Health Care Off
 

the Reservation
 

Understand your options when you move 

off the reservation or live outside of your 

tribe’s service delivery area 

@CMSGov #CMSNativeHealth 

CMS ICN No. 909440-N • August 2017 
 

Beyond Indian Health Service 

Many American Indians and Alaska Natives move “off the 

reservation” or live outside their tribe’s defined Indian Health 

Service (IHS) service delivery area. 

•	 If you have never used a health care provider other than 

IHS, this transition can be confusing 

•	 Talk to your IHS business office before you leave 

•	 Talk to your new employer about health benefits 

•	 Talk to friend and family about their health coverage 

•	 Go to Healthcare.gov to apply for insurance coverage 

•	 Use the Coverage to Care – Tribal Brochure 

to find helpful tips on using health care providers 

outside the IHS system (www.cms.gov/Outreach-andEducation/American-Indian-Alaska-Native/AIAN/ 

AIAN-Coverage-to-Care-Brochure.pdf) 

•	 Call the Marketplace Call Center at 1-800-318-2596 

for more information 

Understanding cost sharing 

If you have employer-sponsored insurance or purchase 

insurance from the Marketplace, you will probably have to pay a 

portion of the cost of your care. These costs include: 

Deductible: The amount you must spend for health care 

services your plan covers before your health insurance begins 

to pay 

Your deductible may not apply to all services. For instance, 

most plans do not require you to pay off your deductible 

before having insurance cover routine doctor’s visits or 

preventive care. 

For example, if your deductible is $1,000, your plan won’t 

pay anything until you’ve met your $1,000 deductible for 

covered health care. 

Copayment: A fixed amount that you pay for a covered health 

care service 

For example, you may need to pay $20 to visit your doctor 

or for a prescription. 

Coinsurance: Your share of the costs of a covered health care 

service, calculated as a percent 

For example, you may pay 30% for lab tests or 80% for a 

medication not listed on the insurance plan’s approved list. 

Keep in mind: 

•	 Cost sharing amounts are set by your insurance 

•	 If you use IHS or a tribal clinic, you may not have to share 

costs 

Learn more about cost sharing at 

www.healthcare.gov/glossary/cost-sharing 
Using insurance 

Types of insurance 

With private or employer insurance, you may have more than 

one coverage provider. You may have different insurance for: 

•	 Medical 

•	 Dental 

•	 Vision 

Your insurance network 

Networks consist of health care providers in your area who 

honor your insurance coverage. It is important to research your 

network to avoid additional costs. 

Your insurance company can give you lists of in-network 

providers. Providers can also confirm your insurance usability 

when you schedule an appointment. 

Health care options
 

If you move off the reservation, you may be eligible to continue 

getting care from your previous IHS or tribal health clinic. 

Or, you may seek care closer to home at a local tribal health 

center or with a private doctor. 

The Purchased/Referred Care (PRC) program (previously 

called contract health services) is for medical/dental care 

provided away from an IHS or tribal health care facility. PRC 

is not an entitlement program and an IHS referral does not 

imply the care will be paid. If IHS is requested to pay, then 

a patient must meet the residency requirements, notification 

requirements, medical priority, and use of alternate resources. 

Here are some key facts about the PRC program if you move 

off the reservation: 

•	 If you are a full-time student in a vocational, technical, or 

academic program, you are eligible for contract health 

services while you are in school (including normal school 

breaks) and up to 180 days after completion of your 

course of study 

•	 If you are in traveling or temporarily employed (e.g., 

seasonal or migratory workers), you are eligible for 

contract health services at your location 

•	 If you move and do not fall under the categories above, 

you are eligible for contract health services for up to 180 

days in your new location 

•	 Services may differ from what you were eligible to 

receive while living in your tribe’s designated service 

area; contact IHS or your tribal clinic for more 

information or visit www.ihs.gov/prc 

Disclaimer: This fact sheet cannot be relied on for eligibility 

for the IHS PRC program. The information provided is only 

intended to be a general summary. Contact IHS or your 

tribal clinic to determine your eligibility. 
Urban Indian health programs 

Some cities have urban Indian health programs funded by 

IHS. You may be responsible for some costs. Locate an urban 

Indian health provider and learn more at www.ihs.gov 

Private doctors and clinics 

You may receive care from doctors who are unaffiliated with 

IHS. You will be responsible for costs not reimbursed by IHS 

or insurance. 

Health insurance 

If you get care from a private doctor, clinic, or hospital, you 

may want insurance to cover some or all of the cost. 

Employer-sponsored insurance 

Many employers offer health insurance to their employees. 

Learn more from your employer’s human resources 

representative. 

Medicare, Medicaid, and CHIP 

If your employer does not provide insurance, you may be 

eligible for a state program for: 

• low-income families, children, and pregnant women 

• people 65 and older 

• people with disabilities 

Learn more from the brochure “CHIP, Medicaid, 

Medicare, and the Health Insurance Marketplace at a 

Glance” at www.cms.gov/Outreach-and-Education/ 

American-Indian-Alaska-Native/AIAN/Downloads/ 

CMSProgramsAtAGlance909323N.pdf 

The Marketplace 

If your employer doesn’t offer insurance and you don’t qualify 

for state programs, you can sign up for insurance on the 

Health Insurance Marketplace. Special protections are in place 

to assist American Indians and Alaska Natives. 

• Learn more healthcare.gov/tribal 

• Apply at healthcare.gov