The short version
Medicare is federal health insurance, mainly for people 65 and older or with certain disabilities. It is not based on income.
Apple Health is Washington's Medicaid program, run by the Washington State Health Care Authority (HCA). For people 65 and older or on Medicare, it is based on income and resources, and DSHS handles applications.
Many people qualify for both at the same time. When you do, you're called "dual-eligible": Medicare pays first, and Apple Health pays after it and covers some services Medicare doesn't.
Side-by-side comparison
| Medicare | Apple Health | |
|---|---|---|
| Run by | Federal government (CMS); Social Security handles enrollment | Washington Health Care Authority; DSHS takes applications for people on Medicare |
| Eligibility | Age 65, certain disabilities, ESRD or ALS | Income and resources (Medicare Savings Programs have no asset test in Washington) |
| Premiums | Part B premium for most people; Part A has no premium for most | None for most Apple Health programs for older adults; Apple Health can pay Medicare premiums |
| Long-term custodial care | Not covered | Covered for people who meet financial and functional rules |
| Dental | Routine dental not covered by Original Medicare | Adult dental coverage |
| Who pays first | Primary | Secondary to Medicare |
What "dual-eligible" means
If you have both Medicare and Apple Health, the Apple Health program you qualify for decides what it pays. A Medicare Savings Program such as QMB pays your Part B premium ($202.90 a month in 2026), Part A and B deductibles, and copayments; SLMB and QI-1 pay the Part B premium. Full Apple Health also pays after Medicare for covered care, and Apple Health covers behavioral health through a Behavioral Health Services Only plan. Anyone with Medicare and Apple Health gets Extra Help with Part D drug costs.
Dual-eligible Washington residents can also enroll in a Dual-Eligible Special Needs Plan (D-SNP), a Medicare Advantage plan with drug coverage that coordinates Medicare and Apple Health. HCA calls these plans Apple Health Medicare Connect. More on D-SNPs →
How Apple Health programs interact with Medicare
Apple Health has several programs. The most relevant for Medicare beneficiaries:
- Apple Health for Workers with Disabilities (HWD): for working people with a disability; no asset test and no upper income limit, with a monthly premium based on income
- Apple Health Classic Medicaid: for people 65 and older, blind or disabled who meet income and resource limits
- Medicare Savings Programs (MSPs): pay Medicare premiums and, for QMB, deductibles and copayments. More →
- Long-term services and supports (LTSS): nursing facility, in-home and community residential care Medicare doesn't cover
Long-term care: a major difference
This is one of the most important things to understand. Medicare covers skilled nursing facility care only after a qualifying inpatient hospital stay, for up to 100 days per benefit period, and only while you need daily skilled care. In 2026 you pay nothing for days 1–20 and $217 a day for days 21–100. Medicare does not pay for custodial care, the help with bathing, dressing and other daily activities that most long-term care involves.
Apple Health long-term services and supports can pay for care, if you meet both the financial rules and a functional assessment, in these settings:
- Nursing facilities (custodial care, not just skilled care)
- Your own home, through in-home personal care and waiver programs such as COPES
- Adult family homes
- Assisted living facilities and other community residential settings
For many Washington families, Apple Health is the safety net once savings run down. The rules count both income and assets, and DSHS reviews asset transfers made in the 60 months before you apply. If you may need Apple Health long-term care in the future, plan carefully, ideally with an elder law attorney.
How to apply for Apple Health
If you are 65 or older or on Medicare, apply through DSHS: online at washingtonconnection.org, by phone at 1-877-501-2233, by mailing the HCA 18-005 application, or at a DSHS Community Services Office. Washington Healthplanfinder is for people who are not entitled to Medicare.
For long-term care, DSHS Home and Community Services handles applications and assessments (1-800-422-3263). Community Living Connections (1-855-567-0252) can point you to local long-term care services and the right starting point. More →
Once you know your Apple Health status, a licensed insurance agent with Benefits Life can explain Medicare plans from the companies they work with that fit it, at no cost to you. Call (206) SENIORS (206-736-4677), TTY 711 or see plans in your ZIP code.
What about the WA Cares Fund?
The WA Cares Fund is a separate program: neither Medicare nor Apple Health. It is a state long-term care benefit that Washington workers pay into through a premium of 0.58% of wages, and benefits became available on July 1, 2026, for people who qualify. WA Cares says its benefits are not counted as income or resources for other state programs and are not subject to estate recovery. It is a first layer of long-term care funding, not a replacement for Apple Health. More on WA Cares →
Sources
- Health Care Authority — Age 65 and older or Medicare eligible
- Health Care Authority — Aged, blind, or disabled (including Apple Health for Workers with Disabilities)
- Health Care Authority — Medicare Savings Program
- Health Care Authority — Long-term care and hospice
- Health Care Authority — Apple Health Medicare Connect
- WAC 182-513-1363 — Evaluating the transfer of an asset for long-term care
- Medicare.gov — Skilled nursing facility care
- Medicare.gov — Long-term care
- WA Cares Fund — Frequently asked questions
- WA Cares Fund — How it works
Frequently asked questions
Can I have both Medicare and Apple Health in Washington?
Yes. People with both are called dual-eligible. Medicare pays first and Apple Health is secondary. Depending on your Apple Health program, it can pay your Medicare premiums, deductibles and coinsurance.
What's the difference between Medicare and Apple Health?
Medicare is federal health insurance based on age, disability and work history, not income. Apple Health is Washington's Medicaid program, run by the Health Care Authority, and is based on income and resources. They serve different purposes and often work together.
Does Medicare cover long-term care?
Only in a limited way. Medicare covers up to 100 days of skilled nursing facility care per benefit period after a qualifying inpatient hospital stay, and not ongoing custodial care. Apple Health long-term services and supports can pay for custodial care at home, in adult family homes and assisted living, or in a nursing facility for people who qualify.
How do I apply for Apple Health if I'm on Medicare?
Apply through DSHS: online at washingtonconnection.org, by phone at 1-877-501-2233, by mailing form HCA 18-005, or at a DSHS office. Washington Healthplanfinder is for people who are not on Medicare.
Is the WA Cares Fund the same as Apple Health?
No. WA Cares is a separate state long-term care benefit that workers pay into through a payroll premium. It is not Medicaid and not Medicare, and WA Cares says its benefits do not count as income or resources for other state programs.
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
