Apple Health 101
Medicaid provides health care for people who meet federal income requirements. Medicaid is the federal name for the program, while Apple Health is what Medicaid is called in the state of Washington.
As an Apple Health recipient, you’re entitled to choose health insurance that works in your best interest. Understanding your options, costs, and benefits can make a big difference in the quality of your care.
Consumer Checklist: What to look for in an Apple Health plan
It can be difficult to find coverage that meets your health care needs. Consider the following qualities when shopping for Apple Health insurance:
- Benefits Offered — Check whether the plan covers the health care services and medications you need. Apple Health plans must meet certain standards, but they’re not all the same.
- Provider Network — Find out if your doctor accepts the type of insurance you’re thinking of getting. Check our provider network.
- Added Benefits — Many insurance companies, including CHPW, offer additional programs and services at no cost to members. We’ve added these services to invest in our members’ long-term health. Look into what’s available to you beyond your baseline coverage.
What’s the difference between Medicaid and Apple Health?
Medicaid and Apple Health are names for the same program. Apple Health is what Medicaid is called in the state of Washington.
What is Community Health Plan of Washington (CHPW)?
CHPW is a not-for-profit health insurance plan. We work with the state to offer health care plans to Apple Health (Medicaid) and Medicare recipients. We offer excellent care, as well as many benefits not covered by Apple Health alone.
Does CHPW coverage cost anything?
If you have CHPW Apple Health coverage as an individual, Medicare Advantage Dual coverage, or Behavioral Health Services Only (BHSO) coverage, covered services and programs that are delivered within network do not cost you anything.
Unless your in-network doctor approves care for you from a provider outside our network, you will likely have to pay the full cost of services provided.
If your child has Apple Health for Kids coverage, you may pay a low monthly premium. Whether or not you pay a premium depends on your income. Check income requirements for Apple Health for Kids.
Does CHPW offer plans where I live?
Community Health Plan of Washington offers Apple Health (Medicaid) coverage in ALL counties in Washington State.
What are the different types of plans and network restrictions?
Traditional HMOs (Health Maintenance Organizations) and EPOs (Exclusive Provider Organizations) may disallow coverage to providers outside their networks. This lets them keep their premiums lower than other kinds of plans. Unless your in-network doctor approves care for you from a provider outside our network, you will likely have to pay the full cost of services provided.
CHPW is an HMO. We’re proud of our network across Washington state and the care they provide our members.
PPOs (Preferred Provider Organizations) or POSs (Point-of-Service Plans) give you a choice of getting care within or outside of the provider network, although the costs are usually higher if the care is out-of-network.
FFSs (Fee-for-Service Plans) usually don’t have networks. That means you can see any doctor you choose, but you may have to pay more and fill out extra paperwork.
If I enroll in CHPW, will I be able to keep seeing my doctor?
What’s the difference between CHPW’s regular Apple Health plan and an Apple Health BHSO plan?
If you already have health coverage through another program, like Medicare, Tribal Health, or Foster Care, you can get additional coverage just for mental health and substance use disorder services through our Behavioral Health Services Only (BHSO) plan. You won’t have copays for services that are covered or approved from in-network providers.
Substance use disorder services include: Assessment, detox, opiate substitution services, inpatient residential treatment, outpatient treatment.
Mental health services include: Evaluation, medication management, stabilization services, family treatment, crisis services.
Other services include: Emergency services, hospital services, evaluations, lab services.
To request a free hard copy of the Member Handbook, please call Customer Service at 1-800-440-1561 (TTY Relay: Dial 711), from 8 a.m. to 5 p.m., Monday through Friday. We will send you a copy within 5 business days of your request.
Will I get an ID card from Community Health Plan of Washington?
When you enroll in CHPW you will be sent an ID card. Your member ID card lets your provider know to bill Community Health Plan of Washington for your services.
Each person in your family who signs up with Community Health Plan of Washington will get their own ID card. Separately, the Health Care Authority (HCA) will send you a ProviderOne services card to show that you are enrolled in Apple Health (Medicaid).
You will need to show the Community Health Plan of Washington ID card and your ProviderOne services card each time you get medical care. That includes medical visits, specialist visits, mental health visits, hospital visits, and when you’re ordering or filling prescriptions.
What happens if I lose my ID card?
If you lose your ProviderOne services card, please call Apple Health Customer Service at 1-800-562-3022 and follow the prompts to request a new card. Or you can submit your request online using the Apple Health contact form with the topic “Services Card” selected.
If you need care and don’t have your ProviderOne services card, go see your provider. They may be able to verify that you are enrolled in Apple Health with your name and date of birth.
What is medical necessity or medically necessary care?
In the state of Washington, medical necessity is used to describe care that is reasonable, necessary, and/or appropriate based on evidence-based clinical standards of care.
Other states may use different definitions of medical necessity. To find out whether a particular treatment meets the standard of medical necessity, talk to your CHPW network doctor or care provider.
We’re here to help
Didn’t find the answer to your question? Interested in becoming a member? Our friendly Customer Service team is happy to assist.