Important Health Insurance Language
from Medicaid for American Indians
Co-insurance / Your share of the cost for a health care service like seeing a doctor or filling a prescription. / As an American Indian, you will not pay any co-insurance for health care services.Co-pay / The amount you pay at the time you receive a health care service like seeing a doctor or filling a prescription. / As an American Indian, you will not pay any co-pays for health care services.
Deductible / The amount you must pay out of your own pocket for your covered health care services each year before your insurance plan will begin sharing the cost with you. / With Medicaid, there is NO DEDUCTIBLE. Medicaid begins helping with your costs right away.
Out-of-pocket maximum / A limit on the amount you will have to pay for the year. After you have reached your out-of-pocket maximum for the year, your insurance plan will pay 100% of your covered health benefits. With Medicaid, this is based on income and cannot exceed 2% of your yearly income. / Some medical expenses may still not be covered if they were not originally covered under your plan. For example, if your plan did not cover cosmetic surgery before you met your out-of-pocket maximum, it will still not be covered.
Premium / The cost you pay for your health insurance. Premiums may be paid by you, your employer, or a combination of both. It is usually paid monthly. / As an American Indian, you will not pay a monthly premium for Medicaid.
Primary Care Physician / Your “regular” doctor, which is also sometimes abbreviated as PCP. This is the doctor you will see on a regular basis for common issues, such as a cough that won’t go away or if you need vaccination like the flu shot. / A primary care physician is usually trained in general medicine and can treat a variety of routine conditions.
Specialist / A doctor who practices medicine in a particular or specific field. Your PCP might refer you to a particular doctor for more specialized care if they think it is necessary. / For example, if someone has a heart condition, their regular doctor may want them to see a cardiologist or heart doctor.
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Remember you MUST report changes to your income, household size, and where you live to the Medicaid office. Call 888-706-1535, log on to apply.mt.gov or visit your navigator!
Your Health Homework
To better serve you, we need you to complete the following tasks by their due dates.
Remember, you are your own best advocate!
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