Can Eastern Band of Cherokee members use Cherokee Indian Hospital with Medicare?

Who can use Cherokee Indian Hospital

Cherokee Indian Hospital, in Cherokee, is run by the Cherokee Indian Hospital Authority, the Eastern Band of Cherokee Indians' health system. The Indian Health Service lists it as a tribally administered program in its Nashville Area.

To register, the hospital asks for your birth certificate, your EBCI enrollment card or descendant letter, your Social Security card, your insurance cards (including Medicare) and a photo ID with your current address. Your chart status then decides what's covered:

• Direct care only: you can use all services available within the hospital authority.
• Contract health eligible: the hospital can also consider paying bills from other facilities through Purchased/Referred Care.
• Ineligible: you aren't enrolled with a federally recognized tribe and are responsible for the cost of services.

Patient Registration: 828-497-9163, ext. 6603. EBCI Enrollment Office: 828-359-6467.

How Medicare fits in

The hospital bills insurance, including Medicare, and says that revenue often pays for additional patient services. With Original Medicare, you can use the hospital and any provider elsewhere that accepts Medicare.

If you're thinking about a Medicare Advantage plan, CMS advises contacting your Indian health provider first, because the hospital may not be in a plan's network. 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 from the hospital's pharmacy continue with Medicare, and Indian health care counts as creditable drug coverage, so you won't owe a Part D penalty if you join a drug plan later.

Outside care: Purchased/Referred Care

1. Check eligibility. You generally must be eligible for direct care, live in Cherokee, Graham, Haywood, Jackson or Swain County, and be an EBCI member, or a member of another federally recognized tribe who meets the hospital's residence and ties rules.
2. Use Medicare first. The hospital says every patient is screened for Medicaid, Medicare or private insurance before referred-care funds are used. That follows the federal rule that IHS pays last (42 CFR 136.61).
3. Get a referral. A primary care or emergency provider issues it, and a committee reviews it. Care without a referral is a common reason bills go unpaid.
4. Bring outside statements. Missing statements from outside providers delay payment. Referred Care: 828-497-9163, ext. 6214, weekdays 8 a.m. to 4:30 p.m.

More in our guide to American Indians and Medicare in North Carolina and Medicare in rural and mountain North Carolina. If you'd like to compare Medicare options after checking with the hospital, you can request a call from a licensed insurance agent.

Related questions

Sources

• Cherokee Indian Hospital Authority — Patient Registration
• Cherokee Indian Hospital Authority — Purchased and Referred Care
• Cherokee Indian Hospital Authority — Third Party Resources department (December 2024)
• Indian Health Service — Nashville Area health care facilities
• CMS Division of Tribal Affairs — Medicare and Tribal Medicare Beneficiaries
• eCFR — 42 CFR 136.61, Payor of last resort

More questions in this guide

• Does Lumbee federal recognition change Medicare or IHS care?
• How does Medicare work with Indian Health Service in North Carolina?
• What is the EBCI Tribal Option?

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

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