How your clinic works with Medicare
Getting Medicare doesn't replace your tribal or IHS care; it adds a payer. CMS's guide for tribal Medicare beneficiaries says most Indian health care providers are reimbursed for the Medicare-covered services they provide. Your clinic bills Medicare, and IHS says the third-party revenue a facility collects stays at the local level.
| Original Medicare | Medicare Advantage | |
|---|---|---|
| Your tribal or IHS clinic | Yes, if it takes Medicare | You can still go, but the plan may pay less or not pay if the clinic is out of network |
| Outside specialists | Any provider that takes Medicare, nationwide | Usually the plan's network; prior authorization may apply |
| Purchased/Referred Care | CMS says PRC often pays Medicare deductibles and copays for eligible patients | Out-of-network care may cost you more |
| Tribe-sponsored Part D plan | Keeps working | May be canceled if you pick a plan with drug coverage |
Oregon tribal and IHS clinics
Each of Oregon's nine federally recognized tribes has a health center, run by the tribe or, at Warm Springs, by IHS:
- Siletz Community Health Clinic, Siletz (Confederated Tribes of Siletz Indians)
- Grand Ronde Health & Wellness Center, Grand Ronde (Confederated Tribes of Grand Ronde)
- Warm Springs Health & Wellness Center, Warm Springs, IHS-operated (Confederated Tribes of Warm Springs)
- Yellowhawk Tribal Health Center, Pendleton area (Confederated Tribes of the Umatilla Indian Reservation)
- Klamath Tribal Health & Family Services, Chiloquin and Klamath Falls (The Klamath Tribes)
- Wadatika Health Clinic, Burns (Burns Paiute Tribe)
- Ko-Kwel Wellness Center, Coos Bay (Coquille Indian Tribe)
- Cow Creek Health & Wellness Center, Roseburg and Canyonville (Cow Creek Band of Umpqua Tribe of Indians)
- Three Rivers Health Center, Coos Bay (Confederated Tribes of Coos, Lower Umpqua and Siuslaw Indians)
Clinic services, hours and eligibility differ; call your clinic to confirm. IHS's Portland Area office serves tribes in Oregon, Washington and Idaho.
Before you choose coverage
- Ask your clinic which Medicare plans it works with. Its benefits staff can also help with Medicare applications.
- Ask whether your tribe sponsors premiums. CMS notes that some tribes pay Medicare or Part D premiums for members.
- Compare Original Medicare and Medicare Advantage with your clinic and outside doctors in mind. You can request a call from a licensed insurance agent.
More in our guide to tribal health and Medicare and the tribes of Oregon.
Related questions
Do Native Americans need Medicare if they use IHS?
Why enrolling still matters.
Can I keep my doctor with Medicare Advantage?
Networks explained.
How do I get Extra Help with drug costs?
Lower Part D costs.
Sources
- CMS Tribal Affairs — Medicare and Tribal Medicare Beneficiaries
- Indian Health Service — Portland Area
- Indian Health Service — Warm Springs Health & Wellness Center
- Indian Health Service — Purchased/Referred Care
- Confederated Tribes of Siletz Indians — About the Siletz Community Health Clinic
- Confederated Tribes of Grand Ronde — Health & Wellness
- Yellowhawk Tribal Health Center — Contact
- Burns Paiute Tribe — Wadatika Health Clinic
More questions in this guide
Part of the guide: Tribal Health and Medicare in Oregon · All questions
Frequently asked questions
Do I have to show my Medicare card at my tribal clinic?
Yes. Give the clinic your Medicare card, and any other coverage cards, so it can bill Medicare. That doesn't change your eligibility for tribal or IHS services.
Can non-Native people use tribal clinics in Oregon?
Some clinics serve the wider community. The Siletz and Grand Ronde clinics, for example, say they serve community members as well as tribal members. Ask the clinic about its eligibility rules.
What if my clinic refers me to a specialist?
With Original Medicare, the specialist bills Medicare, and your clinic's Purchased/Referred Care program may help with what Medicare doesn't pay if you're eligible and get approval.
Medicare in your Oregon county
Plans, local agents and help, county by county: Multnomah · Washington · Clackamas · Lane · Marion · Jackson · Deschutes · Linn · Douglas · Yamhill · Benton · Polk · Josephine · Umatilla · Klamath · Coos · Columbia · Lincoln · Clatsop · Malheur · All 36 counties →
