Apple Health is Washington's name for Medicaid

Apple Health is the official name Washington State uses for its Medicaid program. When you hear "Apple Health" in Washington, it refers to the same federal Medicaid coverage — not a separate program. The state chose this branding in 2014, but the underlying program, funding, and rules are Medicaid.

This matters because it means Apple Health follows federal Medicaid rules while also adding Washington-specific policies on top. If you move to another state, your Medicaid coverage will have a different name and different details, even though it is the same federal program.

Key Takeaways

  • Apple Health is Washington State's official name for Medicaid — they are the same program, not two different things.
  • Apple Health covers medical, dental, vision, and behavioral health services, with coverage varying by which Apple Health category you fall into.
  • Washington expanded Medicaid in 2014, which is why most adults earning under a certain income threshold can now get coverage.
  • You can find out which Apple Health category you might be in by checking the Washington Health Benefit Exchange website or calling 1-855-923-4633.

How Apple Health categories work

Apple Health has several categories, and which one you might be in depends on your age, income, and family situation. The main categories are Apple Health for Adults (for people 19 to 64), Apple Health for Kids (for children under 19), Apple Health for Pregnant Women, and Apple Health for Seniors and People with Disabilities (for people 65 and older or those who may have access to based on disability).

Each category has different income limits and covers slightly different services. For example, Apple Health for Adults covers preventive care, emergency services, and prescription drugs, while Apple Health for Kids includes dental and vision care as a standard benefit. The income threshold for Apple Health for Adults is higher than it is in many other states because Washington expanded its program.

What Apple Health covers

Apple Health covers doctor visits, hospital stays, prescription medications, mental health and substance use treatment, dental care (for children and some adults), vision care (for children and some adults), and emergency services. The exact services covered depend on which Apple Health category you are in and whether you are enrolled in a managed care plan or fee-for-service coverage.

Most people with Apple Health are enrolled in a managed care plan, which means you choose a health plan and that plan coordinates your care. Some people, particularly those with disabilities or complex medical needs, may be in fee-for-service coverage instead, where you can see any provider that accepts Medicaid.

Income limits and how they are calculated

Apple Health for Adults covers people earning up to 138 percent of the federal poverty level, which changes each year. For 2024, that means a single person earning roughly $1,800 per month or less may be covered, though the exact amount depends on your household size and what counts as income.

Income includes wages, self-employment earnings, Social Security, and some other sources, but not all income counts the same way. For example, the first $65 of monthly earnings and half of earnings above that are often excluded when calculating whether you may have access to. If your income is close to the limit, it is worth checking your actual numbers with the Washington Health Benefit Exchange rather than estimating.

How to learn about you can get Apple Health

You can check your situation through the Washington Health Benefit Exchange website at wahealthplanfinder.org, or by calling 1-855-923-4633. Both routes will ask about your income, household size, citizenship status, and other factors to tell you which programs you might be in.

The phone line is often faster if you have straightforward circumstances — a single person with one job, for example. The website is better if you want to explore different scenarios (like what happens if your income changes) or if you need to complete the process in writing.

Apple Health and other coverage

If you have other health insurance — through an employer, a spouse's job, or Medicare — you may still be able to get Apple Health to cover costs that your other insurance does not. This is called coordination of benefits. For example, if you have Medicare, Apple Health can cover your premiums and cost-sharing.

If you have employer coverage, Apple Health usually does not cover you unless your employer plan is very limited. You would need to decline the employer coverage first, and even then, some people are not allowed to drop employer coverage and switch to Apple Health.

Renewal and keeping your coverage

Apple Health coverage is not permanent. You must renew your coverage periodically — usually once a year — by providing updated information about your income and household. Washington sends renewal notices by mail or email, and you can renew online, by phone, or by mail.

If your income changes during the year, you can report the change right away rather than waiting for renewal. If your income goes up, you might lose coverage or move to a different category. If your income goes down, you might become covered or move to a category with better benefits.

Frequently Asked Questions

Is Apple Health free?

Apple Health has no monthly premium for most people, but you may have small copayments when you use services — for example, $3 for a doctor visit or $1 for a generic prescription. Some services like preventive care have no copayment at all. If your income is very low, you may have no copayments.

Can I use Apple Health outside Washington State?

Apple Health works in Washington State and in emergencies anywhere in the United States. If you move to another state permanently, you will need to apply for that state's Medicaid program. If you travel temporarily, your Apple Health card should work for emergency care, but you may have trouble finding providers who accept it outside Washington.

What if I am undocumented?

Washington offers limited Apple Health coverage to undocumented immigrants — specifically emergency services and pregnancy-related care. You do not need a Social Security number to apply, but you will need to provide other proof of identity and residency in Washington. Call 1-855-923-4633 to learn what documents you need.

How long does it take to learn about I can get Apple Health?

If you apply online or by phone with straightforward information, you can get an answer the same day or within a few days. If your situation is more complex or if the program needs to verify information, it may take up to 30 days. You can check the status of your application online or by calling the number on your notice.

Can I switch Apple Health plans?

Yes, you can change which managed care plan you are in during the annual open enrollment period (usually November through January) or if you have a may have access to life event like moving, losing other coverage, or having a baby. You can also switch plans by calling your current plan or the Washington Health Benefit Exchange.