How does Medicare work with Indian Health Service in North Carolina?

Two systems that work together

The Indian Health Service, part of the U.S. Department of Health and Human Services, provides federal health services to American Indians and Alaska Natives. If you qualify for IHS and Medicare, you can use both. CMS's Division of Tribal Affairs says:

• With Original Medicare, you can keep seeing your Indian health care provider, and most IHS, tribal and urban Indian clinics are paid by Medicare for the covered services they provide.
• Enrolling benefits your tribal health program, because Medicare payments give it more resources for services.
• Some tribes pay Medicare premiums for their members (sponsorship). Ask your provider.

Why IHS expects you to use Medicare

When your Indian health program refers you to an outside specialist or hospital, it may pay through Purchased/Referred Care (formerly called contract health services). Federal rules make IHS the "payor of last resort" for that care: it won't pay to the extent you're eligible for Medicare, Medicaid or other coverage, or would be eligible if you applied (42 CFR 136.61). In practice, Cherokee Indian Hospital says it screens every patient for Medicaid, Medicare or private insurance before using referred-care funds.

With Original Medicare, CMS says the referred-care program coordinates your referral and often pays Medicare deductibles, copays and coinsurance.

If you're thinking about Medicare Advantage

CMS cautions that your Indian health care provider may not be in a Medicare Advantage plan's network and may be paid less or not at all. CMS's advice is to contact your Indian health provider before you enroll. 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.

Prescriptions and Part D

• Creditable coverage. CMS says care from IHS, a tribe or tribal organization, or an urban Indian organization includes creditable drug coverage, so you won't pay a Part D late penalty if you join a plan later (42 CFR 423.56). Ask for a letter confirming it.
• No interruption. If you get drugs through an Indian health pharmacy, Medicare says you'll keep getting them at no cost, and a Medicare drug plan pays the facility for them.
• Low income? Extra Help and North Carolina's Medicare Savings Programs (MQB) can lower other Medicare costs.

What to do

1. Sign up for Medicare when you're first eligible. Contact Social Security at 1-800-772-1213 (TTY 1-800-325-0778).
2. Talk to the benefits coordinator before choosing a plan. Ask whether a plan works with your provider and your referred-care program.

More in our guide to American Indians and Medicare in North Carolina. You can also request a call from a licensed insurance agent.

Related questions

Sources

• CMS Division of Tribal Affairs — Medicare and Tribal Medicare Beneficiaries
• Indian Health Service — About IHS
• Indian Health Service — Nashville Area health care facilities
• eCFR — 42 CFR 136.61, Payor of last resort
• CMS — Your Guide to Medicare Drug Coverage (June 2026)
• Medicare.gov — Who pays first? (Indian Health Service)
• Cherokee Indian Hospital Authority — Purchased and Referred Care

More questions in this guide

• Can Eastern Band of Cherokee members use Cherokee Indian Hospital with Medicare?
• Does Lumbee federal recognition change Medicare or IHS care?
• What is the EBCI Tribal Option?

Part of the guide: American Indians and Medicare in North Carolina · All questions

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