Compared with other racial/ethnic groups, American Indians and Alaska Natives (AIANs) have higher uninsured rates and worse health outcomes. Using data from the 2010-2014 American Community Survey, we employ logistic regression techniques to assess the characteristics associated with Indian Health Service (IHS) coverage among working-age AIANs who have health insurance or are uninsured. Across all insurance categories, geographic residence is a factor in IHS coverage. Among the uninsured, those with and without IHS coverage are more dissimilar than similar across socioeconomic characteristics. When controlling for confounding characteristics, people who are uninsured or have Medicaid have a much higher IHS coverage rate compared with those with employer-sponsored insurance. This indicates IHS coverage is an important component for the uninsured and it complements Medicaid services. This work identifies a need for increased outreach to eligible AIANs about IHS programs, particularly those without comprehensive care.