Working with PRC for Better Benefits

Health Care IS a treaty right, but IHS has to work within yearly budgets to meet all the health needs of AI/AN. The current budget only meets about half the current need.  You are limited to what the budget allows and are subject to priority of care restrictions and to location restrictions.

Medicare is a national health insurance program created to provide health insurance to people age 65 and older, regardless of income or medical history.  Both programs, IHS and Medicare, fall under the Department of Health and Human Services.  Medicare will help fill in the areas the HIS cannot cover.  Medicare is also your right!

 

The biggest problem with PRC is that there simply is not enough to go around for everyone who needs it.

When IHS is unable to provide certain types of healthcare in its hospitals and clinics, they may refer patients to providers in the private sector.  These referrals MAY be paid for by the PRC program appropriations.  The budget does not have enough funding to pay for all the referrals and there is a strict priority level to distribute the funds.

Priorities of Care

  1. Emergent or Acutely Urgent Care Services
  2. Preventive Care Services
  3. Primary and Secondary Care Services
  4. Chronic Tertiary Care Services
  5. Excluded Services

The further down the list your service falls, the less likely it will be that there will be funds to pay for it.  At present, there are only funds available for level one priorities.   In addition, to qualify, you must live in an area where a PRC approved clinic is available. (PRC Delivery Area).

Finally, to qualify, you must have exhausted all other healthcare options, federal and state-including Medicare and Medicaid.  PRC was never meant to be a primary resource for healthcare, rather it is the program of last resort.

A Medicare plan can give you access to services near you without the requirement of living in a PRCD.  It does not decrease your access to PRC, rather it is a requirement (if you qualify for Medicare) to receive PRC.  Finally, by having Medicare and Medicaid pay for some or all your services, it leaves more funds available in PRC for other tribal members.

We can help you navigate through the various programs to find the right solution for you.  Help yourself and help your tribe today!

CMS IHS HHS

Working together to help you get all the benefits that you deserve.

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Our vision is to make a positive difference in the lives of Medicare eligible tribal members. Our mission  is to save members money and help them receive the most benefits available to them.

Contact you local tribal health agent to discover the benefits that best fit your needs.   You may also qualify for additional benefits and income.

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