Tribal Health and Medicare in Oregon

Quick answers

Do American Indians and Alaska Natives need Medicare if they use IHS?

IHS and tribal health care isn't insurance, and Purchased/Referred Care pays last. Enrolling in Medicare lets your clinic bill Medicare, stretches tribal health dollars and covers care outside the IHS system.

Can I use my tribal clinic with Medicare?

Yes. Tribal and IHS clinics in Oregon can bill Medicare for covered services they give you, and you can keep using your clinic.

Is IHS drug coverage creditable for Part D?

Yes. Coverage through IHS, a tribe or tribal organization, or an urban Indian organization counts as creditable prescription drug coverage (42 CFR 423.56(b)(9)), so you won't owe a Part D late penalty for the time you had it.

Are there special Medicare enrollment periods for tribal members?

No. American Indians and Alaska Natives use the same Medicare enrollment periods as everyone else. The monthly enrollment option you may have heard about applies to the Health Insurance Marketplace, not Medicare.

Do American Indians pay Medicare premiums?

The same as other people with Medicare. Most people pay no Part A premium, and the standard Part B premium is $202.90 a month in 2026. A Medicare Savings Program can pay Part B for people with limited income.

Oregon is home to nine federally recognized tribes. For tribal members and other American Indian and Alaska Native (AI/AN) people, Medicare works alongside Indian Health Service and tribal health programs. This page explains how they fit together. It is a general guide; your tribal health program can tell you how its services and Purchased/Referred Care work.

Oregon's tribes and their clinics

Each tribe's page has more about its health services. Clinic names are as the tribes and IHS give them; call the clinic to confirm services and hours.

The IHS Portland Area serves tribes in Oregon, Washington and Idaho; most care in the area is run by tribes themselves. Urban Indian health programs also serve AI/AN people who live away from tribal communities. See all Oregon tribes and Medicare.

How IHS and tribal care work with Medicare

IHS clinics, tribally operated clinics and urban Indian programs provide care to eligible AI/AN people, but they are not insurance. Medicare is insurance. The two work together:

• When you have Medicare, your IHS or tribal clinic can bill Medicare for covered services it gives you. That money stays with the clinic and helps pay for more care in your community.
• Medicare also covers care outside the IHS system, such as specialists and hospitals, wherever the provider accepts Medicare.
• Using Medicare doesn't take away your right to use your tribal or IHS clinic.

See can I use my tribal clinic with Medicare in Oregon?

Enrolling in Medicare

AI/AN people sign up for Medicare the same way as everyone else, through Social Security (1-800-772-1213 or ssa.gov). There are no special Medicare enrollment periods for American Indians and Alaska Natives. The usual windows apply: your 7-month Initial Enrollment Period around age 65, Open Enrollment from October 15 to December 7 each year, and Special Enrollment Periods for events such as moving or losing employer coverage. The monthly enrollment option for AI/AN people applies to the Health Insurance Marketplace, not to Medicare.

IHS and tribal health care doesn't count as coverage that lets you delay Part B without a penalty. If you don't sign up for Part B when you're first eligible and don't have job-based coverage, a Part B late enrollment penalty can apply for as long as you have Part B. See Medicare enrollment in Oregon and do Native Americans need Medicare in Oregon?

Premiums and help paying

AI/AN beneficiaries pay the same Medicare premiums as others; IHS doesn't pay them.

• Most people pay no Part A premium after about 10 years of work.
• The standard Part B premium is $202.90 a month in 2026, with a $283 yearly deductible. CMS announces 2027 amounts each fall; see Medicare costs in 2027.
• If your income is limited, a Medicare Savings Program can pay your Part B premium, and some programs also pay deductibles and coinsurance. Oregon's programs have no asset limit. Apply through ONE (one.oregon.gov) or call 1-800-699-9075.
• Extra Help lowers Part D costs for people with limited income and resources.

Part D and tribal pharmacies

Coverage through the medical care program of IHS, a tribe or tribal organization, or an urban Indian organization counts as creditable prescription drug coverage (42 CFR 423.56(b)(9)). That means you won't owe a Part D late enrollment penalty for the months you had it.

A Part D plan can still be useful:

• it covers prescriptions filled at other pharmacies, including specialty drugs your clinic pharmacy may not stock;
• your tribal or IHS pharmacy can bill your Part D plan, which brings money back to the program; and
• drug costs paid by IHS or tribal programs count toward your Part D out-of-pocket cap ($2,100 in 2026).

Ask your clinic pharmacy which Part D plans it works with.

Purchased/Referred Care

Purchased/Referred Care (PRC), formerly called Contract Health Services, pays for care from outside providers when your IHS or tribal clinic can't provide it. Under 42 CFR 136.61, IHS is the payer of last resort: PRC doesn't pay when Medicare, Medicaid, private insurance or other coverage could pay, including coverage you could get by applying for it.

• Enrolling in Medicare makes limited PRC funds go further, because Medicare pays first.
• PRC has its own eligibility rules and usually needs approval before you get outside care. Talk to your clinic's PRC office first.

Medicare Advantage

AI/AN beneficiaries can join Medicare Advantage plans like anyone else, during the usual enrollment periods. Before you join, ask your tribal or IHS clinic whether it works with the plan, and check that the outside doctors and hospitals you use are in the plan's network. In some Oregon counties, such as Grant, Harney, Lake, Umatilla and Union, CMS lists no Medicare Advantage plan open to everyone for 2027. Medicare Advantage plans may offer extra benefits such as dental, vision, hearing or fitness. Extra benefits vary by plan and county, may have limits and costs, and not every plan offers them. Check a plan's Summary of Benefits or Evidence of Coverage.

OHP, Open Card and Medicare

Many AI/AN Oregonians have both Medicare and the Oregon Health Plan. The Oregon Health Authority doesn't automatically enroll AI/AN members in a coordinated care organization (CCO): you can stay on OHP Open Card (fee-for-service) or choose a CCO, and you can change at any time. To change, call OHP Client Services at 1-800-273-0557 (TTY 711).

With Medicare and OHP, most members have OHP with Limited Drug: Medicare Part D covers most prescriptions, and OHP can help with Medicare premiums, deductibles and coinsurance. See the Oregon Health Plan and Medicare and dual eligibility in Oregon.

Resources

• Your tribal health program or clinic: IHS eligibility, PRC and benefits coordination.
• IHS Portland Area: ihs.gov/portland.
• 1-800-MEDICARE (1-800-633-4227, TTY 1-877-486-2048): Medicare coverage questions.
• Social Security: 1-800-772-1213, to sign up for Medicare or apply for Extra Help.
• OHP Client Services: 1-800-273-0557, for Open Card or CCO changes.
• ONE Customer Service Center: 1-800-699-9075, to apply for OHP or a Medicare Savings Program.

To compare Medicare plans with your clinic and medicines in mind, you can request a call from a licensed insurance agent, or meet licensed insurance agents in Oregon.

Related guides

Sources

• 42 CFR 136.61 — Payor of last resort (via Cornell LII)
• 42 CFR 423.56(b)(9) — Creditable prescription drug coverage (via Cornell LII)
• Indian Health Service — Purchased/Referred Care
• Indian Health Service — Portland Area
• Indian Health Service — Warm Springs Health & Wellness Center
• CMS — American Indian/Alaska Native outreach resources
• Oregon Health Authority — CCO plans (American Indian/Alaska Native members)
• Oregon Health Authority — OHP and Medicare
• Oregon Department of Human Services — Medicare Savings Programs
• Medicare.gov — Medicare costs

Every question in this guide

• Can I use my tribal health clinic with Medicare in Oregon?
• Do American Indians and Alaska Natives need Medicare if they use IHS in Oregon?

Frequently asked questions

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