The income limit for Apple Health coverage is 138% of the federal poverty level (FPL), which is a significant expansion from the pre-2018 requirements.
The program utilizes Modified Adjusted Gross Income (MAGI) standards to determine eligibility, applying a 5% income disregard for certain categories.
For families with children, the household size includes the unborn child when calculating eligibility based on MAGI.
Deductions such as a $20 standard deduction are applied to non-MAGI income calculations to streamline the process.
The income thresholds vary depending on family size, with the limit increasing by around $11,600 for each additional household member.
Residency requirements mandate that applicants be citizens or legal residents for at least 5 years to qualify for Apple Health coverage.
Eligible individuals must select a Managed Care Organization (MCO) to facilitate their health coverage, which includes essential benefits and preventive services.
The program covers a broad range of services, including primary care, emergency visits, maternity care, pediatric services, dental, vision, and prescription drugs.
Apple Health is available year-round, and individuals can apply through the Washington Healthplanfinder website or by contacting the state's Health Care Authority.
For families with children, the income limit for the Apple Health for Kids program is higher than the standard Apple Health eligibility threshold.
Individuals with incomes above the MAGI-based limits may still qualify for coverage through non-MAGI Apple Health programs, such as those based on Supplemental Security Income (SSI) criteria.
The income limits and program eligibility are reviewed and updated annually to reflect changes in the federal poverty guidelines.
Apple Health recipients can choose from a variety of Managed Care Organizations (MCOs) to administer their health coverage, allowing them to select the plan that best fits their needs.
Pregnant women who were enrolled in Apple Health at the time of their child's birth are eligible for 12 months of continuous coverage for their newborn, regardless of changes in income.
The program's eligibility guidelines prioritize accessibility, with no resource or asset tests required for most applicants to qualify for coverage.
Apple Health provides coverage for a range of long-term services and supports, including home health care, nursing facility services, and community-based programs.
Individuals enrolled in Apple Health may also be eligible for additional benefits, such as transportation assistance to medical appointments and program-specific incentives for healthy behaviors.
The program's eligibility criteria are designed to be user-friendly, with online tools and resources available to help applicants determine their potential coverage options.
Apple Health's comprehensive benefits package and flexible eligibility guidelines have contributed to Washington's high insurance coverage rates, with the state ranking among the top in the nation for Medicaid enrollment.
The program's eligibility rules and income limits are regularly updated to ensure they remain aligned with the evolving federal and state policy landscape for Medicaid programs.