Age 65 and older or Medicare eligible

Find information about Apple Health eligibility when you are age 65 or older, or are eligible for Medicare.

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Frequently asked questions (FAQ)

Now that I am age 65 or older, or I have Medicare coverage, do I still qualify for Apple Health coverage?

You may still be eligible for Washington Apple Health Classic Medicaid coverage, even if you have Medicare coverage.

This coverage could include Apple Health coverage, help paying for Medicare premiums, or long-term services and supports.

Most Apple Health Classic coverage is determined by your household's income and resources.

Once I am receiving Medicare, can I keep my same provider?

Check with your provider to see if they accept your new Medicare coverage. Some providers may not accept your new coverage.

Any Apple Health coverage you are approved for when you are receiving Medicare will work as a secondary insurance to Medicare. This means that Medicare will pay first, and other coverage will pay after that.

I am not eligible to receive Medicare. Do I have other coverage options?

If you are not eligible for Medicare, you may be eligible to purchase a Qualified Health or Dental Plan through Washington Healthplanfinder. You can explore your options:

If I have Medicare, do I need other coverage?

While Medicare covers many medical expenses, it does not cover everything. If you meet the income and resource limits, Apple Health may help pay for any expenses Medicare does not.

To get help with information about Medicare in your area, visit www.insurance.wa.gov/medicare.

How do I apply for Apple Health Classic Medicaid coverage?

Coverage options

Program Coverage type How to apply

Apple Health Medicare Savings Programs *

Help paying for Medicare premiums, deductibles, and coinsurance.

Washington Connection (DSHS)

Apple Health Long-Term Services **

Covers in-home or residential long-term care for individuals who need assistance with personal care needs.

Washington Connection (DSHS)

Apple Health Aged, Blind, or Disabled **

Covers medical and behavioral health care needs through Medicaid. Either full or spenddown Medicaid coverage.

Washington Connection (DSHS)

Apple Health for Parent/Caretaker Relative **

Physical and behavioral health coverage for parent/caretakers of children age 19 or under.

Washington Healthplanfinder

Health and dental plans ***

Enroll in health and dental plans

Washington Healthplanfinder
Apple Health Medicare Connect* Special kind of Medicare Advantage plan (managed care) for dual-eligible individuals allowing care coordination between Medicare and Apple Health services through a Dual-Eligible Special Needs Plan (D-SNP) Learn about eligibility and enrollment on the Apple Health Medicare Connect webpage.

Legend

* Must be entitled to or receiving Medicare
** Does not require Medicare entitlement
*** Cannot be entitled to or receiving Medicare to receive health coverage through Washington Healthplanfinder (Exception: Dental plans can be purchased by Medicare recipients)

Important additional considerations:

  • Apple Health eligibility is determined by income and resource limits.
  • You may have other private coverage options such as Medicare Supplemental insurance, Tri-Care, or insurance from a former employer. For help deciding on options that may work for you, contact SHIBA at the number below.

Dual-eligible individuals

Being dual-eligible means you are eligible for Apple Health and Medicare coverage. This can include Medicare Part A and Part B.

If you are a dual-eligible client, Medicare is your primary coverage for your physical health care needs. You also have Apple Health Behavioral Health Services Only (BHSO) as secondary coverage. Behavioral health includes mental health and substance use disorder treatment.

You may also apply for long-term care coverage if you need additional support to remain in your community.

Options for dual-eligible individuals

Dual-eligible individuals can enroll in Apple Health Medicare Connect. This coverage works to coordinate Apple Health and Medicare services.

Need help?

If you need assistance in understanding your health coverage options, contact:

  • Statewide Health Insurance Benefits Advisors (SHIBA)
    For questions about enrolling in Medicare, or if you have other insurance options and need help deciding what is best for you:
    Phone: 1-800-562-6900
    Online: Visit the SHIBA webpage

  • Health Care Authority
    For questions about Washington Apple Health:
    Phone: 1-800-562-3022

  • Washington Healthplanfinder
    For questions about enrolling into a Qualified Health or Dental Plan:
    Phone: 1-855-923-4633

  • DSHS Community Services Division
    For help applying for health coverage:
    Phone: 1-877-501-2233
  • DSHS Home and Community Services
    For questions about long-term services and supports (if you need nursing home or help with personal care needs):
    Phone: 1-800-422-3263

Related forms and publications

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