D-SNP Plans in Washington (Apple Health Medicare Connect)

Who qualifies for a D-SNP

• You have Medicare Part A and Part B
• You live in the D-SNP's Washington service area
• You have Apple Health: either full Apple Health coverage, or a Medicare Savings Program (QMB, SLMB or QI) that pays Medicare costs

The Health Care Authority (HCA) calls these two groups full-benefit dual-eligible (Medicare plus full Apple Health) and partial-benefit dual-eligible (Medicare plus a Medicare Savings Program). HCA says enrollment in Apple Health Medicare Connect is open to all dual-eligible clients, including people whose Apple Health covers only Medicare cost-sharing. Learn more about Apple Health.

What you pay on a D-SNP

Your costs depend on your Apple Health category and the plan. Some protections come from Medicare and Apple Health themselves, not from the plan:

• Part B premium: full Apple Health and the QMB, SLMB and QI programs pay your Part B premium ($202.90 a month standard in 2026).
• Medicare cost-sharing: if you have full Apple Health or QMB, federal law bars Medicare providers from billing you for Medicare deductibles, coinsurance and copays for covered services.
• Drugs: people with Apple Health or a Medicare Savings Program automatically get Extra Help. In 2026, Extra Help copays are no more than $5.10 for generics and $12.65 for brand-name drugs, and lower for some people with full Apple Health. See Extra Help.
• Plan premium and other costs: each plan's Summary of Benefits shows its premium, if any, and what you pay for services.

If a Washington provider bills you for Medicare cost-sharing that QMB or full Apple Health protects you from, tell the provider you're protected and call 1-800-MEDICARE (1-800-633-4227, TTY 1-877-486-2048).

Extra benefits on D-SNPs

Medicare Advantage plans may offer extra benefits that Original Medicare doesn't cover, such as dental, vision, hearing or fitness. Extra benefits vary by plan and county, may have limits and costs, and not every plan offers them. Check a plan's Summary of Benefits or Evidence of Coverage.

Extra benefits are real, but they shouldn't be the only reason to switch. Check that your providers and prescriptions are covered first, and compare with what Apple Health already covers.

D-SNPs and Apple Health in Washington

In Washington, HCA contracts with specific D-SNPs to provide the physical health side of Apple Health Medicare Connect. These plans include Part D drug coverage. As a dual-eligible client, you also have behavioral health coverage (mental health and substance use disorder treatment) through an Apple Health Behavioral Health Services Only (BHSO) plan.

• Aligned enrollment: in some counties, the same company offers both a D-SNP and a BHSO plan, and you can choose the same company for both, so your physical and behavioral health care are managed by one plan. HCA's aligned enrollment map shows where this is available.
• Care coordination: the plan coordinates your Medicare and Apple Health services, which HCA says makes referrals and treatment planning easier.
• Indian Health Care Providers are treated as in-network with Apple Health Medicare Connect plans, consistent with Apple Health. See tribal health and Medicare.
• PACE: the Program of All-Inclusive Care for the Elderly is available in limited ZIP codes in King, Pierce, Snohomish and Spokane counties. Enrolling in PACE ends your enrollment in a D-SNP.

Enrollment and changes

You can join a D-SNP during the Annual Enrollment Period (October 15 to December 7), when you first get Medicare, or during a special enrollment period. Since January 2025, Medicare's rules for dual-eligible people are:

• Integrated D-SNP, once a month: if you have full Apple Health and Medicare, you can join or switch to an integrated D-SNP once per calendar month, with coverage starting the first of the next month. Not every D-SNP is integrated; ask the plan or 1-800-MEDICARE.
• Drug coverage, once a month: if you have Apple Health or Extra Help, you can switch to a different Part D plan, or drop a Medicare Advantage plan with drug coverage and join a standalone Part D plan, once per calendar month.

This replaced the earlier quarterly special enrollment period. If you lose Apple Health, your plan may keep you enrolled for a grace period set by the plan (up to 6 months) while you regain eligibility. Check your plan's Evidence of Coverage.

Where to find a D-SNP in Washington

D-SNP availability varies by county. HCA's service area matrix shows which D-SNP serves each county. For 2027, CMS lists 43 special needs plans of all kinds in Washington. To see plans where you live, see plans in your ZIP code, or call (206) SENIORS (206-736-4677), TTY 711 to reach a licensed insurance agent with Benefits Life, at no cost to you, about plans from the companies they work with. You can also find a licensed insurance agent in Washington, or call 1-800-MEDICARE for information on all your options.

Sources

• Washington State Health Care Authority — Apple Health Medicare Connect
• Washington State Health Care Authority — Apple Health Medicare Connect (D-SNP) eligibility (PDF)
• Washington State Health Care Authority — D-SNP aligned enrollment map (PDF)
• Washington State Health Care Authority — D-SNP service area matrix (PDF)
• Medicare.gov — Special Enrollment Periods
• Medicare.gov — Special Needs Plans (SNP)
• CMS — Qualified Medicare Beneficiary (QMB) program and billing protections
• eCFR — 42 CFR 422.52, Eligibility for special needs plans (deemed continued eligibility)
• CMS — Medicare Advantage and Part D Landscape files, contract year 2027

Frequently asked questions

Do I have to give up Original Medicare to join a D-SNP?

A D-SNP is a Medicare Advantage plan, so it replaces Original Medicare while you're enrolled. You keep your Medicare and Apple Health eligibility. Enrolling doesn't change what Medicare or Apple Health covers; the D-SNP manages your Medicare benefits and coordinates them with Apple Health.

Will my doctor accept a D-SNP?

It depends on the plan's network. Ask your doctors which Apple Health Medicare Connect plans they accept, or contact the plans to see whether your providers are in their networks for the coming year. Networks can change each year.

What happens if I lose Apple Health?

Your plan may keep you enrolled for a grace period while you regain eligibility; the length is set by each plan, up to 6 months, and is in your Evidence of Coverage. If you don't regain Apple Health by then, the plan will disenroll you, and you'll have a special enrollment period to choose other coverage.

Who can join a D-SNP in Washington?

People with Medicare Part A and Part B who also have Apple Health, and who live in the plan's service area. The Health Care Authority says enrollment in Apple Health Medicare Connect is open to all dual-eligible clients, including people whose Apple Health covers only Medicare cost-sharing through a Medicare Savings Program.

When can I join or switch D-SNPs?

During the Annual Enrollment Period (October 15 to December 7) and other Medicare enrollment periods. Since 2025, people with full Apple Health and Medicare can also join or switch to an integrated D-SNP once a month, and people with Apple Health or Extra Help can change drug coverage once a month.

Medicare in your Washington county

Plans, local agents and help, county by county: Adams · Asotin · Benton · Chelan · Clallam · Clark · Columbia · Cowlitz · Douglas · Ferry · Franklin · Garfield · Grant · Grays Harbor · Island · Jefferson · King · Kitsap · Kittitas · Klickitat · Lewis · Lincoln · Mason · Okanogan · Pacific · Pend Oreille · Pierce · San Juan · Skagit · Skamania · Snohomish · Spokane · Stevens · Thurston · Wahkiakum · Walla Walla · Whatcom · Whitman · Yakima