IHS Is Underfunded and Medicare Must Fill the Gap — Here's Exactly How It Works When You Turn 65 in San Juan County, NM

What Does "IHS Is Underfunded" Actually Mean for Someone Turning 65 in Shiprock or Farmington?

Let me be direct about something before we go any further: IHS is not a government handout. The Indian Health Service exists because the United States signed treaties with sovereign Native nations — promising healthcare in exchange for land. In San Juan County alone, we're talking about Navajo Nation territory. The promise was made. The land was taken. The healthcare? Still waiting to be fully funded.

The IHS per-patient spending has historically been roughly half — and in some years less than half — of what the federal government spends per person on federal prisoners. That's not a metaphor. That's the budget. When you turn 65 and become eligible for Medicare, you are not abandoning IHS. You are adding a second layer of coverage to a system that was built underfunded and has stayed that way.

What Are the Two Hospitals in San Juan County — and Why Does Their CMS Rating Matter?

San Juan County has two acute-care hospitals. That's it. For a county of 120,675 people, most of them spread across vast stretches of the Navajo Nation and the Four Corners area, two hospitals is a thin safety net.

Northern Navajo Medical Center (NNMC) in Shiprock is the frontline IHS facility for Navajo Nation members in this county. It serves an enormous geographic area — people drive 40, 60, sometimes 80 miles to reach it. Its CMS star rating is listed as "Not Available," which isn't a scandal in itself — IHS facilities operate under a different federal framework than private hospitals. But it does mean that Medicare's standard hospital quality comparison tools won't give you a clear read on this facility.

San Juan Regional Medical Center in Farmington holds a 2-star CMS overall rating. The national average is 3.1 stars. Two stars means it falls below average on the measures CMS tracks: mortality, safety, readmissions, patient experience, and timely and effective care. When IHS sends you there on a PRC referral — or when you drive there yourself in an emergency — that's the facility you're working with. Medicare covers services there under Original Medicare Parts A and B.

What Does the Health Data Tell Us About What San Juan County Elders Actually Need?

The numbers from CDC PLACES are not abstract. They describe real bodies, real pain, real gaps in care that accumulate over a lifetime of using an underfunded system. Here is what the data says about San Juan County adults right now:

27.1% of San Juan County adults aged 65 and older have lost all their teeth. (CDC PLACES, 2022.) That is more than one in four of our elders. This is what forty years of underfunded IHS dental services looks like. It affects nutrition. It affects diabetes management. It affects dignity. Original Medicare covers none of it. If you are turning 65 and dental care matters to you — and it should — the type of Medicare coverage you choose matters enormously.

37.1% of adults in San Juan County report loneliness. (CDC PLACES, 2023.) This is not a soft statistic. Loneliness is a clinical risk factor for cardiovascular disease, cognitive decline, and premature death. Isolated elders on the Navajo Nation — miles from the nearest town, without transportation, without broadband — are at elevated risk. Medicare Advantage plans with transportation and telehealth benefits can make a real difference here. Original Medicare alone does not cover transportation.

24.1% of adults received food stamps (SNAP) in the past year. (CDC PLACES, 2023.) Nearly one in four. That is the economic baseline many of our newly eligible 65-year-olds are starting from. Premium costs matter. The Part B premium in 2026 is $185.00/month — deducted from Social Security — and it is non-negotiable for most beneficiaries. If income is low enough, a Medicare Savings Program may cover that premium. Call 1-800-432-2080 (NM SHIP) to check eligibility immediately.

What Is the Special Enrollment Period That Most Native Seniors Don't Know About?

Here is something the Medicare handbook buries and most insurance agents never mention: American Indians and Alaska Natives have a Special Enrollment Period (SEP) for Medicare Advantage plans that no other group has.

Under federal regulations, AI/AN Medicare beneficiaries can enroll in, disenroll from, or switch Medicare Advantage plans once per calendar quarter: January through March, April through June, July through September, October through December. That's four opportunities per year to make changes, versus the standard annual Open Enrollment Period in the fall.

Why does this matter practically? If you enroll in a Medicare Advantage plan in January and discover in March that your plan's network doesn't include a specialist you need — or that the plan's prior authorization requirements are blocking your IHS referral — you can switch in April. You are not locked in for a year.

This protection exists specifically because Native peoples face unique circumstances: remote locations, IHS dependency, limited provider networks, and the kind of coverage disruptions that come with living in medically underserved areas. Use it.

How Does Medicare Actually Coordinate With IHS at Northern Navajo Medical Center?

When a Medicare-eligible elder receives care at an IHS facility like Northern Navajo Medical Center, IHS bills Medicare on that patient's behalf. The money comes back to the facility — not to the patient, not as a reimbursement check, but as revenue that funds services for the entire community. Having Medicare actually makes IHS facilities financially stronger. Every enrolled elder who walks through the doors of NNMC with a Medicare card brings federal dollars back to Navajo Nation.

For services that NNMC provides directly — primary care, emergency care, pharmacy, basic diagnostics — your out-of-pocket cost at an IHS facility is zero, regardless of whether you have Medicare. IHS does not charge Native patients copays or deductibles. What Medicare adds is the ability to access outside services — at San Juan Regional in Farmington, at specialists in Albuquerque, at facilities that Medicare covers — without waiting for PRC funds to be available.

The coordination works like this in practice: IHS provides what it can. When it can't — and there will be times it can't — Medicare picks up care at outside facilities, subject to standard Medicare cost-sharing (deductibles, coinsurance). If you have a Medicare Savings Program covering your cost-sharing, your out-of-pocket at outside facilities may also be zero or near zero.

What About the Colorectal Cancer Screening Gap — and Why It Matters at 65?

Only 49.1% of eligible adults in San Juan County have received colorectal cancer screening (CDC PLACES, 2022). That means roughly half the population that should be screened — hasn't been. Colorectal cancer is one of the most preventable cancers when caught early. It is also one of the cancers with elevated incidence rates in Native communities.

Medicare Part B covers colonoscopy screening at no cost to the patient when performed by a Medicare-enrolled provider. The question in San Juan County is whether there are enough gastroenterologists in-network, locally, to actually deliver that screening without requiring a 150-mile drive to Albuquerque. The short answer: that depends on your specific plan. Original Medicare gives you the widest provider access. Some Medicare Advantage HMO networks in rural New Mexico are narrow enough to make specialist access genuinely difficult.

This is the conversation no one is having at the kitchen table, but someone should be. Turning 65 is the moment Medicare's preventive benefits kick in fully. A colonoscopy that might have cost thousands out of pocket is now a covered annual benefit. Using it requires knowing it exists, and having a plan that actually connects you to a provider who can perform it.

What Specific Action Steps Should a Newly Eligible 65-Year-Old Take Right Now?

One more thing. The 39.4% disability rate among San Juan County adults (CDC PLACES, 2023) and the 9.4% hearing disability rate mean that a significant share of newly eligible Medicare enrollees in this county have disability-related health needs. Dual-Eligible Special Needs Plans (D-SNPs) and Chronic Care Special Needs Plans (C-SNPs) exist specifically for people with complex, ongoing conditions. If you or an elder you're helping has a qualifying condition — diabetes, heart disease, end-stage renal disease — these plans often provide more coordinated care and additional benefits beyond Original Medicare. Your NM SHIP counselor can help you determine if you qualify.

Joe Redhawk
Indian Country Bureau Chief, SeniorWire
Albuquerque, New Mexico

For our elders. For the next seven generations.

Sources: CDC PLACES Local Data for Better Health, San Juan County NM, 2022–2023 releases (places.cdc.gov). CMS Hospital Compare, San Juan County NM, April 2026 (medicare.gov/care-compare). Social Security Administration Medicare enrollment (ssa.gov). CMS Medicare Plan Finder (medicare.gov/plan-compare). NM Human Services Department Medicaid/MSP (hsd.state.nm.us). HRSA IHS Purchased/Referred Care Program (ihs.gov/prc). NM SHIP, 1-800-432-2080.