Insurance Curator Apple Health is Washington State's name for Medicaid. It provides low-cost or no-cost health coverage to many people who meet income and eligibility rules. This guide explains what Apple Health covers, who can get it, and where to find help.
What Apple Health Covers in Washington
Apple Health covers a broad range of services that help with everyday care and serious medical needs. Coverage is generous compared with many private plans, and many services have little or no copay.
- Primary care visits and preventive care
- Hospital stays and emergency services
- Prescription medications
- Mental health and substance use disorder treatment
- Maternity care, prenatal, and postpartum services
- Pediatric care, including immunizations and well-child checks
- Dental and vision services for children; limited adult dental and vision options
- Long term services and supports for people with disabilities and seniors
- Transportation to medically necessary appointments in many cases
- Telehealth and virtual visits
| Service category | Covered | Notes |
|---|---|---|
| Primary care | Yes | Routine checkups and sick visits |
| Hospital care | Yes | Inpatient and outpatient services |
| Prescriptions | Yes | Most medically necessary drugs |
| Mental health | Yes | Therapy, counseling, inpatient care |
| Substance use disorder | Yes | Detox, outpatient, medications for opioid use disorder |
| Pregnancy care | Yes | Prenatal, delivery, postpartum |
| Pediatric dental | Yes | Comprehensive coverage for kids |
| Adult dental | Limited | Varies by plan and eligibility |
| Long term care | Yes | Home care, waivers, nursing facility based on need |
Who Can Get Apple Health
Apple Health serves several eligibility groups. Income limits are different depending on the group and household size. Most adults under 65 qualify through Washington's Medicaid expansion if their income is at or below the program threshold.
- Low-income adults ages 19 to 64
- Children and teens up to age 19
- Pregnant people, regardless of some income differences
- People who are aged 65 or older
- People who are blind or have a disability
- People who qualify for both Medicare and Medicaid (dual eligible)
- Lawfully present immigrants for many services; emergency care for undocumented people
Eligibility uses Modified Adjusted Gross Income rules for most people, so the number on your tax return matters. For seniors and people with disabilities the program may consider assets and other factors.
Income and Asset Rules
Most adults and children are evaluated using MAGI rules, which focus on income and household size. Seniors and people applying under disability categories may face separate asset limits and additional documentation requirements.
How to Apply
Applying is straightforward and you can choose the method that fits you best. Have basic ID, Social Security numbers if available, proof of income, and proof of Washington residency ready.
- Online through Washington Healthplanfinder is the fastest option.
- Phone help is available for those who prefer to talk to a person.
- In-person assistance is offered at community agencies and DSHS offices for complex cases.
For step-by-step instructions and options by method, see How to Apply for Washington Apple Health Online, by Phone, or In Person Without Confusion.
Special Populations and Services
Apple Health has tailored supports when needs are unique. Below are short summaries and links to detailed guides.
Children and Teens
Apple Health covers pediatric visits, immunizations, dental care for children, and behavioral health services. Families can learn more at Apple Health for Kids and Teens in Washington: Pediatric Visits, Dental Care, and Behavioral Support.
Pregnancy and New Parents
Pregnant people have access to prenatal care, delivery services, and postpartum visits. Baby checkups and newborn coverage are included. See Apple Health and Pregnancy in Washington: Prenatal Care, Postpartum Coverage, and Baby Checkups.
Immigrants
Many lawfully present immigrants qualify for full Apple Health, and emergency services are available regardless of status. Learn options at Medical Aid for Immigrants in Washington: Apple Health Options, Emergency Coverage, and Safe Clinics.
People with Disabilities
Long term services, home and community based waivers, and in-home care help people live independently. Details are at Washington Apple Health for People with Disabilities: Long Term Services, Waivers, and In Home Care.
Mental Health and Addiction Services
Affordable therapy, crisis services, and addiction treatment are covered. For low cost options check Low Cost Mental Health and Addiction Services Under Apple Health in Washington State.
Rural Residents
If you live in a rural area you can access care through mobile clinics, telehealth, and travel support programs. Read more at Medical Aid for Rural Washington Residents: Mobile Clinics, Telehealth, and Travel Support.
Managed Care, Providers, and Using Benefits
Most Apple Health members join a managed care plan that coordinates care and pays providers. Plans have provider networks and member services to help you find a doctor. Prior authorization may be needed for some specialized services, but urgent and emergency care are always covered.
If you are ever unsure about a bill or plan rules there are free helpers across the state. For local assistance see Where Washington Residents Can Get Free Help Understanding Apple Health Bills and Managed Care Plans.
Common Questions
- Will I lose my doctor? You might need to change providers if your current doctor is not in your plan network. Plans publish provider directories to help you check.
- How long does approval take? Simple cases can be decided within weeks. Complex disability determinations may take longer.
- Are there copays? Copays are generally small or none, especially for children, pregnant people, and preventive services.
- What if I lose coverage? There are reapplication and appeal options, and short term coverage choices. See What to Do If You Lose Apple Health in Washington: Reapplication, Appeals, and Short Term Options.
Where to Get Help Right Now
If you want help applying, changing plans, or understanding benefits you have options. Call Washington Healthplanfinder, visit a local community health navigator, or connect with clinics that help enroll patients. For targeted help with immigrant eligibility or emergency care options, check the linked resources above.
Apple Health is designed to make essential care affordable and accessible across Washington. If you think you might qualify, apply or get help today so you and your family get the care you need tomorrow.