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MEDICARE/MEDICAID IN WA STATE

Navigating Medicare and Medicaid can be confusing and oftentimes overwhelming. Below is a breakdown of the basics and additional resources to help with finding the right coverage for you and/or your family.

The Basics

Medicaid is a networkof statewide health care programs cooperatively funded by federal and state governments. The Washington State Medicaid program is called Apple Health.

Apple Health includes:

Apple Health Managed Care Plans:

Newly eligible and renewing Apple Health clients can choose or are auto assigned into a plan (MCO) the day they become eligible and they can change their managed care plan at any time. Managed care enrollment is backdated to the beginning of the current month. Any changes usually take effect the month following when the change was initially made, unless the request was made in the last seven business days of the current month.

Additional Resources:
Apple Health managed care Service area map – January 2024

Video – Learn about Washington Apple Health (Medicaid) health care and services and how to apply for or renew coverage. For more information visit Apple Health Coverage.

If you have questions about Apple Health, please email: hcamcprograms@hca.wa.gov. If you have questions about a manage care plan, please contact the provider.

Medicare

Medicare is federal health care coverage for people 65 or older or under 65 and on Medicare due to a disability. Medicare coverage is for people of any age with End-Stage Renal Disease (ESRD) and amyotrphic lateral sclerosis (ALS). Medicare is a national program the federal government administers and includes includes Part A (hospital insurance), Part B (medical insurance), Part C (Medicare Advantage), and Part D (prescription drug benefit).

Medicare clients enrolled in Medicare Part A, Part B, or both, can receive full Apple Health benefits or help with Medicare premiums or cost-sharing through one of the available Medicare Savings Programs (MSP) eligibility groups:

Additional Resources:

Video – What’s the difference between Original Medicare and Medicare Advantage plans? Washington state Insurance Commissioner Mike Kreidler explains the types of plans.
Statewide Health Insurance Benefits Advisors (SHIBA)
Washington state’s SHIBA provides free, unbiased, and confidential help with Medicare to people of all ages and backgrounds. SHIBA volunteer advisors are located around the state and can help with:
Assessing health care coverage needs.
Determining general eligibility for health care coverage programs.
Evaluating and compare Medicare plans and programs.
Providing enrollment help with Medicare.
Speaking with 1-800 Medicare on your behalf.
Making referrals to other agencies and programs.
Collecting and report possible Medicare fraud complaints.
SHIBA volunteer advisors are trained to give the latest Medicare and health care coverage information.
Find a volunteer in your area. Call 800-562-6900; TDD: 360-586-0241.
Contact the Washington state SHIBA program.
See if there’s a Medicare event in your area.

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