Medical Bills & Health Insurance Help in American Samoa
American Samoa is a U.S. territory, so the rules are different from the 50 states: there is no ACA individual marketplace here, no premium tax credits, and Medicaid runs on a capped federal allotment under Section 1108 with its own eligibility limits. Here is what applies to you in American Samoa, plus the free tools you can use on any bill.
Coverage and enrollment in American Samoa
No ACA marketplace — Medicaid only
There is no ACA individual marketplace here. Residents cannot buy a subsidized marketplace plan, and premium tax credits and cost-sharing reductions are not available. Coverage generally comes from Medicaid, an employer, or Medicare.
Open enrollment: No ACA marketplace — Medicaid enrollment is year-round
Visit No ACA marketplace — Medicaid onlyAS Medicaid
100% fee-for-service, with one hospital serving the territory.
Territory Medicaid is funded by a capped federal allotment (Social Security Act §1108) at a statutory 55% match, so income limits and covered services differ from the states. Verify eligibility directly with the program.
Free Medicare counseling (SHIP): 1-684-633-1187
AS Medicaid websiteAmerican Samoa has no dedicated patient-billing statute in our registry, so the federal baseline applies: non-profit hospitals must offer financial assistance under IRS §501(r) (26 U.S.C. §501(r)), and the federal No Surprises Act limits most surprise out-of-network bills. Ask the hospital for its written financial assistance policy — they are required to have one.
How coverage really works in American Samoa
- Federal Medicaid funding is capped each year under Section 1108 of the Social Security Act, instead of the open-ended match the 50 states and DC receive.
- The federal matching rate (FMAP) is set by statute at 55% rather than calculated from per-capita income, so local funds must cover a larger share.
- Because funding is capped, income limits, covered services, and provider payment can change when the allotment runs low. Always confirm current eligibility with the local agency.
- American Samoa runs Medicaid under a broad waiver granted under Section 1902(j) of the Social Security Act, so many standard Title XIX requirements are waived or modified.
- There are no deductibles or co-payments under the Medicaid program itself, though the hospital charges some fees of its own.
- Medicare Part A and Part B work here, but residents are not eligible for the Medicare Part D low-income subsidy (Extra Help). Instead, the territory's Medicaid program receives an Enhanced Allotment Plan (EAP) grant that must be used to provide Part D drugs to dual-eligible and low-income Medicare beneficiaries.
- Because the program runs under a §1902(j) waiver, children's coverage does not mirror mainland CHIP. Ask the American Samoa Medicaid State Agency what applies.
Verify before you rely on it
- Provider directories such as the national NPPES registry have thin coverage here — a provider missing from a search does not mean they do not exist.
- Program names, income limits, and phone numbers change frequently in the territories. Verify anything you plan to act on directly with the agency before relying on it.
- With a single hospital on-island, specialty and complex care usually means off-island referral. Confirm coverage and authorization for travel and treatment before you go.
Sources (last reviewed 2026-06): Medicaid.gov — American Samoa state overview; MACPAC — Medicaid and CHIP in the U.S. Territories (Congressional testimony, Mar 2021); CMS — Health insurance marketplaces and the U.S. territories
Tools you can use on a American Samoa bill
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