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Questions

Can Seminole Tribe of Florida members use tribal health clinics with Medicare?

Yes. Having Medicare doesn't change your access to the Seminole Tribe of Florida's clinics; the Tribe's own rules decide who its programs serve. Medicare adds coverage for care outside tribal clinics, and CMS says enrolling brings more resources to tribal health programs. Tribal health care also counts as creditable drug coverage for Part D.

The Seminole Tribe's clinics

The Seminole Tribe of Florida's Health and Human Services Department runs health care on the reservations. Its clinics:

ClinicLocation
Betty Mae Jumper ClinicHollywood
Big Cypress ClinicBig Cypress (Clewiston address)
Brighton ClinicBrighton (Okeechobee address)
Immokalee ClinicImmokalee
Tampa Health OfficeTampa

Seminole Pharmacy fills prescriptions for eligible patients, and dental clinics operate at Hollywood, Big Cypress, Immokalee and Brighton. IHS lists the Tribe's health program as tribally administered, and IHS says such programs may have their own eligibility rules. The Tribe has run its health programs under a self-governance compact with IHS since 2001.

How Medicare fits

  • Keep using the clinics. Medicare doesn't take the place of tribal care. With Original Medicare, CMS says most Indian health care providers are paid for the Medicare-covered services they provide, which brings more resources to the program.
  • Care outside the clinics. Medicare covers hospitals and specialists anywhere in the country that accept Medicare. Before tribal or IHS referred-care funds pay for outside care, federal rules require Medicare and other coverage to pay first.
  • The Tribe's health plan. The Tribe has a self-funded health plan. Medicare.gov says Medicare pays first and a tribal health plan pays second.
  • Prescriptions. Medicare says that if you get drugs through an Indian health pharmacy, you'll keep getting them at no cost and your coverage won't be interrupted. If you join a Part D plan, it pays the facility for your drugs.

Before you join a Medicare Advantage plan

CMS's tribal guide says your Indian health care provider may not be in a Medicare Advantage plan's network and may be paid less or not at all, so contact your 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. There's no special enrollment period just for American Indians, so if someone says you can switch plans any time, check with the Tribe's health program first.

Getting help

  1. Ask your clinic. The Tribe's social work program lists help with Social Security and Medicare programs, and the clinics' patient registration coordinators handle registration.
  2. Sign up for Medicare on time. Apply through Social Security at ssa.gov or 1-800-772-1213 (TTY 1-800-325-0778).
  3. Get your creditable coverage letter. Ask your Indian health provider for a letter saying you have creditable drug coverage, in case you join a Part D plan later.

Full details in our guide to the Seminole Tribe, the Miccosukee Tribe and Medicare. After checking with your clinic, you can also request a call from a licensed insurance agent.

Do American Indians need Part B and Part D?

Penalties, creditable coverage and why enrolling helps.

Does IHS referred care pay after Medicare?

Payer of last resort, explained.

How does Medicare work with the Miccosukee clinic?

The Miccosukee Tribe's health program.

Sources

More questions in this guide

Part of the guide: The Seminole Tribe, the Miccosukee Tribe and Medicare in Florida · All questions

Frequently asked questions

Where are the Seminole Tribe's health clinics?

The Tribe lists the Betty Mae Jumper Clinic in Hollywood, the Big Cypress Clinic, the Brighton Clinic, the Immokalee Clinic and the Tampa Health Office.

Does Medicare pay before the Tribe's health plan?

Yes. Medicare.gov says that if you have health insurance through a tribal health plan, Medicare pays first and the tribal health plan pays second.

Who at the Tribe can help me with Medicare?

The Seminole Tribe's Health and Human Services social work program lists help with Social Security and Medicare programs. Clinic patient registration coordinators handle registration.

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