Covered California Certified Enroller Practice Exam

Will AI/AN members still have standard cost-sharing when accessing care from non-Indian providers?

1. Yes

2. No

3. Only for specialist visits

4. Only for urgent care

The correct answer is: Yes

AI/AN (American Indian/Alaska Native) members, when accessing care from non-Indian providers, do indeed have standard cost-sharing obligations. This means that they can be subject to deductibles, copayments, and coinsurance just like any other member of a health insurance plan. Compliance with this standard practice is important for understanding how benefits are structured and how they may differ when receiving care from Indian Health Service (IHS) providers versus non-IHS providers. When accessing services outside of the IHS framework, AI/AN members typically do not receive the federally mandated protections that eliminate cost-sharing requirements, which are specifically designed for care received within the IHS network. This distinction is crucial in patient education, as it directly impacts the healthcare costs individuals should anticipate when seeking care outside of their tribal health services. Understanding this aspect is imperative for providing comprehensive assistance as a certified enroller in California.