Apple Health Medicare Connect

About Apple Health Medicare Connect

Apple Health Medicare Connect is a special kind of Medicare Advantage plan for dual-eligible individuals allowing care coordination between Medicare and Apple Health (Medicaid) services.

Who is a dual-eligible individual?

A dual-eligible individual has both Medicare coverage and Apple Health coverage. This includes physical and behavioral health care coverage.

If you are a dual-eligible client, Medicare is your primary coverage for your physical health care needs. You also have Apple Health as secondary coverage.

Dual-eligible clients also have behavioral health coverage through an Apple Health managed care plan. This is a Behavioral Health Services Only (BHSO) plan. Behavioral health includes mental health and substance use disorder treatment.

A client may choose to have their Medicare managed through a Medicare Part C plan. Medicare Advantage Plans, sometimes called Part C or MA Plans, are offered by private companies approved by Medicare. The state contracts with specific Medicare Advantage plans called Dual-Eligible Special Needs Plans (D-SNP) to provide the physical health for Apple Health Medicare Connect coverage. These plans also offer Part D Drug Coverage.

Eligibility and enrollment

Benefits of enrolling in Apple Health Medicare Connect

Enrolling in Apple Health Medicare Connect does not change what Medicare or Apple Health covers. Apple Health Medicare Connect improves your care coordination and makes it easier for your providers to make referrals and plan your treatment.

You may choose the same plan to cover both your physical health care and your behavioral health care needs. This would mean selecting the same plan for your Apple Health Medicare Connect and Behavioral Health Services Only (BHSO) plan.

The primary benefit of a D-SNP is having one plan for your Medicare and Apple Health coverage. D-SNP coverage makes finding a provider easier, since providers only need to accept one plan.

Some D-SNP plans offer supplemental benefits in addition to what Medicare and Apple health covers. Please contact the plans for more information.

Am I eligible to enroll?

Apple Health Medicare Connect enrollment is open to all dual-eligible clients. If your Apple Health coverage only includes Medicare cost-sharing, you can still enroll in Apple Health Medicare Connect.

How do I choose a plan?

Our Apple Health Medicare Connect service area guide has two resources:

• Aligned enrollment map: Shows counties where D-SNPs and BHSOs offer aligned enrollment.
• Service area matrix: shows which D-SNP is in each county. In some counties, plans have only D-SNPs. In other counties, they have both D-SNPs and BHSOs.

Consult with your providers to see which plans they accept. You can also contact the plans to see if your providers are in their networks.

What to consider when enrolling

You have the option to choose the plan for your Apple Health Medicare Connect and BHSO coverage if you live in a county that offers aligned enrollment.

Aligned enrollment helps dual-eligible clients manage their physical and behavioral health services under one plan. This makes it easier to find a provider and coordinate your Medicare and Apple Health services.

View the aligned enrollment map in our service area guide to see if alignment is available in your county.

Supplemental benefits

Some plans offer supplemental benefits in addition to what Apple Health and Medicare covers. Supplemental benefits vary by plan but may include:

• A monthly credit that may be spent on healthy foods, over the counter products, or eligible utility bills.
• Additional vision benefits including an allowance for glasses or contacts.
• Meal delivery after an inpatient hospital stay.
• Fitness programs that include free gym memberships.
• Personal emergency response systems.
• Routine acupuncture and chiropractor care.
• Podiatry services, including routine foot care appointments.
• Additional hearing benefits, including an allowance for hearing aids.
• Telehealth and virtual appointments.
• Additional dental benefits for covered dental services such as cleaning, fillings, root canals, crowns, dentures, and implants.
• Additional home care benefits such as chore service visits.

How can I get help deciding if Apple Health Medicare Connect is right for me?

• Compare Medicare plans and find answers to common questions.
• Statewide Health Insurance Benefits Advisors (SHIBA) helps with your Medicare questions.
  • Call SHIBA at 1-800-562-6900 for free and unbiased help.

How do I enroll in a D-SNP?

If you are eligible for Apple Health Medicare Connect coverage, you can enroll during the regular Medicare Advantage enrollment period. You can also enroll during a Special Enrollment Period (SEP) with job-based insurance or for exceptional circumstances.

Each plan may recommend different steps to enroll. Visit their webpages for more information.

How do I contact the plans?

How do I change my Behavioral Health Services Only plan?

If you enroll in a D-SNP, your Apple Health BHSO plan will still cover your behavioral health care needs.

You may wish to change your BHSO plan to be the same plan as your D-SNP. You can also choose one plan as your D-SNP and another plan as your BHSO. It is up to you and your providers to choose which plans work best for your health care needs.

Visit our Apple Health managed care map and managed care matrix to see which BHSO plans are available in each region.

Contact Washington Apple Health (Medicaid) if you wish to change your Apple Health BHSO plan.

What if I am an American Indian/Alaska Native?

If you are dual-eligible American Indian/Alaska Native, you can:

• Enroll in an Apple Health BHSO, or
• Receive Apple Health behavioral health coverage without a plan.

There are advantages and disadvantages to each, depending on your individual circumstances. Tribal health clinic and urban Indian clinic staff are very familiar with these options and can help you make this choice. Learn more about coverage for American Indian/Alaska Natives.