How Medicare and Apple Health fit together
People who have both Medicare and Apple Health are called dual-eligible. Medicare is your primary coverage for physical health care, and Apple Health is secondary: depending on your program, it pays Medicare premiums and cost sharing and covers some services Medicare doesn't, such as long-term services and adult dental care for people with full Apple Health. HCA says dual-eligible clients get behavioral health coverage (mental health and substance use treatment) through an Apple Health Behavioral Health Services Only (BHSO) plan.
You choose how to get your Medicare benefits: Original Medicare with a Part D drug plan, or a Medicare Advantage plan. Having Apple Health doesn't take away either choice.
Apple Health Medicare Connect (D-SNPs)
A dual-eligible special needs plan is a Medicare Advantage plan only for people with both Medicare and Medicaid. Washington contracts with specific D-SNPs and calls them Apple Health Medicare Connect. According to HCA:
- Joining doesn't change what Medicare or Apple Health covers; the aim is better coordination, so your providers deal with one plan for your Medicare and Apple Health coverage.
- The plans include Part D drug coverage.
- Enrollment is open to all dual-eligible clients, including those whose Apple Health covers only Medicare cost sharing.
- In some counties you can choose the same company for your D-SNP and your BHSO plan, which HCA calls aligned enrollment. HCA's service area guide shows which D-SNPs serve each county and where alignment is available.
Under CMS 2027 plan data, Washington has 43 special needs plans of all types. Which D-SNPs serve you depends on your county, and some plans also cover only certain counties or certain kinds of dual eligibility. Check that your doctors and pharmacies are in a plan's network before you join.
Other Medicare Advantage plans
You aren't limited to D-SNPs. Someone with Apple Health can join a regular Medicare Advantage plan, too. Before you do, ask how the plan works with Apple Health: whether your providers accept both, and how cost sharing is billed. If you have QMB, providers can't bill you for Medicare cost sharing for services Medicare covers, in any type of Medicare plan.
When you can change
You can join, switch or drop a plan during the Annual Enrollment Period (October 15 to December 7) and, if you are in Medicare Advantage, the Medicare Advantage Open Enrollment Period (January 1 to March 31). Because you have Medicaid, you also qualify for special enrollment periods. Since 2025, people with Medicaid or Extra Help can switch once a month to Original Medicare with a stand-alone drug plan, or to change stand-alone drug plans, and people with full Apple Health can use a separate monthly period to join certain fully integrated D-SNPs where those plans and matching Apple Health plans are available. If your Medicare Advantage plan is ending on December 31, 2026, see what to do when your plan is ending.
Get help
A licensed insurance agent with Benefits Life can compare D-SNPs and other plans from the companies they work with in your county, at no cost to you: (206) SENIORS (206-736-4677), TTY 711. You can also see plans in your ZIP code. For Apple Health eligibility questions, call Apple Health customer service at 1-800-562-3022. More: D-SNPs in Washington and Apple Health and Medicare.
Related questions
Does Apple Health pay Medicare premiums?
QMB, SLMB and QI-1 in Washington.
My Medicare Advantage plan is ending in 2027. What now?
Deadlines if your plan won't continue.
Does Medicare cover dental?
Medicare's limits and Apple Health's adult dental coverage.
Sources
- Washington State Health Care Authority — Apple Health Medicare Connect
- CMS — Dual and LIS special enrollment periods job aid, effective January 1, 2025 (PDF)
- Medicare.gov — Special Enrollment Periods
- Medicare.gov — Medicare Savings Programs (QMB billing protections)
- CMS — Medicare Advantage and Part D plan data (2027 Landscape)
Frequently asked questions
What is Apple Health Medicare Connect?
It is Washington's name for dual-eligible special needs plans (D-SNPs): Medicare Advantage plans for people with both Medicare and Apple Health that the state contracts with to coordinate the two. Joining one doesn't change what Medicare or Apple Health covers; it is meant to make care coordination and referrals easier.
Who pays first if I have both?
Medicare pays first for your physical health care, and Apple Health is secondary. HCA notes that dual-eligible clients also get behavioral health coverage through an Apple Health Behavioral Health Services Only (BHSO) plan.
When can I join or change plans?
During the usual Medicare enrollment periods, and also through special enrollment periods for people with Medicaid or Extra Help. Since 2025, those include a once-a-month chance to switch to Original Medicare with a stand-alone drug plan. Check the exact rules for your situation with Medicare or a licensed insurance agent.
Can I have QMB only and still join a D-SNP?
Yes. HCA says that if your Apple Health coverage includes only Medicare cost sharing, such as QMB, you can still enroll in Apple Health Medicare Connect.
Medicare in your Washington county
Plans, local agents and help, county by county: Adams · Asotin · Benton · Chelan · Clallam · Clark · Columbia · Cowlitz · Douglas · Ferry · Franklin · Garfield · Grant · Grays Harbor · Island · Jefferson · King · Kitsap · Kittitas · Klickitat · Lewis · Lincoln · Mason · Okanogan · Pacific · Pend Oreille · Pierce · San Juan · Skagit · Skamania · Snohomish · Spokane · Stevens · Thurston · Wahkiakum · Walla Walla · Whatcom · Whitman · Yakima
