally recognized Tribes, but who are eligible for or get
services from an I/T/U, (Indian Health Service, Tribal clinic or urban
Indian clinic) must apply through the Marketplace and will need to verify
their AI/AN status or eligibility for services through an I/T/U.
Question: Will I be able to get assistance with paying the cost of my
premium if I enroll in a Marketplace health plan?
Answer: While AI/ANs are NOT exempt from paying premiums, they
may be able to get lower costs on monthly premiums through a new tax
credit that is paid to insurance plans each month to reduce an individ-
ual’s premium. Eligibility for the tax credit depends on income, family
size and access to other coverage. Members of federally recognized
Tribes can use tax credits to pay for premiums on certain plans and
still receive cost-sharing reductions as well. The type of cost-sharing
reduction depends on income and whether an individual is enrolled in
a zero cost-sharing plan or limited cost-sharing plan.
Question: Are there special protections for AI/ANs who enroll in
Medicaid?
Answer: AI/ANs who are eligible for or get services from an I/T/U,
including Contract Health Services, are exempt from Medicaid pre-
miums and enrollment fees and, if they have ever used one of these
programs, they are also exempt from other cost sharing, such as co-
payments, co-insurance, and deductibles. Certain Indian resources and
payments are not counted for Medicaid eligibility. AI/ANs can continue
to get services through an I/T/U even if the I/T/U is not a provider in a
managed care network.
S moke S ignals
1
Graduates honored
Photo by Michelle Alaimo
Christina Jungers receives an eagle feather from Tribal Education
Department Manager Eirik Thorsgard during the department’s
Graduation Celebration held in the Tribal gymnasium on Friday, June
20. Jungers, who graduated from Portland State university with a
master’s degree in social work, was one of 102 graduates honored
this year. This year’s theme was “Carve Your Path Through Education.”
The Education Department will be putting out an Honors in Education
special section later this year honoring the Tribe’s graduates.
Free online learning source
The information includes:
Everyday life
Math and money
Computer training
Online classes
Work and career information
Check it out at www.gcflearnfree.org
Links to assist you in learning more about
the ACA and Marketplace products:
• www.healthcare.gov: Click on see plans now;
• www.coveroregon.com: Go to learn more and click on the link.
If you have questions, please contact
• Tresa Mercier, tresa.mercier@grandronde.org
• Loretta Meneley, loretta.meneley@grandronde.org
• Melody Baker, melody.baker@grandronde.or
• Barbara Steere, barbara.steere@grandronde.org
Or call 800-775-0095 to speak to anyone listed above.
Ad created by George Valdez