Coverage for Children
Washington Apple Health for Children (Apple Health for Kids)
Who is Eligible?
Newborns are automatically eligible if their mother received WAH at the time of the child's birth. The eligibility will last for 12 months.
Children under age 19 may be eligible if their family’s income is less than 317% of the FPL. To be eligible above 215% of FPL, children must not be covered by other insurance, and families must pay a monthly premium to HCA (between $20-30 per child). You do not need to provide a citizenship or immigrant status to be eligible, but you must be a state resident.
What Is Covered?
Enrollees receive Categorically Needy (CN) coverage, which is comprehensive. The general categories of CN service are listed inWAC 182-501-0060(6); all medically necessary services are covered.
Enrollees are not required to pay cost sharing, copayments or deductibles for any service.
Enrollees are usually required to be in a managed care plan called Apple Health Managed Care. This means you must have a primary provider who is the gatekeeper to other medical providers, and the plan determines which providers will be covered under their plan. There are exemptions from Apple Health Managed Care for certain reasons, such as being a foster child or children with special health care needs.
Coverage may be retroactive, up to 3 months before you apply.
Other Things to Know
There are no time limits, work requirements, or limits on assets you can own.
Apply for coverage and renew coverage through Washington Healthplanfinder.
If your family income changes over the year, you may apply based on an average of that income.
Qualified Health Plans and Other Individual Insurance
Who Is Eligible?
Children and adults can buy Qualified Health Plans if they are US citizens or have an eligible immigration status, are state residents, and are not in jail/prison.
Children and adults can get subsidies to help with the costs of buying a Qualified Health Plan if they meet other requirements, including: having household income below 400% of the Federal Poverty Level; not qualifying for public programs like Apple Health (Medicaid and CHIP) or Medicare (some exceptions); and not having an affordable offer of coverage through a parent's employer.
QHP coverage became available January 1, 2014. The next open enrollment period runs from 11/1/15 through 1/31/16 but in some cases you can apply before or after those dates. Other individual health insurance plans are available outside the QHP marketplace at full price.