Your Comprehensive

Washington Apple Care

Guide

Published on
February 13, 2024
Last updated
February 13, 2024
Written by
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Katie Wilkinson
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Quick Overview of Washington Apple Care

Medicaid in Washington State, known as Washington Apple Health, provides a comprehensive healthcare coverage program for low-income individuals and families. It encompasses many services, including medical, dental, vision, and mental health care, ensuring beneficiaries can access necessary health services without financial hardship. The program is designed to support various groups, including children, pregnant women, adults, and individuals with disabilities, by offering free or low-cost health insurance.

Washington Apple Health is funded jointly by the state and federal government, aligning with the broader Medicaid program's objectives across the United States. Over the years, Washington State has actively worked to expand Medicaid coverage, taking advantage of provisions under the Affordable Care Act (ACA) to extend healthcare access to more residents. This expansion has significantly reduced the uninsured rate in the state, improving health outcomes and financial security for its population.

Benefits you get with Washington Apple Care

Eligibility for Medicaid in Washington State, or Washington Apple Health, is determined by several factors, including income, family size, and specific individual circumstances such as disability or pregnancy. The program aims to cover low-income individuals and families, with income thresholds set as a percentage of the Federal Poverty Level (FPL). Here are the specific eligibility levels by category as a percentage of the FPL:

  • Children: For children under 19, families with incomes up to 312% of the FPL can qualify for Medicaid.
  • Pregnant Women: Pregnant women can qualify for Medicaid if their household income is up to 198% of the FPL.
  • Adults (19-64 years old): Under the Medicaid expansion through the Affordable Care Act, adults aged 19-64 with incomes up to 138% of the FPL are eligible.
  • Parents/Caretaker Relatives: The income threshold for parents and caretaker relatives of dependent children varies but generally aligns with the standards set for adults, up to 138% of the FPL.
  • Individuals with Disabilities: Those aged, blind, or disabled can qualify under different criteria that consider income, resources, and medical needs, often with income limits set at a higher level than for other adults.

These thresholds are subject to change annually based on adjustments to the Federal Poverty Level. Additionally, Washington State considers other factors such as residency, citizenship, or immigration status and not being incarcerated or institutionalized. Apply or consult with the Washington State Health Care Authority for the most current eligibility criteria and to determine individual or family eligibility.

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Washington Apple Care eligiblity rules

Medicaid in Washington State, known as Washington Apple Health, provides a comprehensive range of covered services designed to meet the healthcare needs of its beneficiaries. Here's an overview of the key services covered, each with a brief description:

Medical Services

  • Primary Care Visits: Routine visits to healthcare providers to assess, diagnose, and treat health issues.
  • Hospital Services: Inpatient and outpatient medical, surgical, and emergency services.
  • Prescription Drugs: Medications prescribed by healthcare providers, including generic and brand-name drugs.
  • Laboratory and X-Ray Services: Diagnostic services, including blood tests, X-rays, and other imaging services.
  • Family Planning Services: Includes counseling, education, and access to contraceptive methods and supplies.
  • Maternity and Newborn Care: Comprehensive care during pregnancy, childbirth, and postpartum, as well as newborn care.

Specialty Services

  • Pediatric Services: Health services for children and adolescents, including well-child visits and immunizations.
  • Dental Services: Preventive, diagnostic, and therapeutic dental health services (coverage may vary by age group).
  • Vision Services: Eye exams and corrective lenses (adult coverage may be limited).
  • Behavioral Health Services: Mental health and substance use disorder treatment services, including counseling and therapy.
  • Rehabilitative Services: Services aimed at enhancing and restoring functional ability and quality of life to those with physical or mental impairments.
  • Long-Term Services and Supports: Services for individuals with chronic illnesses or disabilities, including home health care and community-based services.

Additional Benefits

  • Non-Emergency Medical Transportation (NEMT): Transportation to medical appointments for eligible individuals without other means.
  • Early Periodic Screening, Diagnostic, and Treatment (EPSDT) Services: Comprehensive preventive and treatment services for individuals under 21.

This list is not exhaustive, and specific coverage details may vary based on individual eligibility, age, and other factors. Washington State ensures that Medicaid beneficiaries access necessary health services to maintain or improve their health. Beneficiaries are encouraged to consult the Washington State Health Care Authority or their Medicaid health plan for the most current and detailed information about covered services.

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How to apply for Washington Apple Care

Applying for Washington Apple Health is a straightforward process that can be completed in several ways to accommodate different preferences and needs. Here's how you can apply:

Online Application

Healthplanfinder Website: The most convenient way to apply for Washington Apple Health is through the Washington Healthplanfinder website. The online platform guides you through the application process, allowing you to submit all necessary information electronically.

By Phone

Customer Support Center: If you prefer to apply over the phone or need assistance, call the Washington Healthplanfinder Customer Support Center at 1-855-923-4633. The support center can help answer questions and guide you through the application process.

In Person

Navigator or Broker Assistance: You can apply in person with the help of a trained navigator or broker who can assist with the application process. To find a navigator or broker near you, visit the Washington Healthplanfinder website or call their Customer Support Center.

Local Department of Social and Health Services (DSHS) Office: You can also visit your local DSHS office to apply in person. To find your nearest office, visit the DSHS website or call the DSHS Customer Service Contact Center at 1-877-501-2233 for locations and hours.

By Mail

Application Forms: If you prefer to apply by mail, you can download the application form from the Health Care Authority's website or the Washington Healthplanfinder website. Once completed, mail the application to the address provided on the form.

When applying, you must provide personal information, including your Social Security number (if you have one), income details, and household size and composition information. Be prepared to provide documentation that verifies your income, citizenship or immigration status, and any other relevant information.

Once you submit your application, you will receive a notice of eligibility. If approved, you will obtain information on how to select a health plan and access your benefits.

For the most accurate and up-to-date information, it's always a good idea to check the official Washington Healthplanfinder website or contact customer support directly.

How to renew Washington Apple Care

Medicaid coverage in Washington State typically must be renewed once every 12 months. You will receive a notice from the Washington State Health Care Authority (HCA) or your managed care plan about your renewal date and instructions.

How to Renew

  1. Online: The easiest way to renew your Medicaid coverage is through the Washington Healthplanfinder website. Log in to your account to access your renewal application and update any necessary information.
  2. By Phone: You can call the Washington Healthplanfinder Customer Support Center at 1-855-923-4633 for assistance with the renewal process.
  3. In Person: Assistance with renewal is available through local navigators or brokers who can help you in person. To find help near you, use the Washington Healthplanfinder website or contact the Customer Support Center.
  4. By Mail: Some individuals may receive a paper renewal form. Complete the form and return it to the address provided. If you have yet to obtain a form but prefer to renew by mail, contact the Customer Support Center to request a form.

You must provide current information about your household composition, income, and any changes to your eligibility status. Have documents ready to verify your income and any other required information.

Tips for a Smooth Renewal Process

  • Respond Promptly: As soon as you receive your renewal notice, start the renewal process to avoid any lapse in coverage.
  • Update Your Information: Ensure all your information is current and accurate, especially your contact details, so you get all the important notices.
  • Keep Documentation: Have all necessary documents ready, such as proof of income or changes in household size, to ensure your renewal can be processed efficiently.

Renewing your Medicaid coverage on time ensures no interruption in your access to healthcare services. If you have any questions or need assistance during the renewal process, please use the resources above.

Additional programs through Washington Apple Care

These programs are available to help family caregivers get paid for caring for loved ones on Washington Apple Care.

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