Apple Health is Washington State's Medicaid program

Apple Health is the name Washington State uses for its Medicaid program. It is not a separate program or a private insurance product — it is the state's version of the federal Medicaid system. If you live in Washington and hear someone refer to "Apple Health," they are talking about Medicaid coverage run by the Washington State Department of Social and Health Services (DSHS).

The name comes from Washington's apple industry and was chosen when the state rebranded its Medicaid program in the 1990s. The coverage itself works the same way as Medicaid in other states: it pays for hospital care, doctor visits, prescription drugs, and other medical services for people who meet income and other requirements. Your coverage card will say "Apple Health" on it, but you are enrolled in Medicaid.

If you live outside Washington, your state's Medicaid program will have a different name. Some states call it by the state name plus "Medicaid" (like "California Medicaid"), while others use a distinct brand name. The rules, income limits, and covered services vary by state, so what applies in Washington does not necessarily apply where you live.

Key Takeaways

  • Apple Health is Washington State's Medicaid program, not a separate or private insurance option.
  • Coverage includes hospital care, doctor visits, emergency services, prescription drugs, and other medical benefits under the same federal Medicaid rules as other states.
  • Income limits and may be able to access rules for Apple Health are set by Washington State and differ from other states' Medicaid programs.
  • You apply for Apple Health through Washington's Health Benefit Exchange or DSHS, not through Apple Inc. or any private company.

How Apple Health coverage works

Apple Health operates under the same federal Medicaid structure as every other state program, but Washington administers it directly. When you are enrolled in Apple Health, the state pays your medical providers — hospitals, doctors, clinics, pharmacies — for the care you receive. You do not pay a monthly premium for most Apple Health plans, though some plans may have small copayments when you use services.

Washington expanded Apple Health in 2014 to cover more adults, which is why many people in the state became newly may be able to access. The program covers preventive care, emergency services, mental health treatment, substance use disorder services, and prescription medications. Dental and vision coverage vary depending on your age and which Apple Health plan you are in.

Apple Health is not the same as the Washington Health Benefit Exchange (the state's health insurance marketplace), where people buy private insurance plans. Some people use the marketplace to find coverage, while others use Apple Health. The two systems are separate, though both are administered by state agencies.

Who can enroll in Apple Health

Income limits for Apple Health in Washington are based on the federal poverty level. As of 2024, an adult can earn up to roughly 138% of the federal poverty level and still be may be able to access, though this amount changes yearly. For a single adult, that is approximately $1,800 per month before taxes; for a family of four, roughly $3,700 per month. These numbers shift annually, so you should check the current limits with DSHS or through the Washington Health Benefit Exchange.

You must also be a Washington resident and a U.S. citizen or may have access to immigrant to enroll. Washington does not have a waiting period or asset limit for most adults, meaning you can have savings and still be may be able to access. Some groups — like children, pregnant people, and seniors — have different income limits, usually higher than the general adult limit.

Immigration status matters. U.S. citizens and certain may have access to immigrants (like those with green cards or specific visa types) can enroll. Undocumented immigrants are not may be able to access for standard Apple Health, though Washington does offer limited emergency-only coverage in some cases.

How to apply for Apple Health

You can apply for Apple Health through the Washington Health Benefit Exchange website (wahealthplanfinder.org) or by contacting DSHS directly. You will need to provide proof of income (recent pay stubs, tax returns, or a letter from your employer), proof of residency, and proof of citizenship or immigration status. The application asks about your household size, income, and any other insurance you have.

Processing usually takes two to three weeks. If you are approved, you will receive a notice in the mail and your coverage card will arrive within one to two weeks after that. If you are denied, the notice will explain why and tell you how to appeal or provide additional information.

You can apply any time of year — there is no open enrollment period for Medicaid like there is for private insurance. If your circumstances change (you lose a job, your income drops, you move), you can report the change and your coverage will be updated.

Apple Health plans and coverage options

Washington offers several Apple Health plans, and the one you are assigned to depends on where you live and which managed care organization serves your area. Each plan covers the same core services — doctor visits, hospital care, emergency services, prescription drugs — but may have different networks of providers and different copayment amounts.

Some Apple Health plans include dental coverage for adults; others do not. Vision coverage for adults is limited in most plans. Mental health and substance use disorder services are covered in all plans. If you have specific health needs, you can ask DSHS or the Health Benefit Exchange which plan in your area offers the best coverage for your situation.

You can change plans once a year during the annual enrollment period, or immediately if you have a may have access to life event (like moving to a new county or losing other insurance).

Apple Health and other insurance

If you have other insurance — through an employer, a spouse's job, or a private plan — you can still enroll in Apple Health. Medicaid becomes the "payer of last resort," meaning it pays for services after your other insurance has paid its share. This is called coordination of benefits.

If you are offered employer health insurance, you may lose Apple Health coverage or have to pay back some benefits, depending on the plan's cost. DSHS can tell you how accepting employer insurance would affect your Apple Health coverage before you make a decision.

Frequently Asked Questions

Is Apple Health the same as regular Medicaid?

Yes. Apple Health is Washington State's name for its Medicaid program. It follows all federal Medicaid rules and provides the same types of coverage as Medicaid in other states. The name is specific to Washington; other states use different names for their Medicaid programs.

Do I have to pay a monthly premium for Apple Health?

Most Apple Health plans have no monthly premium. You may have small copayments when you use services (like $3 for a doctor visit), but you do not pay a monthly fee to be enrolled. Some people with higher incomes may have small premiums, but most do not.

Can I use Apple Health outside Washington State?

Apple Health coverage generally works only in Washington. If you move to another state, you will need to apply for that state's Medicaid program. If you travel out of state temporarily, emergency services are usually covered, but routine care is not. Check with your Apple Health plan before traveling.

What if I am undocumented?

Undocumented immigrants are not may be able to access for standard Apple Health. Washington does offer emergency-only Medicaid coverage for some undocumented people, which pays for emergency hospital care and emergency services only. Contact DSHS or a local community health center to learn what emergency coverage may be available to you.

How do I know which Apple Health plan I am in?

Your enrollment notice will tell you which managed care organization (MCO) you are assigned to. You can also call DSHS or check your coverage card. If you want to change plans, you can do so during the annual enrollment period or if you have a may have access to life event.