Ten Tips to Help Tribal Members save big money on health care
Are you missing out on your Health Benefits?
Tribal Members can save thousands of dollars every year on medical expenses, but many are missing out.
Indeed, says Suquamish Tribe Health Benefits Supervisor Rebecca Jones, “If you are a Tribal Member and you are enrolled in Health Benefits, you should never pay for anything.”
How it works
For most Tribal Members, Suquamish Tribe provides secondary coverage that picks up where employer-provided insurance or Medicare or Medicaid leave off.
To qualify, Tribal Members must live in Kitsap County or one of the six surrounding counties—Jefferson, King, Mason, Pierce, Snohomish, and Whatcom Counties.
The Tribe uses Shasta to provide this secondary coverage. But if Shasta does not fully cover something, the Tribe will pay for most things out of its own funds.
There are some limits and exceptions. If a doctor says you need to exercise more, for example, that doesn’t mean the Tribe will pay for a gym membership. (However, the Tribe’s Fitness Center is free to all Tribal Members). Also, incidental expenses such as over-the-counter medications and band-aids, are not covered.
“The Suquamish Tribe is very generous,” said Jones. “At the end of the day, the goal is that Tribal Members are covered 100 percent and nothing comes out of pocket.”
How can you make sure you are not missing out on receiving these benefits?
Who’s Eligible for Suquamish Health Care Coverage
- Enrolled Suquamish Tribal Members who reside within Kitsap, Jefferson, King, Mason, Pierce, Snohomish, and Whatcom Counties
- Descendant Dependent children of enrolled Suquamish Tribal Members who are enrolled as a descendant in the Suquamish Tribe and are under the age of 18.
Keep paperwork up to date
“You can save yourself a lot of grief – and money — if you just update us whenever you move or your insurance changes,” says Jones. Doing so makes sure that claims aren’t unnecessarily denied. “This is where a lot of people start seeing bills piling up.”
Keeping information updated also reduces problems with pre-authorization for medical procedures and reduces delays on appeals.
Boost Medicare Savings
For Elders 65 and older, Medicare covers a lot, but $170 is deducted from Elders’ Social Security check every month. Send Health Benefits a copy of your annual Social Security letter confirming that the premium is being deducted, and you’ll get reimbursed every month along with your Elder’s check. Make sure to send in your letter each year to make sure your reimbursement goes up with any increased premium deduction. Last year, for example, the premium was $148 a month; this year it jumped to $170. That’s $264 in savings per year if you get your new letter to Health Benefits.
Get Premiums Back
It’s not just Elders who get their premiums reimbursed. If you are paying a portion of your monthly insurance premium, the Tribe will reimburse your share.
For example, if your employer deducts $40 month from your paycheck every month as your share of your insurance premium, send Health Benefits your pay stub to be reimbursed for that deduction. In this example, that would amount to $480 back in your pocket over the year.
“As of right now, we only have four people doing this,” says Jones. “There have to be many others that could be getting that money back every month.”
Show all your cards
Remember to provide care providers all of your insurance cards – primary insurance as well as Tribal insurance. Otherwise, the Tribe could wind up covering costs that your primary insurance company should be paying for – and that costs the Tribe a lot of money.
Bring in the bills
You should never have to pay any medical bills, says Jones. Call Health Benefits if you’re getting billed or being charged copays. But don’t delay. As soon as a provider sends you a bill, a 90-day clock starts ticking, and then it can be sent to collections. “At that point, it’s largely out of our hands because it becomes a legal matter,” Jones says. The Health Benefits team has sometimes been able to help even then, but there are still often fees and interest that the Tribal Member will have to cover.
Mental Health and Substance Abuse Help
The Suquamish Tribe Wellness Center provides free counseling to all Tribal Members and their families, but if you prefer, you can see a mental health provider elsewhere. Just get a referral from Wellness. If your primary insurance covers mental health, the Tribe will pick up any co-pays or premiums that are not fully covered.
Smile, you’re covered for dental implants and braces too!
Health Benefits recently worked out an arrangement with a specialist in Silverdale to provide dental implants at a group cost.
The Tribe will now pay for up to ten dental implants, and adult braces are now covered up to $5500.
Eyewear
The Tribe will pay up to $425-$625, depending on your vision, for prescription eyewear every two years. Eye exams are always free.
Lose weight, not money
New coverage to help with obesity was just added last year. Tribal members who want to slim down can work with a dietitian every week, see a doctor for possible medications, and usually there’s also a mental health therapist involved – it’s a team approach. The new coverage also includes the option of bariatric surgery.
Appeals
Some things may not be covered by Medicare or Medicaid or other primary insurance, but the Tribe can still cover it if the Tribal Member can show it’s needed. Health Benefits staff will assist Tribal members with appeals, and the person bringing the appeal can remain anonymous.
“If people don’t ever appeal, we will never know what they need,” Jones says.
