What Apple Health is
Apple Health is the name of Washington's Medicaid program. It is run by the Washington State Health Care Authority (HCA), and for people who are 65 or older, blind or disabled, the Department of Social and Health Services (DSHS) takes the applications and decides eligibility. Unlike Medicare, which is based on age, disability and work history, Apple Health is based on financial need: your income and, for most programs for older adults, your resources.
Having Medicare does not stop you from getting Apple Health. HCA says any Apple Health coverage you get while on Medicare works as secondary insurance: Medicare pays first, and Apple Health pays after that.
Apple Health categories that matter for Medicare beneficiaries
Apple Health Classic Medicaid (aged, blind or disabled)
For people who are 65 or older, blind, or disabled, live in Washington, and meet income and resource limits. HCA publishes the monthly income standard for one person and for a two-person household on its aged, blind, or disabled page; the standards change every January. Coverage can be full Medicaid or "spenddown" coverage, where you qualify after medical bills bring your income down to the limit.
If you have full Apple Health and Medicare, Apple Health generally pays your Medicare premiums and the deductibles and coinsurance Medicare leaves, so your out-of-pocket costs for Medicare-covered care are usually small. You also get Extra Help with Part D drug costs automatically.
Medicare Savings Programs (MSPs)
These Apple Health programs help with Medicare costs at higher income levels than Classic Medicaid. Washington has no asset test for them, so HCA does not ask about bank balances or other resources:
- QMB (Qualified Medicare Beneficiary): pays Part A and Part B premiums, deductibles, and copayments (except for prescriptions)
- SLMB (Specified Low-Income Medicare Beneficiary): pays the Part B premium ($202.90 a month in 2026)
- QI-1 (Qualifying Individual): pays the Part B premium
- QDWI (Qualified Disabled Working Individual): pays the Part A premium for certain working people with disabilities
If you qualify for QMB, SLMB or QI-1, you also get Extra Help with Part D automatically. Full MSP details →
Apple Health long-term services and supports (LTSS)
This is the part of Apple Health that pays for long-term care. To qualify you must meet both the income and resource standards and a functional assessment of your care needs. Care can be provided:
- in your own home, including in-home personal care
- in an adult family home, assisted living facility or other community residential setting
- in a nursing facility
Home and community programs include the COPES waiver and Community First Choice, administered by DSHS. DSHS also reviews any assets you gave away or sold for less than they were worth in the 60 months before you apply, which can create a period when Apple Health won't pay for long-term care. The rules are detailed, and many families get advice from an elder law attorney before applying.
Apple Health Medicare Connect (D-SNPs)
If you have Medicare and Apple Health, Medicare is your primary coverage for physical health care, and Apple Health covers behavioral health (mental health and substance use treatment) through a Behavioral Health Services Only (BHSO) plan.
You can also choose to get your Medicare through a Dual-Eligible Special Needs Plan (D-SNP). In Washington, HCA calls these plans Apple Health Medicare Connect. They are Medicare Advantage plans with Part D drug coverage, open only to people who have both Medicare and Apple Health, including people whose Apple Health only pays Medicare cost sharing. HCA says enrolling does not change what Medicare or Apple Health covers; the plan helps coordinate the two. More on D-SNPs →
If your Medicare Advantage plan is ending on December 31, 2026, see Washington plans ending in 2027 for your deadlines.
What Apple Health covers that Medicare doesn't
Depending on the Apple Health program you qualify for, Apple Health can cover services Original Medicare doesn't, including:
- Long-term custodial care in a nursing facility
- In-home personal care services
- Care in adult family homes and assisted living facilities
- Dental care for adults
- Nonemergency transportation to covered medical appointments, arranged through regional brokers
How to apply
For people 65 and older or on Medicare, HCA sends every Apple Health program, including the Medicare Savings Programs and long-term care, through DSHS:
- Online: washingtonconnection.org
- By phone: DSHS Community Services Division, 1-877-501-2233
- On paper: the Application for Aged, Blind, Disabled/Long-Term Care Coverage (HCA 18-005), mailed to DSHS
- In person: a DSHS Community Services Office, or a Home and Community Services office for long-term care
- Long-term care questions: DSHS Home and Community Services, 1-800-422-3263. Community Living Connections (1-855-567-0252) can also point you to local long-term care services.
Washington Healthplanfinder is for people who are not entitled to Medicare; Medicare beneficiaries can use it only to buy dental plans.
Renewals and reporting changes
Apple Health coverage must be renewed, and you need to report changes in income, resources, household and address. Not reporting a change can lead to an overpayment you have to repay.
If you are on Apple Health and becoming eligible for Medicare, your Apple Health may continue under a different program (often Classic Medicaid or a Medicare Savings Program). HCA asks people to check with their providers about whether they accept Medicare. For questions about your Apple Health, call HCA at 1-800-562-3022. For help choosing Medicare coverage that works with Apple Health, a licensed insurance agent with Benefits Life can explain plans from the companies they work with at no cost to you: call (206) SENIORS (206-736-4677), TTY 711 or see plans in your ZIP code.
Estate recovery
After an Apple Health client dies, Washington can recover from the estate what it paid for certain services. Under WAC 182-527-2742, for services since 2014 this mainly covers long-term services and supports, such as nursing facility care, COPES and other home and community waiver services, Medicaid personal care and hospice, plus hospital and prescription drug services received while getting them. For Medicare Savings Program benefits, the rule says the estate is not liable for Medicare cost-sharing payments made since 2010. DSHS's Office of Financial Recovery handles estate recovery.
Tribal members and Apple Health
American Indians and Alaska Natives have specific Apple Health options. For example, they are exempt from premiums for Apple Health for Workers with Disabilities, and dual-eligible American Indians and Alaska Natives can choose a BHSO plan or receive behavioral health coverage without a plan. Tribal and urban Indian clinic staff can help with these choices. More on tribal health →
Sources
- Health Care Authority — Age 65 and older or Medicare eligible
- Health Care Authority — Aged, blind, or disabled
- Health Care Authority — Medicare Savings Program
- Health Care Authority — Long-term care and hospice
- Health Care Authority — Apple Health Medicare Connect
- Health Care Authority — Transportation services (nonemergency)
- Health Care Authority — Dental services
- DSHS — Long-term care services and information
- WAC 182-513-1363 — Evaluating the transfer of an asset for long-term care
- WAC 182-527-2742 — Estate recovery: services subject to recovery
- Medicare.gov — Medicare Savings Programs
Frequently asked questions
What is Apple Health?
Apple Health is the name of Washington's Medicaid program, run by the Washington State Health Care Authority (HCA). For people with Medicare, eligibility is based on income and resources, and the Department of Social and Health Services (DSHS) handles the applications.
Can I have both Medicare and Apple Health?
Yes. People with both are called dual-eligible. Medicare pays first and Apple Health pays after it. Depending on the program you qualify for, Apple Health can pay your Medicare premiums, deductibles and coinsurance, and cover services Medicare doesn't, such as long-term care.
How do I apply for Apple Health if I have Medicare?
Apply online at washingtonconnection.org, call DSHS at 1-877-501-2233, visit a DSHS Community Services Office, or mail the HCA 18-005 application. For long-term care, you can also contact DSHS Home and Community Services. Washington Healthplanfinder is for people who are not on Medicare.
Does Apple Health cover long-term care?
Yes, if you meet both the financial rules and a functional assessment. Apple Health long-term services and supports can pay for care at home, in an adult family home or assisted living facility, or in a nursing facility. DSHS reviews asset transfers made in the 60 months before you apply.
What is Apple Health Medicare Connect?
It is Washington's name for Dual-Eligible Special Needs Plans (D-SNPs): Medicare Advantage plans for people who have both Medicare and Apple Health. HCA says enrolling does not change what Medicare or Apple Health covers; it helps coordinate the two.
Medicare in your Washington county
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