Enhance Health

ACA Coverage For Native Americans: Enrollment Guide

The healthcare system can feel intimidating if you’re looking to enroll in a new health insurance plan. This is especially true for Native American communities where various challenges make it harder to get and use healthcare, but this doesn’t have to be the case. 

In this article, we explore the specific provisions and strategies that can help Native Americans access healthcare coverage under the Affordable Care Act (ACA).

Unique Healthcare Challenges Faced By Native Americans

Native Americans face several challenges, sometimes overlooked in mainstream healthcare reform discussions. These challenges include geographical and logistical barriers and cultural differences that impact healthcare access. 

Geographical Location

Many Native Americans live in rural or remote areas far from general and more specified healthcare facilities. This can make it far more difficult to access primary care services, specific doctors, and emergency services. 

For some, the closest healthcare facility may be hours away, something that can prevent many Native Americans from accessing the healthcare they need. 

Socioeconomic Factors 

Historical traumas, discrimination and socioeconomic disparities have resulted in profound social and psychological effects, including mistrust of government and healthcare systems.

The poverty rate is higher in Native American communities, which leads to many being unable to afford health insurance or unwilling to spend the money on prescriptions or doctor visits that they might need. 

The Indian Health Services is the federal agency responsible for providing Native Americans healthcare. Unfortunately, it’s drastically underfunded, which has led to inadequate medical services and outdated equipment.

Cultural Practices 

Many Native American communities have deep-rooted traditional healing practices, which may involve herbal remedies, spiritual ceremonies, or the guidance of tribal healers. There may be challenges in integrating traditional healing with conventional medical treatments.

The Importance Of Healthcare Access For Native Communities

Healthcare is vital in every community across the United States. Still, for Native Americans, healthcare is especially important. A long history of injustices, systematic disparities, and specific cultural factors have resulted in several adverse health outcomes for Native Americans. These include:

  • Higher rates of chronic diseases: Native Americans suffer from disproportionately high rates of chronic diseases such as diabetes, heart disease, and obesity.
  • Mental health challenges: Historical trauma and ongoing discrimination contribute to high rates of mental health issues, including depression, anxiety, and suicide.
  • Substance abuse: Substance abuse, including alcohol and drug addiction, is a significant problem in some Native communities..
  • Limited life expectancy: Native Americans generally have lower life expectancies than the general population in the United States. This can be attributed to a combination of factors, including higher rates of chronic diseases, and social determinants of health such as poverty and education.

Without healthcare, chronic diseases like diabetes and hypertension will grow more prevalent among Native Americans. 

Improving healthcare access leads to an enhanced quality of life. It benefits the individuals and the group as a whole. It can bring about economic growth and foster trust and collaboration between Native Americans and the healthcare system. 

Enrollment Options For Native Americans Under The ACA

Navigating the American healthcare system can be complex. However, certain features have been implemented that make accessing healthcare through the ACA easier for Native American communities. 

No Cost Sharing 

One of the most essential features of ACA plans for Native Americans is the provision for no cost-sharing (this is subject to specific income and other criteria). If you meet these criteria, you could be exempt from out-of-pocket costs like copayments, coinsurance, and deductibles.

Year Round Enrollment

For Native Americans, year-round enrollment is a special provision that recognizes their unique healthcare needs and the fact that their circumstances may change throughout the year. This flexibility allows them to access and adjust their healthcare coverage when needed, without being restricted to the typical open enrollment period, which for most people occurs once a year.

Medicaid Expansion

Medicaid expansion can expand healthcare coverage and subsidies to more low-income Native Americans who may have previously been ineligible due to income or other eligibility criteria. This can lead to increased access to essential healthcare services.

Overcoming Barriers To ACA Enrollment In Native Communities

Overcoming barriers to ACA enrollment in Native communities requires a multifaceted approach that addresses both systemic challenges and community-specific needs. 

Here are several strategies to help overcome these barriers:

  • Lack of awareness and information: This is one of the major issues faced by Native American communities regarding ACA enrollment. Some need to be made aware of the healthcare access they could have or the benefits, like no-cost sharing and year-round enrollment. 
  • Cultural and linguistic barriers: This is another important issue that can make ACA enrollment very difficult and requires documents and assistance in native languages to be offered where possible.
  • Limited internet access: With many Native American communities living in rural areas, it’s common to find that individuals do not have consistent Internet access and, therefore, cannot enroll in health insurance. 
  • Complex enrollment processes: The ACA enrollment process can be confusing and complicated. This is a deterrent for many seeking assistance in native languages where possible.
  • Geographic challenges: As noted above, geographic challenges, such as the distance one lives from doctors and emergency medical services, make it far more difficult to use one’s health care even if they are enrolled. 


The world of healthcare can feel confusing, complicated, and out of reach for many within Native American communities. 

If you’re hesitating to enroll in health insurance for financial reasons or the complexity of the process, this is where Enhance Health can help. Financial and geographic constraints do not need to prevent you from caring for your health.

Our professionals can help you find tailored, affordable healthcare plans that meet your needs and budget. 

Enhance Health-Representative
Get a Free Quote

Speak to a Licensed Agent

Affordable Healthcare
Get a Free Quote
Save big on health insurance