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Tribes, Individual Indians Missing Out on Health Insurance Breaks

Tribes are missing out on big savings by not taking advantage of a couple of huge health insurance breaks they are eligible for.

According to Matt Silverstein, chief executive of FirstNation Health in Tulsa, many tribes still don’t use the Medicare-Like Rates break they can get and many individual American Indians do not use a huge break allowed for them under the Affordable Care Act.

Silverstein, Choctaw, said his firm filed a Freedom of Information Act (FOIA) request to find out how many tribes are signed up for Medicare-Like Rates through “638 contracting” with the Indian Health Service. The FOIA showed that 70 percent of tribes are signed up for it—meaning 30 percent are not.

Medicare-Like Rates is “a very powerful tool but sadly, too many tribes don’t realize they have access to it,” says Silverstein, who has been running Native health insurance companies since 2001.

He told Native Business Magazine™ that Medicare-Like Rates is “a legal trigger that allows for the law to say that if you are a Medicare-participating provider you must accept whatever the Medicare rate was for the employees of the tribe.”

Under this trigger, in other words, many Indians will not have to wait until the age of 65 to get the same rates as Medicare patients do.

The benefit to tribes can be discounts as steep as 85 percent for medical services, Silverstein says. This “blows away” PPO providers like Blue Cross and Aetna, he says.

However, even many of the tribes that have enrolled in the program “are not receiving this increasingly valuable benefit,” the chief executive says.

He describes it as “a shock factor” that many insurers working with tribes “are not delivering that benefit.”

Instead, they are fed “half truths, propaganda and innuendo” that mean “tribes will get tricked into buying fully insured plans.”

Silverstein points out that health care costs have been going up six times faster than wages have, for decades, and that healthcare is usually a tribe’s second-biggest expense after payroll.

A PPO plan is “an exorbitant sum of money” that can give insurers 600 percent return on their investments. First Nation Health instead will negotiate on behalf of tribes.

In the future, healthcare could become a tribe’s biggest expense, he feels, “unless they take control and use benefits in an efficient way.”

On the individual Indian side, the Affordable Care Act has a couple of benefits not enough Indians are using, he feels.

One is expanded access to the insurance marketplace. While most people can only enroll in the ACA during a short sign-up period or after a significant life event like losing a job and insurance coverage, Indians have much greater access to ACA.

Natives can enroll in any month and as long as it is before the 15th of the month, they will be insured as of the first of the next month. This means they have much more flexibility in shopping for insurance and can change policies easily if they find a better plan.

The other break Indians get from the ACA, Silverstein says, is if they are eligible for a premium tax break of any amount, that triggers highly advantageous terms on insurance (most Indians will qualify for the tax credit, he says).

These include zero-dollar deductibles, co-pays, and out of pocket expense limits, he says.

“Most Indians are not aware of this,” he says. If a tribe does business with FirstNation Health, the company will, for no charge, advise individual tribal members how best to access the ACA.FirstNation is both a broker of insurance for tribes (finding the right insurers to use) and a “Third Party Administrator,” meaning a third-party vendor actually administering healthcare benefits for a tribe.

It does business in 30 states and has claims processing units in California and Michigan. Silverstein has also dabbled in politics, becoming the first Choctaw in Oklahoma to get a Democratic party nomination for United States senator, a position he ran for in 2014.

The company has recently made a high-profile hire in Dave Archambault, the chairman of the Standing Rock Sioux Tribe during the Dakota Access Pipeline standoff.

Former Sen. Ben Nighthorse Campbell is a board member and chief strategist for the firm.

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