Washington Medicaid, or Apple Health, is a free or low-cost health insurance plan for low-income Washington state residents. The Washington State Health Care Authority offers this insurance to cover preventative healthcare, prescription drugs, and other benefits.
Anyone living in Washington meeting the minimum Apple Health eligibility requirements can apply for the insurance plan regardless of whether they have a fixed address. As of June 2023, 2,038,345 Washingtonians were enrolled in the program.
If you're a resident of Washington State and need affordable healthcare, consider enrolling in Apple Health, the brand name for Washington Medicaid. With this guide, you can discover everything you need to know about what it takes to enroll in Apple Health, the benefits it provides, and the services it doesn't cover.
Washington Apple Health has much to offer citizens of all ages who need affordable healthcare, but it won't cover everything. To prevent shouldering the debt of unexpected medical expenses, many Floridians extend their Medicaid coverage to include a more comprehensive range of benefits and services by way of private health insurance.
What is Washington Apple Health coverage? It's Washington Medicaid, a state and federal government-funded insurance program governed by the Washington State Health Care Authority.
The purpose of Apple Health is to ensure vulnerable Washington residents have access to free or low-cost health insurance coverage. Program benefits include everything from pediatric care and prescription medication to primary care and emergency room visits.
Some Apple Health programs come with a premium payment, which you must pay each month. For instance, Apple Health for Kids comes with a $20 monthly premium for each child, with a family maximum of $40. Premiums can be as high as $60 for families with children with incomes at or below 317% of the federal poverty level.
The Services Card or the ProviderOne card is the identification you'd present to doctors, specialists, hospitals, and pharmacies to claim your Washington Medicaid benefits. The ProviderOne card will feature a unique ID number.
Everyone in your household will have their own ProviderOne card with their personal ID number. You will have your ProviderOne ID number for life, even if you stop receiving benefits.
When you're ready to apply for Washington Medicaid, you can do so in multiple ways. First, you could apply in person with the help of an assistant or navigator. Visit wahealthplanfinder.org and click the "Get Support" link, or call (855) 923-463 (toll-free) or (855) 627-9604 (TTY/TTD).
Mailing your application is also an option. You can download the application form online. Then, follow the mailing instructions on the document.
The easiest and most convenient way to apply for Apple Health is to complete the application online. Taking the online application route will show you upfront if you're eligible for Washington Medicaid's free or low-cost coverage. You can apply at any time; there's no specific enrollment period to consider.
When applying online, you'll need the following information:
By applying for Apple Health online, you could enroll in one of the health care plans available in your community. However, if you don't enroll in a specific health plan, the Washington State Health Care Authority will select one for you.
You could be eligible for Washington Apple Health benefits if you're a U.S. citizen or a qualified immigrant according to Medicaid standards.
Other eligible groups include:
Eligibility includes monthly income maximums; your income must be at or below the Medicaid standard amounts. Monthly income requirements can change depending on the number of people in your household and your specific living circumstances. For example, adults 19 to 64 must have a maximum monthly income of $1,677 for a single-person household or $2,268 for a two-person household.
Within two weeks of enrolling into Washington Apple Health, you'll automatically receive your ProviderOne card. When you get your card, you can use it immediately. It doesn't require activation.
If you don't get your ProviderOne card within the two weeks following your Apple Health application submission, you can request a free card replacement by visiting the ProviderOne client portal.
Under typical circumstances, Washington Apple Health coverage will last one year. Before the end of your coverage period, the Washington State Health Care Authority will send you a renewal letter. You may also see a public health emergency reminder when you visit the Health Care Authority website.
If it's time to renew your coverage, you can do so at www.wahealthplanfinder.org. People who are over 65, blind, or disabled should visit www.washingtonconnection.org to renew their coverage. The renewal letters will also provide additional details about coverage renewals via phone or mail.
Since you will retain your ProviderOne ID number when you're enrolled in Apple Health, you won't have to request a new card when you renew your coverage. However, if you lose your card, you can request a new one through the ProviderOne client portal.
Washington Medicaid covers a wide scope of healthcare services. Coverage extends to wellness screenings, diagnostic imaging, medical transportation, and many other services. Below, you'll get a general idea of what Washington Apple Health covers.
Washington Apple Health covers select dental services for children and adult enrollees. Children under age 20 can use their ProviderOne card to get the following dental services:
Adults over 21 with Apple health coverage can also see a dentist regularly and receive services similar to those of children. However, adults with dental coverage can also get coverage for services like root canals on front teeth, nitrous oxide, partial dentures, oral surgery, and periodontal maintenance if they have diabetes. Apple Health won't cover orthodontics, dental bridges, or porcelain crowns for adults. Therefore investing in private dental plans in Washington is advisable; especially if you have more serious dental issues and anticipate requiring more visits to the dentist.
Your Washington Medicaid coverage includes some prescription drugs and over-the-counter medications. All managed health care and fee-for-service plans for Apple Health participants must use the Apple Health Preferred Drug List.
If your medication is on the preferred drug list, you likely won't need to consult your doctor to obtain a pre-authorization. However, prior approval is often necessary to cover a drug that's not on the Apple Health Preferred Drug List if you tried to take or cannot take the preferred drug equivalent of the medication you need.
If you require maintenance medications to treat long-term conditions, you can get 90-day supplies of your drugs. You could also use the CVS Mail Service for medication delivery to your door anywhere in the country at no cost.
Washington State's Medicaid program covers a variety of healthcare coverage for people with special needs. For instance, Apple Health for Workers with Disabilities offers healthcare benefits to working adults who are blind or have other disabilities.
Under this program, affordable monthly premiums won't exceed 7.5% of your total income. Yet, there's no minimum or maximum amount that you must earn as an Apple Health HWD participant.
Contact the Washington State Health Care Authority to learn more about other programs you may qualify for if you have special needs that other types of insurance may not cover.
Another crucial aspect to contemplate is the impact on your finances in the event of a temporary or permanent illness. While Washington Medicaid aids in covering necessary drugs and equipment, it doesn't replace your financial stability. Acquiring reliable disability insurance is a smart strategy to offset some of the expenses associated with the inability to work, whether temporarily or permanently, and to manage the financial aspects of medical needs.
As an Apple Health program participant, the Health Care Authority will pay for non emergency transportation as long as you qualify for the benefit. If you don't have transportation for your doctor visits, you may arrange transportation or transportation assistance like taxi fare, gas vouchers, vehicle mileage reimbursement, and public bus fare.
Eligibility requirements for transportation services to and from doctor appointments through an authorized transportation broker include:
Contact your county's transportation broker when you're reading to schedule transportation. Arrange your pickup at least a week in advance.
If you need medical services while traveling out of state, Washington Medicaid won't cover the expense. Every state has its own Medicaid eligibility requirements. The exception to the out-of-state coverage rule is if you need emergency health care outside of Washington State.
When embarking on leisure travels outside of Florida, always be sure to invest in suitable travel insurance for added protection and peace of mind.
Though there aren't any specific benefits for students through Washington Medicaid, anyone in the state who's eligible for the benefits can apply for them. That includes college students who are not dependents on their parents' insurance plans.
Seniors and people with disabilities can also benefit from the Apple Health Long-Term Services and Supports program. Through the program, you could get help with:
Besides seniors, children, and people with disabilities, Washington Medicaid also provides coverage for Indigenous Americans and military members.
If you're an Indigenous or Native American seeking low-income health care, you could be eligible for Apple Health. By enrolling in an Apple Health managed care plan or HMO, you could continue visiting a tribal, Indian clinic, or Indian healthcare facility without losing your Apple Health coverage.
Regardless of whether you have Washington Medicaid or not, you can seek treatment at urban Indian or tribal clinics and incur no out-of-pocket expenses. Still, enrolling in Washington Apple Health can increase your coverage in case your traditional clinic cannot provide the healthcare services you need.
As a current or former member of the U.S. military, you could receive healthcare benefits through Apple Health and the Washington State Department of Veteran Affairs. TRICARE healthcare coverage is available for active-duty military, veterans, reserve members, and immediate family members of military personnel.
Through these programs, you, your spouse, and your children could get financial help covering everything from routine doctor appointments to mental health and behavioral services. Despite having TRICARE, military members can expand their coverage by enrolling in Washington Medicaid if they meet the program's eligibility requirements.
Even though Washington Apple Health offers comprehensive healthcare coverage for eligible residents through managed care plans or fee-for-service plans, the program won't cover everything. Here's a short list of procedures and services Washington Medicaid doesn't cover:
When it comes to paying for funerals, Washington Medicaid does not provide financial assistance. However, if you're eligible for Medicaid in Washington State, you can allocate $1,500 for burial expenses in a dedicated "Pay on Death" account. This sum goes to your chosen individual or beneficiary for final arrangements. The Washington Master Trust, a program by the Washington State Funeral Directors Association, facilitates prepaid burial plans. Consult the planning counselor at your selected funeral home for additional details. Still, the funds you may receive will not be sufficient to cover the rising cost of burials. Protect your family with comprehensive funeral insurance.
Healthcare coverages and services confuse many people, especially those looking for an affordable option like Medicaid. Since Medicaid programs receive federal and state funding, it's not unusual for different states to approve certain healthcare services and procedures while excluding others. Let's review some of the most common services and whether Washington Apple Health covers them.
|X-Rays and Exams
|Children and adults with dental coverage through Apple Health can schedule routine and comprehensive exams. X-rays are also part of the dental coverage and include full mouth series, panoramic X-rays, and bitewings for cavity detection.
|For adults, wisdom teeth extraction is also allowable. Extractions fall under oral surgeries, which Apple Health covers for adults over 21.
|You could get some vision benefits through Washington Medicaid, depending on the health plan you select. For example, the Community Health Plan Washington and Molina Healthcare of Washington offer routine eye exams for adults and children.
|Children under 20 can qualify for eyeglass frames, lenses, and contact lenses coverage under Apple Health. That coverage does not extend to adults, but you could buy discounted eyeglasses from participating optical providers.
|Laser Eye Surgery
|Unfortunately, Medicaid won't cover elective laser eye surgery to eliminate the need for glasses or contact lenses. However, it may cover some procedures that are medically necessary.
|A rhinoplasty procedure is usually an elective surgery, which Washington Apple Health doesn't cover. However, you could get a medically necessary nose job through Medicaid if you need the procedure to treat a deviated septum or your primary care doctor otherwise deems it medically necessary.
|Since breast reductions change a person's appearance, the procedure won't always have health care coverage. Washington Medicaid may deem the surgery medically necessary and cover the cost if you experience tissue loss in a breast due to a genetic condition, an accident, or cancer.
|Rest assured that your Apple Health benefits will cover your hospital stays. When receiving inpatient care, you must notify Coordinated Care within one business day or 24 hours of admission. If you choose to receive inpatient care, you'll need prior authorization.
|If you have a managed care plan and a ProviderOne card, you can get emergency ambulatory services through Apple Health. That benefit includes air and ground ambulance transportation.
|Washington Medicaid will cover birth centers, home births, child birthing classes, and family planning services. Your ProviderOne card can also cover maternity support services and maternity preterm labor prevention.
Washington Medicaid's comprehensive services include some therapy and counseling services with funding from the Health Care Authority. Through Apple Health, you can get inpatient or outpatient psychiatric evaluations with prior authorization. Additional services include:
If you're battling a substance use disorder, you can get help through Apple Health. Opiate substitution therapy, adult and youth residential treatments, outpatient group therapy for substance abuse, and acute withdrawal management are just some of the covered substance use disorder services under Medicaid. Some exclusions apply, and prior authorization is often necessary.
Despite these benefits, marriage counseling and sex therapy are not part of Washington Medicaid's approved services.
|You can schedule routine checkups with a gynecologist within your health plan's network. Follow-up appointments also have coverage.
|Washington Apple Health will not cover sexual dysfunction testing, including erectile dysfunction. It also won't cover penile implants or sex therapy.
|The Washington State Health Care Authority promotes family planning, which includes providing coverage for contraceptives. Coverage extends to oral hormonal birth control pills, the insertion and removal of intrauterine devices, diaphragms, male condoms, and transdermal hormonal patches.
|Unfortunately, you cannot get coverage for fertility treatments as a participant in the Apple Health program. You'd need another way to pay for in vitro fertilization, artificial insemination, or donor sperm and ovum services.
|Dermatology care is something you can get through Washington Medicaid. You may need a referral from your primary care physician.
|Short-term physiotherapy or physical therapy is allowable for people 21 and older. Through Apple Health, you could get 24 units or about six hours of treatment. You can also get one physical therapy evaluation per calendar year.
|Massage therapy therapy may be beneficial to manage pain and promote relaxation. However, it's not something Washington Medicaid covers.
|Podiatry and Foot Care
|If you want routine foot care, you can't pay for the service through Washington Medicaid. Being a diabetic with severe lower extremity conditions is the exception to this rule, but you'll need prior authorization in most cases.
|Allergist and Allergy Testing
|Apple Health will cover some allergy services like allergy shots.
|Sleep Physician Services and CPAP Machines
|Though psychiatric sleep therapy has no coverage under Washington Apple Health, you could get a continuous positive airway pressure machine and supplies to treat obstructive sleep apnea. Some exclusions apply to CPAP machines and visits with a sleep physician. You must also have prior authorization to receive services.
Becoming a member of Washington's Medicaid program is a great way to get affordable health care for yourself and your family. However, it may not be enough to cover all of the medical services, prescriptions, and procedures you need. That's where third-party health insurance comes into play.
Third-party health insurance can supplement your Apple Health benefits by filling the gaps that Medicaid leaves open. Though you would be responsible for acquiring and paying for your third-party health insurance policy, you could take advantage of many benefits, such as:
At Insurdinary, we know that medical coverage is a major concern for many Americans, including those with Washington Apple Health coverage. Fortunately, our company is available to make it easier to compare quotes from top health insurance providers in the country.
Insurdinary, and its network of partners offer many different types of insurance. In addition to health, dental, disability, life, funeral and travel insurance as discussed on this page, you may also be interested to explore the following: