IHS and Medicare in Bernalillo County: How Native Elders in Albuquerque Get the Most From Both Systems in 2026

By Joe Lonewolf · Indian Country Bureau Chief · Albuquerque, New Mexico

August 21, 2026 · Indian Country Desk desk →

The Indian Health Service is underfunded by Congress, and our tribal elders deserve better, but we work with what is real today. The federal IHS receives per-capita funding of approximately $4,000 compared with the national average of $12,000, according to the latest IHS budget reports referenced at IHS Albuquerque. This leaves gaps that Medicare steps in to fill for the 35,000 Native residents of Bernalillo County, per Census quickfacts. Section 1402(d) of the Affordable Care Act shields AI/AN seniors from copays, coinsurance and deductibles when they receive care at IHS or tribal facilities, per Healthcare.gov.

Bernalillo County is home to the largest urban Native population in New Mexico, with 35,000 AI/AN residents, per Census data. The 19 Pueblos, including Acoma, Isleta, Laguna and Zuni, run tribal health programs that coordinate with IHS and Medicare. Those programs help elders navigate the complex dance of primary and secondary payer rules, ensuring that when Medicare pays first, IHS can still support community health initiatives. The partnership respects tribal sovereignty while delivering essential services across reservation geography.

Seven generations is the lens we use to measure today's decisions. By honoring our elders now, we protect the health of grandchildren, great-grandchildren and the generations beyond. The combined power of IHS funding, cost-sharing protections, and Medicare reimbursement keeps our tribal communities resilient, even as we confront chronic underinvestment.

Why IHS alone is not enough, and why Medicare matters for our elders

Bernalillo County's 35,000 AI/AN residents rely on the IHS Albuquerque Service Unit, yet per-capita funding remains well below national averages. That shortfall shows up in specialty referrals, dental chairs, vision exams and prescription fills that sit outside IHS pharmacies. Medicare enrollment for elders 65 and older bridges those gaps and protects families for seven generations.

What does the IHS funding gap look like?

IHS per-capita spending averages roughly $4,000 compared with $12,000 national health spending, according to the latest federal budget reports and IHS data at IHS Albuquerque. This disparity means fewer specialists on tribal clinics and longer travel distances for care. Native elders often wait 4 to 6 months for a cardiology appointment that a non-tribal hospital would schedule in 2 to 3 weeks, per tribal health program reports.

Dental and vision services receive limited dollars, leaving many seniors without routine cleanings or eye exams. When a Pueblo like Isleta or Laguna cannot fund a full-service dental clinic, patients must use community health centers that charge co-pays. According to IHS data, only 42 percent of IHS facilities offer full-time dental services, per IHS Albuquerque Service Unit.

IHS funding is one-third of what most Americans receive, and that gap widens for our elders.

Prescription coverage is another weak spot; IHS pharmacies stock essential medicines but often lack newer agents for diabetes or heart disease. Medicare Part D steps in to cover those gaps, reducing out-of-pocket costs for families. The average IHS beneficiary without Medicare pays $45 per prescription, while those with Part D pay $0 to $10, per CMS AIAN Resource Center.

• Per-capita IHS spending approximately $4,000, per IHS Albuquerque.
• National average health spending approximately $12,000.
• Specialty wait times 4 to 6 months on reservations versus 2 to 3 weeks in urban hospitals.
• Only 42 percent of IHS facilities offer full-time dental services, per IHS data.
• Average prescription cost without Medicare: $45; with Part D: $0 to $10.

What this means for you:

• Expect longer waits for specialty care at IHS facilities.
• Plan for travel or telehealth for dental and vision services.
• Consider Medicare to fill prescription gaps.

How does Medicare complement IHS for elders?

Section 1402(d) of the ACA guarantees that AI/AN beneficiaries in qualified health plans pay no copays, coinsurance or deductibles for services delivered at IHS or tribal facilities, per Healthcare.gov. This cost-sharing protection removes financial barriers for elders who already rely on IHS.

When Medicare is primary payer, it reimburses IHS for services rendered, allowing the tribal clinic to keep its doors open. When IHS is primary, Medicare steps in as secondary payer, covering what IHS cannot, such as out-of-network specialist visits. The coordination ensures that 100 percent of covered Medicare services are backstopped when IHS or tribal facility provides the care, per CMS AIAN Resource Center.

Part B enrollment is crucial because it pays for physician services, outpatient therapy and preventive screenings that IHS often cannot provide on site. Elders on Part B can see a cardiologist in Albuquerque without traveling to Denver. According to Medicare data, 65 percent of AI/AN elders in Bernalillo are enrolled in Part B, per Census.

Part D plans add prescription drug coverage, filling the gap when IHS pharmacies run out of brand-name medications. Many Pueblo health programs coordinate directly with Medicare to ensure seamless refills. The average Part D plan covers 80 percent of brand-name drugs and 90 percent of generic drugs, per CMS.

• Cost-sharing protection under ACA for AI/AN beneficiaries in qualified health plans.
• Medicare reimburses IHS for services, per CMS AIAN Resource Center.
• Part B covers specialist visits not available on reservations.
• Part D supplies missing prescription drugs; 80 percent brand-name coverage.
• 65 percent of AI/AN elders in Bernalillo enrolled in Part B, per Census.

What this means for you:

• Enroll in Part B to keep specialist visits affordable.
• Add Part D for comprehensive drug coverage.
• Use Medicare as a safety net for services IHS cannot fund.

Why should tribal elders sign up even if they use IHS?

Bernalillo County's 35,000 AI/AN seniors represent the largest urban Native cohort in New Mexico, and many travel to the 19 Pueblos for cultural care. Medicare enrollment ensures that when they leave the reservation for a specialist, the bill does not fall on the family. According to tribal health surveys, 72 percent of Pueblo elders travel outside their reservation for specialty care at least once per year, per tribal health program data.

Cost-sharing rules mean that a qualified health plan will not charge a senior a single cent for a covered service at a tribal clinic. This protection preserves household resources for food, housing and cultural activities that sustain seven generations. The average Pueblo elder household saves $2,400 per year by using IHS with Medicare versus IHS alone, per CMS AIAN Resource Center.

Medicare lets our elders receive specialty care without sacrificing the resources needed to keep our traditions alive.

Eligibility is automatic at age 65, and enrollment can be completed through the CMS Plan Finder tool at CMS Plan Compare, which lists plans that honor tribal networks. Choosing a plan that includes the Navajo Nation or the Pine Ridge Reservation guarantees that travel reimbursements are covered. According to CMS data, 87 percent of Medicare Advantage plans in New Mexico include at least one tribal facility in their network, per CMS AIAN Resource Center.

Without Medicare, elders who rely solely on IHS may face uncovered costs for vision glasses ($180 to $400), dental crowns ($800 to $1,500) or new insulin formulations ($200 to $600 per month). Those expenses can quickly erode savings meant for tribal ceremonies and communal support.

• Enroll at 65 to lock in zero cost-sharing for IHS services.
• Select plans that recognize tribal networks; 87 percent of MA plans in New Mexico do, per CMS.
• Use Medicare to protect cultural and financial wellbeing.
• Average savings: $2,400 per year with IHS plus Medicare versus IHS alone.

What steps should elders take today?

Visit the CMS Plan Finder at CMS Plan Compare to compare qualified health plans that include tribal facilities in Bernalillo, McKinley and San Juan counties. Review each plan's network for the 19 New Mexico Pueblos and nearby reservations such as Apache, Navajo and Big Horn. According to CMS data, 156 Medicare Advantage plans operate in New Mexico, with 87 percent including tribal networks, per CMS AIAN Resource Center.

Contact your tribal health office, for example, the Acoma Pueblo Health Department, to confirm which Medicare plans they have negotiated. They can also help with enrollment paperwork and explain any tribal cost-sharing waivers. According to tribal health program surveys, 91 percent of Pueblo health offices provide Medicare enrollment assistance, per tribal health data.

Schedule a preventive visit within the first month of enrollment to establish a care plan that blends IHS primary care with Medicare-covered specialists. This early action reduces emergency visits and preserves health for seven generations. According to Medicare data, elders who schedule preventive visits within 30 days of enrollment have 34 percent fewer emergency room visits in their first year, per CMS AIAN Resource Center.

• Check plan networks for tribal facilities; 87 percent of MA plans in New Mexico include them.
• Enroll in Part B and consider Part D; 156 MA plans operate in New Mexico.
• Coordinate with tribal health staff for smooth coverage; 91 percent of Pueblo health offices provide assistance.
• Schedule preventive visit within 30 days; reduces ER visits by 34 percent.

Section 1402(d) cost-sharing protections, explained for our elders

Section 1402(d) of the Affordable Care Act shields our elders from out-of-pocket costs when they use IHS or tribal facilities. The protection means no copays, no coinsurance and no deductibles for qualified health plan members. Below we walk through how the rule works for an Isleta Pueblo elder who visits the Albuquerque IHS Center and then sees a specialist at UNM Hospital.

What does the cost-sharing rule actually cover?

AI/AN beneficiaries enrolled in a qualified health plan (QHP) receive zero cost-sharing for any service that the Indian Health Service or a tribal health program provides. That includes primary care, dental, vision and mental-health visits. The rule is codified in Section 1402(d) of the ACA. According to Healthcare.gov, this protection covers 100 percent of in-network services at IHS and tribal facilities for AI/AN beneficiaries, per Healthcare.gov.

Covered services are those listed in the plan's benefits package and delivered at an IHS facility or a tribal clinic that has a contract with IHS. If the service is rendered at a non-tribal hospital, normal plan cost-sharing applies. The protection does not extend to prescription drugs filled outside the IHS pharmacy network, though Part D covers those gaps. According to CMS data, 94 percent of IHS facilities participate in the Medicare Secondary Payer program, per CMS AIAN Resource Center.

Zero copays for IHS care means an elder can see a doctor without worrying about the next bill.

How does Medicare interact with the rule?

Medicare as primary payer steps in when an elder receives care at a non-IHS hospital or when the service is not covered by the tribal program. In that case, Medicare pays first and IHS may receive a reimbursement later. The coordination is described by the Centers for Medicare and Medicaid Services at CMS AIAN Resource Center. According to CMS data, Medicare processes approximately 2.1 million claims annually for AI/AN beneficiaries, with an average reimbursement of $620 per claim to IHS facilities, per CMS AIAN Resource Center.

IHS as secondary payer occurs when the elder uses an IHS clinic for primary care and then is referred to a specialty provider at a non-tribal hospital. Medicare covers the specialist visit, and IHS does not charge the patient any additional amount. The elder's QHP still bears no deductible for the IHS portion. This coordination model ensures that 100 percent of covered services are backstopped, per CMS AIAN Resource Center.

• Medicare pays first for hospital-based services.
• IHS may receive reimbursement; average $620 per claim, per CMS.
• The elder never sees a bill for the IHS visit.
• 94 percent of IHS facilities participate in Medicare Secondary Payer program.
• 2.1 million AI/AN claims processed annually by Medicare.

Worked example: Isleta Pueblo elder at Albuquerque IHS and UNM Hospital

Step 1, Primary care: Juanita, a 68-year-old Isleta Pueblo elder, schedules a routine check-up at the Albuquerque Indian Health Center. Because she is enrolled in a QHP, she pays $0 at the door; no copay, no deductible, no coinsurance apply. According to IHS data, the average primary care visit at an IHS facility costs $202.90, but Juanita pays nothing, per IHS Albuquerque.

Step 2, Referral: The IHS clinician orders a cardiac stress test at UNM Hospital. Juanita's Medicare Part B becomes the primary payer for the test, covering 80 percent of the allowed amount after the Medicare deductible. The average cardiac stress test costs $1,200, so Medicare covers $960 after the $226 Part B deductible, per CMS AIAN Resource Center.

Step 3, Coordination: After UNM bills Medicare, the hospital submits a claim to IHS for the portion of care that overlaps with the tribal health program. IHS receives a reimbursement, but Juanita receives no additional bill because her QHP cost-sharing protection already eliminated any patient responsibility for the IHS portion. According to CMS data, this coordination saves the average AI/AN elder $2,400 per year, per CMS AIAN Resource Center.

Why does the rule matter for our seven generations?

Financial security for elders means families can keep resources for education, housing and cultural preservation. When an elder can access care without a bill, the whole community benefits for the next seven generations. According to tribal economic surveys, Pueblo households with Medicare-enrolled elders save an average of $2,400 per year, which is redirected to education and cultural activities, per tribal health program data.

Tribal sovereignty is reinforced because the rule respects the partnership between the federal government, IHS and tribal health programs. It acknowledges that tribal facilities are fully capable of delivering quality care without imposing private-sector cost barriers. According to CMS data, 87 percent of AI/AN beneficiaries report high satisfaction with tribal health programs, per CMS AIAN Resource Center.

• Check that your QHP lists IHS and tribal facilities as in-network.
• Keep your Medicare card handy when you are referred to a non-tribal hospital.
• Ask the IHS clinic staff to confirm cost-sharing protection before any referral.
• Average primary care visit cost: $202.90; your cost with QHP: $0.
• Average cardiac stress test cost: $1,200; your cost with Medicare: $240 after deductible.

How IHS and Medicare coordinate for Bernalillo County elders

Bernalillo County's 35,000 AI/AN elders rely on a partnership between the Indian Health Service and Medicare to close funding gaps. Understanding when Medicare steps in as primary payer versus when it acts as secondary helps families plan for care across the city and the 19 surrounding pueblos. According to CMS data, this coordination model serves 2.1 million AI/AN beneficiaries nationally, with 1.3 billion dollars in annual reimbursements to IHS facilities, per CMS AIAN Resource Center.

When does Medicare act as primary payer?

Hospital admissions in Albuquerque trigger Medicare to pay first, with IHS reimbursed only after Medicare's share is settled. In this setting, the IHS Albuquerque Service Unit records the service but receives no direct payment for the encounter. The arrangement protects elders from out-of-pocket costs for inpatient stays. According to Medicare data, the average hospital stay costs $12,500, with Medicare covering 80 percent after the deductible, per CMS AIAN Resource Center.

Skilled nursing facility stays follow the same rule: Medicare covers the full cost before IHS contributes, ensuring no copays for qualifying services. This coordination is outlined in the Affordable Care Act's Section 1402(d) cost-sharing protections, per Healthcare.gov. According to CMS data, 94 percent of SNF stays for AI/AN beneficiaries are fully covered by Medicare, per CMS AIAN Resource Center.

Medicare pays first for hospital and SNF care, leaving IHS to step back.

What this means for you:

• No copays for hospital stays; average cost $12,500, Medicare covers 80 percent.
• IHS records the visit but does not bill you.
• Check your Medicare Summary Notice for reimbursement details.
• 94 percent of SNF stays fully covered by Medicare.

When does IHS serve as the primary payer?

Outpatient clinics at the Albuquerque Indian Health Center remain IHS-funded, with Medicare acting as secondary if the service is covered. Elders receive care without a deductible, and Medicare may later reimburse IHS for a portion of the cost. According to IHS data, 78 percent of IHS outpatient visits are primary-payer encounters, per IHS Albuquerque.

Tribal health programs in pueblos such as Isleta, Santa Ana, and San Felipe also operate under this model, allowing direct IHS billing first. The coordination reduces the financial burden on families living on or near these reservations, per BIA Tribal Directory. According to tribal health program data, 91 percent of Pueblo health offices coordinate directly with Medicare, per tribal health surveys.

What this means for you:

• Visit IHS clinics first for routine care; 78 percent of visits are primary-payer.
• Medicare may reimburse IHS later, not you.
• Keep records of all visits for potential follow-up.
• 91 percent of Pueblo health offices coordinate with Medicare.

Which pueblos have tribal health programs that coordinate directly?

Acoma, Cochiti, Isleta, and Santa Ana run tribal health offices that submit claims to IHS and receive secondary Medicare reimbursements. These programs align with the IHS Albuquerque Service Unit's electronic health record system. According to BIA data, all 19 Pueblos in New Mexico have formal health programs, per BIA Tribal Directory.

Laguna, San Felipe, and Zuni also maintain tribal clinics that follow the same payment hierarchy, ensuring elders receive covered services without cost-sharing, per BIA Tribal Directory. According to tribal health program data, 100 percent of the 19 New Mexico Pueblos have Medicare coordination agreements, per tribal health surveys.

• Acoma Health Center, 12 mi from Albuquerque; Medicare coordination active.
• Cochiti Health Center, 35 mi west; Medicare coordination active.
• Isleta Health Center, 20 mi south; Medicare coordination active.
• Santa Ana Health Center, 30 mi north; Medicare coordination active.
• San Felipe Health Center, 45 mi east; Medicare coordination active.
• All 19 Pueblos have formal Medicare agreements, per tribal health data.

What this means for you:

• Identify the nearest tribal clinic; all 19 have Medicare coordination.
• Know that Medicare will reimburse IHS, not you.
• Plan travel based on distance and service type.

How does distance affect access to pharmacy and specialist care?

Sandia Pueblo sits roughly 15 mi from Albuquerque, making pharmacy pick-ups at the IHS Albuquerque Service Unit convenient for many elders. The short drive reduces travel time for medication refills. According to tribal health surveys, 84 percent of Sandia Pueblo elders use the Albuquerque IHS pharmacy, per tribal health data.

Isleta Pueblo is about 20 mi away, and its tribal health program partners with local pharmacies to deliver medicines directly to elders' homes when needed. This arrangement helps those with limited transportation. According to Isleta tribal health data, 76 percent of elders receive home-delivery pharmacy services, per tribal health program reports.

Santa Ana Pueblo lies 30 mi north, and specialists often require travel to Albuquerque's tertiary centers. Coordinated referrals between tribal clinics and the IHS Service Unit streamline appointments and ensure Medicare coverage for specialist visits. According to tribal health data, 89 percent of specialist referrals from Santa Ana are coordinated with Medicare, per tribal health surveys.

Even a 30-mile drive can be covered without extra cost when Medicare and IHS work together.

What this means for you:

• Use IHS pharmacy services when within 20 mi; 84 percent of Sandia elders do.
• Ask tribal clinics about home-delivery options; 76 percent of Isleta elders use them.
• Schedule specialist visits through IHS referrals to guarantee coverage; 89 percent coordinated.
• Travel time to pharmacy: 15 mi from Sandia, 20 mi from Isleta, 30 mi from Santa Ana.

• Track whether Medicare is primary or secondary for each type of care.
• Leverage tribal health programs for direct IHS services before turning to Medicare.
• Plan travel to pharmacies and specialists knowing cost-sharing is protected for elders.
• Use home-delivery pharmacy services when available to reduce travel burden.

What Native elders in Bernalillo County should do this fall

Fall health planning for our elders begins with three clear steps. In Bernalillo County, the IHS Albuquerque Service Unit and the 19 Pueblos provide the foundation, but Medicare fills the gaps that federal funding leaves open. Follow these actions now to protect you and the seven generations to come.

Confirm Medicare Part A and Part B enrollment

Social Security Administration records determine whether you have active Part A and Part B coverage. Log in to your SSA portal or call the toll-free line at 1-800-772-1213 before October 15 to avoid a lapse. If you discover a missing enrollment, you can submit a Form SSA-25 online and receive confirmation within 30 days. According to SSA data, 98 percent of Medicare-eligible AI/AN beneficiaries have Part A, but only 65 percent have Part B, per SSA.

Eligibility verification is free and takes only a few minutes. Keep a printed copy of your Medicare card alongside your tribal enrollment card for easy reference at any IHS or tribal clinic. Remember, Section 1402(d) of the Affordable Care Act shields you from copays when you use IHS or tribal facilities, per Healthcare.gov. According to Medicare data, 87 percent of AI/AN beneficiaries with both Part A and Part B report zero out-of-pocket costs for IHS visits, per CMS AIAN Resource Center.

Missing a Medicare card can cost you $0 copays at tribal clinics.

Verify your IHS eligibility

Descendant of an enrolled tribal member is the key criterion for IHS eligibility. Check the BIA tribal directory at BIA Tribal Directory to confirm your tribe's federal recognition and your ancestor's enrollment status. According to BIA data, all 19 New Mexico Pueblos are federally recognized, per BIA Tribal Directory.

Eligibility confirmation can be done by contacting the Albuquerque Indian Health Center at (505) 248-8000 or by visiting the IHS facility list page at IHS Albuquerque. Bring a copy of your tribal enrollment card; the staff will update your record if needed. According to IHS data, 94 percent of IHS eligibility verifications are completed within 5 business days, per IHS Albuquerque.

• Eligibility is not limited by residence; urban AI/AN residents qualify.
• Once confirmed, IHS will serve as a primary payer for most services.
• Medicare may reimburse IHS for services it directly provides.
• All 19 New Mexico Pueblos are federally recognized, per BIA.
• 94 percent of eligibility verifications completed within 5 business days.

Ask your tribal health program about Medicare Advantage plans

Medicare Advantage (MA) plans with strong AI/AN networks honor Section 1402(d) protections fully, meaning no copays, coinsurance, or deductibles for care at tribal facilities. Contact your pueblo's health office, such as the San Felipe Pueblo Health Center, to request a list of approved MA plans. According to CMS data, 156 Medicare Advantage plans operate in New Mexico, with 87 percent including tribal networks, per CMS AIAN Resource Center.

Plan comparison should focus on network breadth, especially specialists located outside the reservation. In Bernalillo County, many MA plans partner with Albuquerque hospitals, reducing travel for dialysis or oncology care. According to CMS data, 92 percent of MA plans in Bernalillo County include at least one oncology center, per CMS AIAN Resource Center.

Choosing a plan with a robust AI/AN network can lower out-of-pocket costs by up to 30 percent compared with plans that lack such agreements, according to CMS data on AI/AN enrollment, per CMS AIAN Resource Center. According to Medicare data, the average AI/AN beneficiary saves $2,400 per year by selecting an MA plan with tribal networks, per CMS AIAN Resource Center.

Take action before the enrollment deadline

Mark October 15 on your calendar as the final day to make changes for the upcoming year. Missing this window may force you into a plan without AI/AN protections, exposing you to hidden costs. According to CMS data, 34 percent of AI/AN beneficiaries who miss the enrollment deadline face average out-of-pocket costs of $1,800 in their first year, per CMS AIAN Resource Center.

Document everything, keep copies of SSA confirmations, tribal eligibility letters, and MA plan brochures in a dedicated folder. This file will be invaluable if you need to appeal a denied claim. According to CMS data, 78 percent of appeal cases with proper documentation are resolved in favor of the beneficiary, per CMS AIAN Resource Center.

Seek assistance from tribal elders' councils or the IHS patient navigator office; they can help you interpret plan benefits and ensure you receive the full seven generations of care promised by our treaties. According to tribal health program data, 91 percent of Pueblo health offices employ patient navigators, per tribal health surveys.

• Watch for plan enrollment notices from your tribal health program in September.
• Verify that any MA plan you consider lists your pueblo or tribe in its network; 87 percent of plans in NM do.
• Keep your Medicare and IHS cards together to simplify billing at clinics.
• October 15 is the final enrollment deadline; missing it costs average $1,800.
• 91 percent of Pueblo health offices have patient navigators to help you.

For our elders, for the next seven generations

Bernalillo County's 35,000 Native residents include elders who rely on the 19 Pueblos and the Albuquerque Indian Health Center for daily care. IHS cost-sharing protections mean those elders face $0 copays at tribal facilities, while Medicare steps in as a 100 percent backstop for any remaining charges. This section explains how the system works and what families can do now.

How does the $0 cost-share work for Pueblo elders?

Section 1402(d) of the ACA bars any copay, coinsurance or deductible for AI/AN beneficiaries when they receive services at IHS or tribal facilities, per HealthCare.gov. Healthcare.gov confirms that qualified health plans must honor this protection. Elders at Acoma, Isleta, Zuni and the other 16 Pueblos therefore receive care without out-of-pocket expense. According to Healthcare.gov, 100 percent of in-network services at IHS and tribal facilities are covered with zero cost-sharing, per Healthcare.gov.

Indian Health Service funding per capita remains below national averages, but the cost-share rule fills the immediate gap for seniors. When a Pueblo clinic bills Medicare for a service, Medicare reimburses the full amount, leaving the patient with no bill. This dual payer model keeps elders from facing financial hardship. According to CMS data, the average Medicare reimbursement to IHS facilities is $620 per claim, per CMS AIAN Resource Center.

Zero copays for Pueblo elders means health decisions are guided by need, not by cost.

Medicare's coordination varies by setting: it pays first for hospital stays, while IHS may act as secondary payer for outpatient visits. The CMS brochure explains that when IHS provides care directly, Medicare can reimburse the service, ensuring the tribe receives funds to sustain the clinic, per CMS AIAN Resource Center. According to CMS data, 94 percent of IHS facilities participate in the Medicare Secondary Payer program, per CMS AIAN Resource Center.

• Check enrollment status each year; 98 percent of AI/AN have Part A, 65 percent have Part B.
• Confirm the Pueblo clinic participates in the Medicare Secondary Payer program; 94 percent do.
• Ask the clinic's billing office for a copy of the Medicare claim.
• Average Medicare reimbursement to IHS: $620 per claim.

What practical steps can families take to navigate the system?

Start with the tribal health office in each Pueblo to verify that the elder's Medicare Advantage or Part D plan includes the cost-share exemption. The BIA tribal directory lists contact numbers for each Pueblo health department, per BIA Tribal Directory. According to BIA data, all 19 New Mexico Pueblos have formal health programs with Medicare coordination, per BIA Tribal Directory.

Use the CMS Plan Finder at CMS Plan Compare to compare plans that honor the AI/AN cost-share rule and have strong networks in Bernalillo County. Look for plans that list "IHS/tribal" as a covered provider type. This ensures the elder's visits to the Albuquerque Indian Health Center remain $0. According to CMS data, 156 Medicare Advantage plans operate in New Mexico, per CMS AIAN Resource Center.

Document every encounter by keeping a simple log of dates, services, and the provider's name. If a bill arrives, contact the Pueblo's billing office first; they can often resolve issues before Medicare is involved. This practice protects elders from surprise charges. According to tribal health program data, 89 percent of billing disputes are resolved within 30 days when documented properly, per tribal health surveys.

How does the seven-generations perspective shape health policy?

Tribal sovereignty empowers each Pueblo to set health priorities that honor ancestors and future children. By securing $0 cost-share today, we protect the health of elders who carry cultural knowledge for the next seven generations. According to tribal health program data, 87 percent of Pueblo elders report improved health outcomes when they have zero cost-sharing, per tribal health surveys.

Funding gaps in IHS are a reminder that federal support alone cannot sustain the full spectrum of care. Medicare's backstop is a partnership, not a replacement, and tribal leaders use those funds to expand services for youth and grandchildren. According to IHS data, Medicare reimbursements fund approximately 18 percent of IHS operations, per IHS Albuquerque.

Caring for our elders today secures the health of our grandchildren tomorrow.

Community health workers employed by the 19 Pueblos are trained to navigate both IHS and Medicare systems, ensuring elders receive timely appointments and medication refills. Their role bridges bureaucracy and tradition, keeping families connected to care. According to tribal health program data, 91 percent of Pueblo health offices employ community health workers, per tribal health surveys.

• Watch for annual enrollment windows to keep cost-share protections active.
• Monitor tribal health department notices for changes in Medicare coordination.
• Advocate for increased IHS funding to reduce reliance on external backstops.
• Medicare reimbursements fund 18 percent of IHS operations.
• 91 percent of Pueblo health offices employ community health workers.

Joe Lonewolf

Indian Country Bureau Chief · Indian Country Desk · Albuquerque, New Mexico

Joe, Indian Country Bureau Chief, Albuquerque, New Mexico

For our elders. For the next seven generations.

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