About 22% of the Washington population is enrolled in Medicaid. That represents about one out of every six adults and two out of every five children in Washington. Contrary to what a lot of people believe, about 62% of those Medicaid members are working. You might qualify and not even know it! Consider this page your ultimate guide to Apple Health, the Washington Medicaid program.
Click below to learn more about WA Medicaid:
Apple Health is the name for the Washington Medicaid program. They are the same program.
Since Medicaid is both a federal and state program, Washington Medicaid is required to cover the same essential benefits as every other state Medicaid plan (but does include some additional benefits). The basic benefits included are:
There are no premiums, copayments, or deductibles for any of these services. Apple Health for Kids may require a low monthly premium depending on your income, but will not charge any copayments or deductibles either.
Washington Medicaid includes a very comprehensive mental and behavioral health program. You can get coverage for everything from gambling addiction support groups to psychiatric hospital care. Your plan will be with you every step of the way from assessing your needs to case management post-hospital stay.
Washington State Medicaid Drug Benefits
Medicaid covers most prescription drugs but requires prior approval for some. It is up to your doctor to prescribe generic drugs whenever possible and to use the Washington Medicaid preferred drug list. If your doctor wants to prescribe you a non-generic or non-preferred drug, he or she will have to seek approval from the Medicaid program first.
Washington Medicaid pays for dental services for eligible members, but children and adults get different coverage. Kids can get:
Adults can get coverage for all of those services plus front teeth root canals, dentures, oral surgery, gum disease treatment, and nitrous oxide (laughing gas). Adults do not have coverage for crowns, implants, bridges, or orthodontics.
Most Washington Medicaid members will be enrolled in an Apple Health Managed Care Plan. Managed care means that you have a set doctor network to choose from, which means that your doctors and specialists are more likely to have a line of communication with each other and you are more likely to get the best care possible. There are five separate managed care plans: Amerigroup Washington, Coordinated Care of Washington, Community Health Plan of Washington, Molina Healthcare of Washington, and United Healthcare Community Plan. The plans are not all available in every area. Use this map to find out which of the five are available in your area.
All WA Medicaid plans include the same basic benefits, but each plan offers “extras” that may convince you to join one over another.
Some of the additional benefits that the Amerigroup Washington plan includes are:
There are two Coordinated Care of Washington plans. The Apple Health Core Connections plan is for youth in foster care or adoption support, while Washington Apple Health Plan is for most other members. The adult plan includes a cell phone program with unlimited texting, and both plans include a comprehensive rewards program:
A Community Health Plan of Washington enrollment can come with:
The Molina Healthcare of Washington plan includes a virtual urgent care clinic at no cost. You can video chat with a healthcare professional without an appointment and quickly get medical advice and prescriptions for allergies, cold/flu symptoms, pink eye, and even minor burns!
UnitedHealthcare offers a few different types of WA Medicaid managed care plans. One option is an “HMO SNP” for those who have Medicaid and Medicare, and another is a behavioral health-only plan. The plan most people will want is the Washington Apple Health Integrated Managed Care plan (IMC). On top of its comprehensive healthcare benefits, the IMC plan offers health education, translation services, tobacco cessation, Boys & Girls Club memberships, and a healthy rewards program.
You can apply for Washington Medicaid through the online portal (WA Health Plan Finder) or by the physical application. You can download the application here and either take it to your local CSO (Community Services Office), fax it to 1-888-338-7410, or mail it to the address on the application. We recommend applying online to for the easiest approach and the fastest results.
Unlike Medicare and private health insurance plans, there is no enrollment period for Medicaid. You can enroll in Medicaid at any time of the year.
You can use your WA Health Plan Finder account to apply for coverage, renew your current coverage, report a change (new household members, new baby, income change, etc.), and make any owed payments.
Medicaid eligibility is mostly based on your monthly household income compared to your household size. You also must be a legal resident of Washington State and the United States to qualify. Some legal aliens who have severe medical needs may be able to qualify as well.
Apple Health for Kids
Eligibility requirements per household are slightly different for kids, so your child may qualify for Apple Health for Kids even if your family is not eligible for full Medicaid.
The aged, blind, and disabled WA Medicaid program has slightly different income requirements than the adult Medicaid program. In 2019, anyone who is blind, disabled, or over 65 can qualify for Medicaid with an income of $771 per month or less ($1,157 for couples). If you are disabled and employed, you can qualify at $2,290 per month ($3,100 for couples) as long as you pay a monthly premium. Your premium would not exceed 7.5% of your income.
Washington Medicare Special Needs Plans
If you qualify for Medicaid and are over the age of 65, disabled, or have either ALS or ESRD, you can enroll in a Dual-Eligible Special Needs Plan (DSNP). A DSNP is a type of Medicare Advantage plan that can effectively combine your Medicaid and Medicare benefits into one very low or no-cost plan.
We have licensed Medicare agents in Washington state that can lay out all of your DSNP options and help you figure out which one makes the most sense for you. For help, call 833-438-3676 or send us a message now.
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