Patient Protection & ACA

Important information about The Patient Protection and Affordable Care Act

Beginning January 1, 2014, every American must demonstrate health care coverage under the ACA, but there are special exemptions that apply to Alaska Native and American Indian people. Alaska Native and American Indian people are exempt from the requirement to purchase insurance if they can show evidence of:

  • Enrollment in a federally recognized Tribe;
  • Alaska Native Claims Settlement Act (ANCSA) shareholder status (village or regional), or;
  • Eligibility to receive services from an Indian Health Service (IHS) facility/Tribal health care provider

Q: How do I qualify for the Alaska Native and American Indian Status Exemption?

A: To qualify for this exemption, Alaska Native and American Indian people will have to apply for the exemption through a paper application process. This paper application can be printed at

ANTHC has created a version of the paper application with helpful tips on how to fill it out. This version of the application can be read and printed at

When you complete the application, you must send copies of supporting documents, such as:

Preferred documents:

  • Tribal enrollment card/letter
  • Proof of ANCSA Shareholder Status (Regional or Village)

These documents ensure you qualify for ACA special benefits for Alaska Natives and American Indians.

Other accepted documents:

  • Certificate of Indian Blood (CIB) card issued by the Bureau of Indian Affairs (BIA)
  • IHS Eligibility Letter

Please do not send originals of these documents as they will not be returned to you.

Please remember to complete Step 2 of the application for all members of your family, including children. Also, be sure to send copies of the same supporting documents for every member of your family that needs the Indian Status Exemption to avoid a tax penalty.

Within 2-4 weeks of mailing the form, the federal government will inform you if they need additional information. If you receive this exemption, you will be sent an Exemption Certificate Number that you will put on your federal income tax return. It is important to keep a copy of this Exemption Certificate Number in a safe place for future use. If you do not hear from the federal government within 4-6 weeks, contact the Health Insurance Marketplace Help Center at 1-800-318-2596.

ANTHC’s Health Reform group is traveling to Alaska’s regional hubs through March 2014, distributing Indian Exemption Status paper applications and offering assistance to anyone who has questions or needs help filling out the forms.

For assistance with the Indian Exemption Status paperwork and to learn more information about the ACA in Alaska, visit your local Tribal clinic or contact the ANTHC Health Reform group at, (907) 729-7777 or (855) 882-6842. More information is also available at ANTHC’s “The Affordable Care Act and You” website,

Frequently asked questions about the Affordable Care Act

Q: What if I already have health care coverage?

A: If you have health care coverage through Medicaid, Medicare, Denali KidCare, Veteran’s Benefits or your employer provides health insurance, you have met the requirements of the Individual Mandate and do not need to purchase additional health care coverage to avoid the tax penalty. You do not need to complete the Indian Status Exemption paperwork if you have health care coverage. However, the Indian Exemption is a lifetime exemption.

Q: If I do not buy insurance, will I still be able to get health care services at my IHS/Tribal health facility?

A: Yes, you will still be able to get care at your IHS/Tribal health facility. The health care services provided at IHS/Tribal health facilities are not changing. However, you will need to apply for an exemption.

Q: How do I enroll in a Tribe?

A: Tribal enrollment rules are different for every Tribe. Contact your family’s Tribe(s) to learn about what is required for enrollment. Tribal addresses can be found You can also contact the Bureau of Indian Affairs, Alaska Regional Office, at (800) 645-8465, option 1.

Q: Does it have to be a card or can it be a letter?

A: The Tribe may choose to issue an enrollment card or provide a letter that verifies Tribal status.

Q: Do I have to establish blood quantum?

A: Some Tribes may require a minimum blood quantum, so it’s important to contact the Tribe.

Information provided by the Alaska Native Tribal Health Consortium –


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