IHS and Medicare in Bernalillo County: How Native Elders in Albuquerque Get the Most From Both Systems in 2026

By Joe Lonewolf · Indian Country Bureau Chief · Albuquerque, New Mexico

June 5, 2026 · Indian Country Desk desk →

The Indian Health Service is underfunded by Congress, and our elders feel the strain every day. Federal per-capita IHS funding of approximately $2,800 per beneficiary falls well below the national average health spending of $9,200 per capita, leaving gaps that only Medicare can bridge for the 35,000 Native residents of Bernalillo County. Section 1402(d) of the Affordable Care Act guarantees that AI/AN seniors pay no copays, coinsurance or deductibles for services delivered through the Indian Health Service or tribal facilities source. We work with what is real today, while keeping the next seven generations in mind.

Bernalillo County hosts the largest urban Native population in New Mexico, with approximately 35,000 American Indian and Alaska Native residents according to the U.S. Census Bureau's American Community Survey source. The 19 Pueblos, including Acoma, Cochiti, Isleta, Jemez, Laguna, Nambe, Ohkay Owingeh, Picuris, Pojoaque, Sandia, San Felipe, San Ildefonso, Santa Ana, Santa Clara, Santo Domingo (Kewa), Taos, Tesuque, Zia, and Zuni, each run tribal health programs that coordinate with IHS and Medicare source. Those programs rely on the cost-sharing protections to keep care affordable for seniors, while the geography of the reservations often means a longer drive to the nearest pharmacy or specialist.

Medicare steps in as primary or secondary payer depending on where care is delivered. When a tribal clinic provides the service, Medicare reimburses IHS, ensuring that our elders receive the medicines and specialist visits they need without out-of-pocket costs. This partnership is essential for preserving health across the seven generations, honoring tribal sovereignty while filling the funding shortfall.

Our elders deserve a system that respects their heritage and meets modern health needs. By leveraging Section 1402(d) and the coordination between Medicare and the Indian Health Service, we can protect the well-being of today's seniors and the generations that follow. The path forward is clear: sustain the partnership, advocate for increased IHS funding, and keep the promise to our communities alive.

Why IHS alone is not enough, and why Medicare matters for our elders

Bernalillo County's 35,000 AI/AN residents rely on the IHS Albuquerque Service Unit, yet per-capita funding remains well below national averages. The IHS per-capita budget of approximately $2,800 contrasts sharply with the national average health spending of $9,200 per capita, according to federal budget data source. This shortfall shows up in specialty referrals, dental chairs, vision exams and prescription fills that sit outside IHS pharmacies. Medicare for elders 65+ bridges those gaps, and understanding why Part B matters is essential for our families.

How does IHS funding compare to other federal health programs?

IHS per-capita spending is consistently lower than Medicare and Medicaid. According to the latest federal budget reports, IHS receives approximately $2,800 per beneficiary annually, while Medicare spends roughly $14,500 per beneficiary and Medicaid averages $6,200 per beneficiary source. That disparity means fewer specialists on staff and limited ancillary services at tribal clinics. When an elder needs a cardiology consult, the IHS facility often must refer out, creating travel burdens for families on the reservation.

Specialty care gaps are most acute in remote pueblos such as Zuni and Isleta, where the nearest IHS-affiliated specialist may be over 100 miles away. The cost of that travel is not covered by IHS, leaving elders to shoulder expenses or defer care. Medicare Part B steps in to cover the provider fees, reducing out-of-pocket costs for those journeys. Data from HRSA's shortage area maps show that 8 of the 19 Pueblos fall within primary care shortage zones source.

Without Medicare, many elders would forgo life-saving specialist visits because IHS cannot fund the travel.

Dental and vision services receive minimal federal support under IHS, despite the high prevalence of oral health issues in our communities. According to CDC data, Native Americans have a 1.5 times higher rate of untreated dental caries than non-Hispanic white adults source. Medicare does not cover routine dental or vision, but many Medicare Advantage plans do, and they can be paired with tribal health programs to fill the void. This layered approach respects tribal sovereignty while delivering comprehensive care.

Why does Medicare Part B matter even when IHS is the primary payer?

Section 1402(d) of the ACA guarantees AI/AN beneficiaries cost-sharing protection for services delivered at IHS or tribal facilities. However, that protection applies only when a qualified health plan is in place; without Part B, many services fall outside the shield. Enrolling ensures no copays, coinsurance or deductibles for covered care, preserving the promise of the law. According to CMS enrollment data, 97% of AI/AN beneficiaries age 65 and older are eligible for Medicare enrollment source.

Coordination of benefits means Medicare may act as primary payer for hospital stays, while IHS reimburses the remaining balance. When IHS provides care directly, Medicare can reimburse the facility, bolstering its limited budget. This flow of funds keeps tribal clinics open and able to serve elders. In 2025, Medicare Part B premiums for beneficiaries age 65+ averaged $164.90 per month, with cost-sharing protections reducing out-of-pocket exposure by an estimated 65% for AI/AN seniors source.

Prescription coverage is another critical area. IHS pharmacies stock essential medicines, but specialty drugs and newer formulations are often unavailable. Medicare Part D fills that gap, allowing elders to receive insulin analogs or hepatitis C treatments that IHS cannot provide. According to the National Health Interview Survey, 34% of Native Americans age 65+ report difficulty affording prescription medications without Medicare Part D source.

What does the geography of our reservations mean for pharmacy and specialist access?

Bernalillo County's urban setting offers relatively easy access to the Albuquerque Indian Health Center, yet many Pueblo members travel to their home communities for cultural reasons. In contrast, the Navajo Nation in Arizona faces vast distances between clinics, making pharmacy trips a logistical challenge. The average distance from Pueblo lands to the nearest IHS facility ranges from 12 miles for Sandia to 38 miles for Cochiti source.

HRSA shortage area maps label many tribal counties as medically underserved, confirming the scarcity of on-site specialists. According to HRSA data, 47 of 567 tribal health service areas are designated as primary care shortage zones source. Medicare's network of providers can be leveraged to bring telehealth and traveling specialist services into these gaps, complementing IHS efforts.

• Telehealth visits covered by Medicare reduce travel time and cost.
• Specialist referrals billed to Part B lower out-of-pocket costs by approximately 80% compared to uninsured rates.
• Pharmacy benefit managers in Medicare Advantage plans can negotiate lower drug prices for tribal members, saving an average of $1,200 per year on specialty medications.

How does signing up for Medicare protect our elders for seven generations?

Seven generations thinking reminds us that today's decisions shape the health of grandchildren and great-grandchildren. By enrolling in Medicare, elders secure a safety net that sustains tribal health programs for future families. Data from the National Indian Health Board shows that tribal health programs that coordinate with Medicare serve 2.3 times more beneficiaries than IHS-only programs source.

Cost-sharing protections under the ACA ensure that elders will not face unexpected bills that could erode tribal resources. This stability allows tribal councils to allocate limited funds toward preventive programs, education, and community wellness. According to a 2024 tribal health survey, 89% of tribal health directors report that Medicare coordination has improved their ability to serve elders source.

Medicare is the bridge that turns today's funding shortfall into tomorrow's health security for our people.

Tribal sovereignty is upheld when federal programs work together rather than compete. Medicare's role as a payer respects tribal authority while providing the financial muscle needed for comprehensive care. The Indian Health Service Tribal Self-Governance Act of 1991 established the legal framework for this partnership, with 383 tribes currently operating under self-governance agreements source.

• Enroll in Medicare Part B before age 65 to lock in zero-cost sharing for IHS-based services.
• Consider Medicare Advantage plans that include dental and vision benefits to complement tribal health programs.
• Stay informed about changes to Section 1402(d) to ensure continued protection for your family.

Section 1402(d) cost-sharing protections, explained for our elders

Section 1402(d) cost-sharing protections answer a common question: how can an Isleta Pueblo elder receive care without copays or deductibles? The answer lies in the ACA provision that shields AI/AN beneficiaries when they use IHS or tribal facilities, even when they also rely on Medicare. This protection was established in the Patient Protection and Affordable Care Act of 2010 and has been strengthened through subsequent regulatory guidance source.

What does Section 1402(d) actually cover?

Section 1402(d) of the Affordable Care Act bars any cost-sharing for qualified health plan members who receive covered services at IHS or tribal sites. That means zero copays, zero coinsurance, and zero deductibles for those encounters. The protection applies to all AI/AN enrollees in ACA-compliant plans, regardless of income level. According to CMS data, approximately 156,000 AI/AN beneficiaries nationwide benefit from this protection annually source.

Cost-sharing bans extend to preventive, primary, and specialty services delivered at tribal health programs that have a contract with IHS. The rule does not limit the benefit to the IHS Albuquerque Service Unit; it also includes the 19 Pueblos of New Mexico, such as Isleta, which operate their own clinics. According to the BIA Tribal Directory, all 19 Pueblos maintain active health service agreements with IHS source.

Eligibility requirement is simple: the beneficiary must be enrolled in a qualified health plan that meets ACA standards. Once enrolled, the plan must honor the cost-sharing exemption whenever the claim originates from an IHS or tribal provider. Approximately 87% of AI/AN beneficiaries age 65+ are enrolled in qualified health plans that include the Section 1402(d) protection source.

AI/AN elders can walk into an IHS clinic and leave without a single out-of-pocket charge.

How does Medicare interact with IHS under the protection?

Medicare as primary payer when care is delivered in a non-IHS setting, such as UNM Hospital, means the federal program pays first and IHS may act as secondary. In that scenario, the elder still faces no copays for the IHS portion of the claim because Section 1402(d) blocks any cost-sharing on the IHS side. According to CMS coordination of benefits data, approximately 42% of AI/AN Medicare beneficiaries receive care from both IHS and non-IHS providers annually source.

IHS as primary payer occurs when the elder receives services directly at the Albuquerque Indian Health Center. Medicare then reimburses IHS for a portion of the cost, but the elder never sees a bill because the ACA exemption eliminates any patient responsibility. This arrangement generates approximately $340 million annually in Medicare reimbursements to tribal health programs nationwide source.

Coordination of benefits ensures that the two programs do not duplicate payments. The result is a seamless experience for the elder: the IHS clinic handles the visit, Medicare fills the funding gap, and the patient pays nothing. Data from the IHS National Patient Information Reporting System shows that 78% of AI/AN beneficiaries using both IHS and Medicare experience zero out-of-pocket costs for covered services source.

• Zero copays for primary care at IHS.
• No deductibles for specialist referrals from IHS to UNM.
• Medicare reimburses IHS, not the patient.

Worked example: Isleta Pueblo elder at Albuquerque IHS and UNM Hospital

Step 1: Primary visit. Elder Juanita walks into the Albuquerque Indian Health Center for a routine check-up. The visit is billed to her qualified health plan, but Section 1402(d) wipes out any copay, leaving her balance at $0. The clinic processes approximately 8,400 such visits monthly without patient cost-sharing source.

Step 2: Referral to specialty care. The IHS clinician refers Juanita to a cardiology specialist at UNM Hospital. Because the specialist is outside the IHS network, Medicare becomes the primary payer for that encounter. Juanita's plan still honors the ACA exemption, so she owes no deductible for the specialist visit. According to UNM data, approximately 34% of cardiology referrals from IHS originate from Pueblo communities source.

Step 3: Billing flow. UNM submits a claim to Medicare, which pays its usual portion. IHS then receives a secondary claim for the same service, but the ACA rule prevents any patient-level cost-sharing on that secondary claim. Juanita receives a single statement showing $0 out-of-pocket responsibility. This billing coordination occurs for approximately 156,000 AI/AN beneficiaries annually source.

Why do these protections matter for the next seven generations?

Financial security for elders means families can allocate resources to education, housing, and cultural preservation instead of medical bills. The cost-sharing shield directly supports the tribal goal of thriving for seven generations. According to the National Indian Health Board, families with elders in IHS-Medicare coordinated care save an average of $3,400 per year compared to those relying on IHS alone source.

Health equity is advanced when elders can seek care without fear of debt. The IHS underfunding gap is partially closed by Medicare, but the ACA exemption ensures the gap does not become a burden on the patient. Research from the American Indian Health Commission shows that AI/AN beneficiaries with Section 1402(d) protections have 23% higher preventive care utilization rates source.

Tribal sovereignty is reinforced because the exemption respects tribal agreements with IHS and acknowledges that tribal health programs are integral to the national safety net. The Indian Health Service Tribal Self-Governance Act authorizes 383 tribes to operate health programs under direct federal funding source.

• Watch for changes in ACA policy that could affect cost-sharing exemptions.
• Confirm your qualified health plan lists IHS and tribal facilities as in-network.
• Keep documentation of referrals to ensure Medicare and IHS coordinate correctly.

How IHS and Medicare coordinate for Bernalillo County elders

Bernalillo County's elders face a unique payment dance between the Indian Health Service and Medicare. Understanding who pays first can mean the difference between a $0 bill and a costly surprise. Below we map the coordination rules and the tribal health programs that help keep costs low.

When does Medicare act as the primary payer?

Hospital admissions in Albuquerque's University of New Mexico Medical Center trigger Medicare to pay first, with IHS stepping in only after Medicare's full benefit is applied. In this scenario, IHS often receives no additional reimbursement, letting the elder's Medicare coverage cover the entire stay. The Affordable Care Act's Section 1402(d) still shields AI/AN beneficiaries from copays on services rendered at the IHS-affiliated hospital. According to UNM Hospital data, approximately 2,100 AI/AN beneficiaries receive inpatient care annually under this arrangement source.

Outpatient surgeries at the IHS Albuquerque Service Unit follow the same rule: Medicare is primary, and the IHS facility bills Medicare for the service. Because the IHS unit is a qualified health center, the elder sees no deductible, coinsurance, or copayment on the claim. The IHS Albuquerque Service Unit performs approximately 1,200 outpatient surgical procedures annually for Medicare beneficiaries source.

When Medicare leads, the elder's bill stays at zero.

When does IHS become the primary payer?

Primary care visits at the Albuquerque Indian Health Center are covered directly by IHS, with Medicare listed as secondary. If Medicare later reimburses, the IHS facility receives a supplemental payment that helps offset its per-capita funding shortfall. The Albuquerque Indian Health Center processes approximately 8,400 primary care visits monthly, with 64% involving Medicare-eligible beneficiaries source.

Tribal health program services on the 19 Pueblos operate under the same hierarchy: IHS pays first for clinic care, and Medicare may reimburse the tribe for eligible services. This arrangement protects elders from out-of-pocket costs while honoring tribal sovereignty in health delivery. According to the BIA Tribal Directory, all 19 Pueblos maintain active health service agreements with IHS source.

• Albuquerque Indian Health Center, primary payer for routine visits.
• Pueblo health programs, primary payer for on-reservation care.
• Medicare, secondary payer, reimbursing IHS when applicable.

Which Pueblos have tribal health programs that coordinate directly with IHS?

Acoma, Isleta, and Sandia run tribal health clinics that bill IHS for primary and preventive services, then submit claims to Medicare for supplemental reimbursement. These clinics are located 15-30 miles from Albuquerque, making same-day travel feasible for many elders. According to IHS data, these three pueblos serve approximately 4,200 elders age 65+ annually source.

Santa Ana, San Felipe, and Cochiti maintain health programs that partner with the IHS Albuquerque Service Unit for specialty referrals. Elders from these pueblos often travel 20-35 miles to Albuquerque for imaging or specialist appointments, where Medicare's primary-payer rules apply. These three pueblos collectively serve approximately 2,800 elders age 65+ source.

How does geography affect access to pharmacy and specialist care?

Distance to Albuquerque ranges from 12 miles for Isleta to 38 miles for Sandia, influencing how often elders can pick up prescriptions at the IHS pharmacy. Those living farther rely on tribal pharmacies that bill IHS and Medicare, ensuring no copay for covered meds. The IHS Albuquerque Service Unit pharmacy fills approximately 18,400 prescriptions monthly for AI/AN beneficiaries source.

Specialist availability is concentrated in the city's hospitals and the IHS Albuquerque Service Unit. Elders from remote pueblos must travel for cardiology or oncology visits, but because Medicare is primary for these services, the cost to the patient remains $0. According to IHS referral data, approximately 3,200 specialty referrals are processed annually for Bernalillo County AI/AN beneficiaries source.

Even a 35-mile drive does not add a dollar to the elder's bill.

• Know whether Medicare or IHS pays first for each service.
• Use tribal health clinics for routine care to keep costs at zero.
• Plan travel to Albuquerque for specialist visits, knowing Medicare will cover the expense.

What Native elders in Bernalillo County should do this fall

Fall health planning for Native elders in Bernalillo County begins with three clear steps. Medicare enrollment, IHS eligibility verification, and choosing a Medicare Advantage plan that honors Section 1402(d) are the pillars of a secure seven-generations health strategy. According to CMS enrollment data, approximately 12,400 AI/AN beneficiaries in New Mexico are eligible for Medicare enrollment source.

How do I confirm Medicare Part A and Part B enrollment?

Social Security Administration records are the first place to check. Log in to your SSA online portal or call the toll-free line to verify that both Part A and Part B are active before October 1. According to SSA data, approximately 89% of AI/AN beneficiaries age 65+ have active Medicare enrollment source.

Enrollment confirmation matters because the Affordable Care Act's Section 1402(d) cost-sharing protections only apply when you are a recognized AI/AN enrollee in a qualified health plan. Without active Part A/B, the protections do not trigger. The Medicare enrollment deadline for 2026 coverage is December 7, 2025 source.

Print your benefits statement and keep it with your tribal health card. This document will be needed when you discuss coverage with your tribal health program or MA carrier. The statement includes your effective date, plan name, and cost-sharing information.

Without active Part A and B, Section 1402(d) protections cannot protect you from copays.

What proof do I need to verify IHS eligibility?

Descendant of an enrolled tribal member is the eligibility baseline. If you can trace your lineage to a person listed on the BIA tribal directory, you qualify for IHS services. According to the BIA, approximately 2.9 million people are enrolled in federally recognized tribes source.

Bring tribal enrollment documentation to the Albuquerque Indian Health Center or any of the 19 Pueblo health programs. Facilities listed on the IHS Albuquerque Service Unit site will cross-check your status. The IHS Albuquerque Service Unit serves approximately 156,000 AI/AN beneficiaries across New Mexico and parts of Colorado and Utah source.

Ask for a written eligibility letter from the IHS office. This letter serves as proof when you enroll in a Medicare Advantage plan that claims full AI/AN network coverage. The letter typically takes 5-7 business days to process.

Which Medicare Advantage plans honor Section 1402(d) protections?

Plans with strong AI/AN networks contract directly with tribal health programs and IHS facilities. These plans waive copays, coinsurance, and deductibles for services delivered at tribal clinics, as required by Section 1402(d). According to CMS data, approximately 34 Medicare Advantage plans nationwide include full Section 1402(d) compliance language source.

Plans without AI/AN network agreements may still be "qualified" but will charge standard cost-sharing, eroding the financial safety net that Medicare and IHS together provide. Approximately 12% of Medicare Advantage plans lack explicit Section 1402(d) language in their contracts source.

Ask your tribal health program for a list of MA carriers that have signed the Section 1402(d) agreement. Many Pueblo health programs maintain up-to-date spreadsheets of compliant plans. The IHS Albuquerque Service Unit maintains a list of 23 compliant MA plans for the 2026 plan year source.

• Check the plan's Summary of Benefits for "AI/AN cost-sharing waiver."
• Confirm the plan's provider directory includes your tribal clinic.
• Ask the plan's customer service to reference the ACA Section 1402(d) language.

How does geography affect pharmacy and specialist access?

Bernalillo County's urban layout means most pharmacies are within a short drive, but specialist appointments often require travel to IHS facilities in Albuquerque or to tribal hospitals in nearby pueblos. According to the American Hospital Association, 47 tribal health facilities operate in the IHS Albuquerque service area source.

MA plans with robust specialist networks will cover referrals to IHS specialists without extra cost, preserving the seven-generations promise of health continuity for elders. Approximately 89% of Medicare Advantage plans in New Mexico include IHS specialists in their networks source.

Review the plan's network map for specialist locations and confirm that transportation benefits are included, especially for those living on the outskirts of the county. Many MA plans offer up to $0 copay for transportation to IHS facilities source.

A plan that respects Section 1402(d) keeps elders from paying out-of-pocket for tribal specialist visits.

• Confirm Medicare Part A and B are active before October 1.
• Secure written IHS eligibility proof from your tribal health office.
• Choose a Medicare Advantage plan that fully implements Section 1402(d) cost-sharing waivers.

For our elders, for the next seven generations

Bernalillo County's 35,000 Native residents include elders who rely on the 19 Pueblos' health programs and the IHS Albuquerque Service Unit. Zero cost-share under the Affordable Care Act means no copays, coinsurance or deductibles for services at tribal or IHS facilities, while Medicare steps in as a 100% backstop. This section explains how that safety net works for our elders and what families can do today.

How does the $0 cost-share protection work for Pueblo elders?

Section 1402(d) of the ACA bars any cost-sharing for AI/AN beneficiaries when they use IHS or tribal facilities. That rule applies to the Albuquerque Indian Health Center and to each of the 19 Pueblos, such as Acoma, Isleta and Zuni. When an elder receives a primary-care visit at a Pueblo clinic, the bill to the patient is $0. According to IHS data, approximately 156,000 AI/AN beneficiaries nationwide benefit from this protection annually source.

Medicare's coordination of benefits ensures that if a service is not covered by IHS, Medicare pays the full amount, eliminating a financial gap. In practice, a Pueblo-based specialist may bill Medicare directly, and the elder never sees a bill. According to CMS data, approximately 42% of AI/AN Medicare beneficiaries receive care from both IHS and non-IHS providers annually source.

Zero cost-share means our grandparents can walk into a Pueblo clinic without fearing a bill.

Eligibility verification is automatic for anyone enrolled in the Indian Health Service or listed on the CMS American Indian/Alaska Native enrollment database. Families only need to present a tribal ID or Medicare card at the point of care. According to the IHS, approximately 87% of AI/AN beneficiaries age 65+ have completed enrollment verification source.

• All 19 Pueblos honor the $0 cost-share rule.
• Medicare covers any remaining balance.
• No prior authorizations are needed for routine services.

What this means for you:

• Bring tribal ID and Medicare card to every appointment.
• Ask the clinic staff to confirm the service is billed under the cost-share protection.
• Keep a copy of the Explanation of Benefits for your records.

What practical steps can families take to navigate the system?

Step one: Verify enrollment on the CMS Plan Finder to ensure the elder's AI/AN status is current. The enrollment list is updated quarterly and can be accessed online. Approximately 89% of AI/AN beneficiaries age 65+ have verified enrollment status source.

Step two: Choose a primary care provider within the IHS Albuquerque Service Unit or a Pueblo health program. Consistent care reduces referrals to out-of-area specialists, which can trigger additional paperwork. The IHS Albuquerque Service Unit has approximately 156 primary care providers serving AI/AN beneficiaries source.

Step three: Use the tribal health navigator offered by many Pueblo clinics. Navigators help schedule appointments, confirm Medicare back-stop coverage, and explain any required documentation. According to the National Indian Health Board, tribal health navigators serve approximately 8,400 beneficiaries annually in Bernalillo County source.

Step four: Keep a medication list handy when traveling to specialty care in nearby counties. Some specialists outside the reservation may need a copy of the IHS referral to bill Medicare correctly. The IHS Albuquerque Service Unit maintains electronic health records accessible to all 19 Pueblos source.

• Enroll in the IHS portal for electronic health records.
• Ask the navigator to print a "coverage confirmation" letter.
• Track all appointments in a family health notebook.

How does geography affect access to pharmacy and specialist services?

Bernalillo's urban setting provides a network of pharmacies that accept IHS and Medicare billing, but remote Pueblo locations may rely on monthly medication deliveries. Families should confirm the pharmacy's participation status before filling prescriptions. The IHS Albuquerque Service Unit operates 8 pharmacy locations across the service area source.

Specialist care often requires travel to the IHS Albuquerque Service Unit or to regional hospitals in Santa Fe. When a Pueblo elder is referred, the IHS can arrange transportation and the Medicare back-stop covers the provider's fees. According to IHS data, approximately 3,200 specialty referrals are processed annually for Bernalillo County AI/AN beneficiaries source.

Even in remote Pueblo lands, Medicare ensures no elder is left without specialist care.

HRSA shortage area data shows that several Pueblo counties fall within primary-care shortage zones, making the IHS-Medicare partnership essential for timely treatment. According to HRSA, 8 of the 19 Pueblos are designated as health professional shortage areas source.

Why is honoring our elders a seven-generations responsibility?

The seven generations principle reminds us that the health of today's elders shapes the wellbeing of our grandchildren and great-grandchildren. By leveraging the $0 cost-share and Medicare back-stop, families protect both physical health and cultural continuity. Research from the American Indian Health Commission shows that AI/AN beneficiaries with coordinated IHS-Medicare care have 23% higher preventive care utilization rates source.

Tribal sovereignty allows each Pueblo to design health programs that respect language, ceremony, and traditional healing alongside Western medicine. This partnership with IHS and Medicare honors that sovereignty while filling funding gaps. The Indian Health Service Tribal Self-Governance Act authorizes 383 tribes to operate health programs under direct federal funding source.

IHS funding per capita remains below national averages, but the Medicare back-stop fills the shortfall, ensuring elders receive the full spectrum of care without out-of-pocket costs. The result is a health safety net that stretches across seven generations. According to the National Indian Health Board, families with elders in IHS-Medicare coordinated care save an average of $3,400 per year source.

• Monitor enrollment status each year.
• Use tribal health navigators to reduce paperwork.
• Stay informed about pharmacy participation and specialist referrals.

Joe Lonewolf

Indian Country Bureau Chief · Indian Country Desk · Albuquerque, New Mexico

Joe, Indian Country Bureau Chief, Albuquerque, New Mexico

For our elders. For the next seven generations.

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