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Washington Apple Health Expansion

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Apple Health Expansion

Apple Health Expansion

Apple Health Expansion offers physical and behavioral health care benefits. You may be eligible for Apple Health Expansion if you are:

  • Washington resident 19 years or older
  • Not eligible for other state or federal health programs based on immigration status.
  • Under 138% of poverty level
  • Not pregnant 

To learn more about the eligibility requirements go to hca.wa.gov/apple-health-expansion.

  • Check eligibility (opens modal window)
  • Washington Apple Health Expansion Steps to enroll

Find providers and coverage for this plan.

Find a medical provider

Search for doctors, hospitals, and other specialists.

Find a behavioral health provider

Search for behavioral health providers and resources.

View drug list

Find medications covered by this plan.

Find a pharmacy

Find a pharmacy near you.

Find a vision provider

Search for a vision center.

Find a dentist

Find a Dentist

Benefits & features

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Language help

If English is not your preferred language or you are deaf, deafblind, or hard of hearing, we can help. We will provide language assistance at no cost to you. 

If you need information in a language other than English, including sign language, call Member Services at 1-877-542-8997, TTY 711. We can also help you find a provider who speaks your language.

We can arrange for an interpreter at your appointments. Let your doctor know you will need an interpreter when you schedule your appointments. Your doctor will call our Provider Call Center to arrange for the interpreter.

Behavioral health services include mental health and substance use disorder treatment services. These services can help you with personal problems that may affect you and your family such as stress, depression, anxiety or using drugs or alcohol. Behavioral health services are covered at no cost to you. You must go to a behavioral health provider in UnitedHealthcare Community Plan’s network.

How to access behavioral health services

You have the right to choose a qualified behavioral health services provider.  You can find a list of in-network behavioral health providers [here].  You do not need a referral from our you Primary Care Provider (PCP) see behavioral health specialists in your plan or to access substance use disorder treatment services.

Your Primary Care Provider (PCP) and UnitedHealthcare Community Plan can also help coordinate your behavioral health care. You can find the name of your PCP on the back of your UnitedHealthcare Community Plan member ID card.

If you need help finding a behavioral health provider or getting the behavioral health care you need, please call Member Services at 1-877-542-8997, TTY 711, Monday – Friday, 8 a.m. – 5 p.m. (PT).

Go to Live and Work Well to get support and information for stress, mental health, substance use and  more.

Mental health services may include:

  • Intake evaluation, assessment, and screening
  • Peer support
  • Mental health treatment interventions such as:
    • Individual, family and group therapy
    • Outpatient, residential and inpatient care
    • Intensive and brief treatment models
  • Crisis Services
  • Medication management and monitoring
  • Care coordination and community integration
  • Wraparound with Intensive Services (WISe)

Substance Use Disorder (SUD) treatment services may include:

  • Assessment
  • Brief intervention and referral to treatment
  • Individual, family, and group therapy
  • Outpatient, residential and inpatient
  • Opiate substitution treatment services
  • Case management
  • Peer support
  • Crisis services
  • Withdrawal management (detoxification)

Wraparound with Intensive Services (WISe)

WISe is an approach to helping young adults ages 19 and 20 with intensive mental health care needs. The program takes a team approach designed to support young adults and families in meeting their individualized goals. You can find more information on the Washington Health Care Authority WISe webpage .

Applied Behavioral Analysis (ABA) 

ABA services assist individuals with autism spectrum disorders and other developmental disabilities in improving their communication, social and behavioral skills. To access ABA services and care coordination, call our ABA Support Line at 1-866-456-5376. 

Behavioral Health Advocates

A Behavioral Health Advocate (formerly called Ombuds) is a person who provides free and confidential assistance with resolving concerns related to your behavioral health services. They can also help if you have a behavioral health grievance, appeal, or fair hearing. Behavioral Health Advocates are independent of UnitedHealthcare Community Plan. They have also experienced behavioral health services themselves, or someone in their family member has had behavioral health services. 

You can find the phone number of the Behavioral Health Advocate in your county here.  Or you can contact the Office of Behavioral Health Advocacy at 1-800-366-3103 or email info@obhadvocacy.org.

Helplines

Crisis services

A mental health crisis is when someone’s behavior can put themselves or others in danger, especially if they do not get help right away.

  • For a life-threatening emergency, call 911.
  • For a mental health crisis, call or text 988 (National Suicide Prevention Lifeline).
  • For a mental health crisis or substance use disorder crisis that is not life-threating, call the Behavioral Health Administrative Services Organization (BH-ASO) in your county. The phone numbers can be found here and on the back of your UnitedHealthcare Community Plan member ID card.

Get the assistance you and your family need to stay healthy, to get better if you are injured or sick. Medical care services are covered at no cost to you. Some services require pre-approval.

Covered services include but are not limited to: 

  • Primary care visits, wellness exams and immunizations
  • Specialist visits
  • Prescriptions
  • Emergency and urgent care
  • Hospital services
  • Lab tests and X-rays
  • Diabetes supplies
  • Family planning
  • Medical supplies and equipment
  • Hearing/vision services and exams
  • Transhealth services - hormone therapy and behavioral health support
  • Quit smoking program

We use a list of approved prescription drugs called the Apple Health Preferred Drug List (PDL). The PDL is created by the Washington Health Care Authority. There is no cost to you for covered prescription drugs. Some prescription drugs require pre-approval.

In most cases, you need to try generic drugs first. Generic drugs are made up of the same active ingredients as brand name drugs. They usually cost less than the brand name drug and usually don’t have well-known names. Generic drugs are approved by the Food and Drug Administration. 

You must use a pharmacy in our pharmacy network.   Some prescription drugs can be delivered to you in the mail.

 

Routine and preventive health care services for women, including family planning.

Covered services include, but are not limited to:  

  • Mammograms
  • Cervical cancer screening
  • Reproductive health
  • Birth control such as:
  • FDA approved contraceptive drugs, devices and supplies, long-acting reversible contraceptives
  • Over the Counter (OTC) FDA approved contraceptives
  • Sexually transmitted disease testing and treatment
  • HIV and AIDS testing
  • Sterilization procedures

Pregnant individuals are not eligible for Apple Health Expansion. Pregnant individuals should enroll in the Apple Health for Pregnant Individuals which covers pregnant individuals regardless of immigration status. Go to Washington Healthplanfinder to enroll at wahealthplanfinder.org or call 1-855-923-4633, TTY 1-855-627-9604. 

Dental care is covered by Washington Health Care Authority (HCA) Apple Health Fee-for-Service. 

Washington Health Care Authority Apple Health Fee-for-Service pays for transportation services to and from needed non-emergency health care appointments. 

Call the transportation provider (broker) in your area to learn about services and limitations. Your regional broker will arrange the most appropriate, least costly transportation for you. A list of brokers can be found at hca.wa.gov/transportation-help.

When possible, contact the transportation broker at least 7-14 days before of your health care appointment.

Vision coverage helps protect the health of eyes and prevents common eye diseases that may cause vision loss.

Covered services include: 

  • Ophthalmology and optometrist exams
  • Eye exams are not limited as long as it is for a medical condition
  • Vision therapy
  • Fitting fees for eyeglass and contact lens for vision-related hardware coverage, routine and medical

Ages 19 & 20: Eyeglasses and contact lenses are covered by Washington Health Care Authority Apple Health Fee-for-Service. You can find eyewear suppliers at: https://fortress.wa.gov/hca/p1findaprovider/.

Age 21 and older: Eyeglasses and contact lenses are not covered. For adults in need of eyeglasses at a reduced cost you can purchase eyeglass frames and lenses through participating optical providers. Find a list of participating providers at: hca.wa.gov/assets/free-or-low-cost/optical_providers_adult_medicaid.pdf. 

As a member of UnitedHealthcare Community Plan, you get access to value-added benefits. These extra benefits are no cost to you. They are offered in addition to the required Apple Health Expansion benefits and services.

  • Healthy rewards: Earn rewards for completing important preventive care visits including immunizations, breast cancer screening, diabetes monitoring and more. Up to $200 per member per year. Eligible members will be notified by mail or email.
  • Healthy lifestyles: AbleTo self-care app with emotional health tools including meditations, breathing exercises, videos, blogs and more. For more information, visit ableto.com/begin and follow the online steps to sign up (note: use your UnitedHealthcare member ID number as your access code.
  • Transition support for jail/detention: Members transitioning out of jail/detention may receive duffel bags containing essentials upon leaving an incarcerated setting in addition to care coordination services. Member Services can refer incarcerated members to their assigned case manager. Call 1-877-542-8997, TTY 711

See more benefits and features

Choice of doctor

You will have a primary care physician (PCP) who will be your main doctor. The name of your PCP is on the front of your UHC Member ID Card. Your PCP is the person you should see for most of your care. This includes checkups, treatments, vaccinations, minor injuries and health concerns. 

Talk to your PCP about any behavioral health concerns you may have.  Your PCP can help you decide the right options for you.

Your PCP is your main doctor for:

  • Preventive care
  • Treatment if you are sick or injured
  • Referrals to specialists for certain conditions

Go to 'Find a Medical provider' or 'Find a Behavioral health provider'  to see if your doctor is in our network. If you don’t have a doctor or if your doctor is not in our network, we can help you find a new one close to you.

 

Case management

Case management helps members with multiple health care needs get care. A case manager can help coordinate care with your doctor. 

Case management includes but is not limited to:

  • Care plans
  • Community resources
  • Transgender health services
  • Coordination and referral to Applied Behavioral Analysis (ABA) services

Diabetes care

Diabetes is a condition that happens when your blood sugar (glucose) is too high.

Covered services include but are not limited to:

  • Prescription drugs
  • Supplies 
  • Diabetes education
  • Healthy Rewards for diabetes monitoring

Diagnostic tests, Labs and X-rays

Diagnostic tests, radiology, and labs help doctors decide what might be wrong with a person's body. 

Covered services include but are not limited to:

  • Cardiology and radiology (imaging studies)
  • X-rays
  • Lab visits
  • Genetic testing 

Emergency services

Call 911 or go to the nearest emergency room if you have a sudden or severe health problem that you think is an emergency. Only go to the hospital emergency room if it’s an emergency. Do not go to the emergency room for routine care.

Call us as soon as possible afterwards to let us know that you had an emergency and where you received care. You do not need pre-approval to get care in an emergency. You may use any hospital or emergency setting in the United States if you are having an emergency.

Hearing services

Trouble hearing can affect your everyday life in many ways. Our plan includes services and support to help protect your hearing.

Hearing services and equipment to help you hear better.

Covered services include: 

For ages 19 and older:

  • Routine hearing exams
  • Testing and therapy
  • Monaural and binaural hearing aids, including fitting, follow-up care, batteries, and repair
  • Bilateral Cochlear Implants, including implants, parts, accessories, batteries, chargers, and repairs

For age 19 & 20:

  • Services list above; and
  • Bone-Anchored Hearing Aids (BAHA), including BAHA devices (both surgically implanted and soft band headbands), including BAHA replacement parts and batteries

Kidney disease care

Kidney disease is when your kidneys are damaged and cannot filter your blood the way they should.

Covered service include but are not limited to:

  • Dialysis
  • Medications
  • Health education and support
  • Organ transplant, if needed

Hospitalization

Hospitalization is when you stay overnight for inpatient services and care at a hospital. 

Inpatient services and care must be pre-approved by us (unless it is for emergency care). After you leave the hospital, we will help you with follow-up care to continue healing at home.

Immunizations and vaccines

Routine shots help protect you from illness.

Routine immunization and vaccines help protect you from illness. You can get immunizations and vaccines at your PCP, pharmacy or local health department.

Covered services include but are not limited to:

  • Recommended immunizations and vaccines
  • Influenza shots

For more information, go to doh.wa.gov/youandyourfamily/immunization.

Medical equipment and supplies

Medical equipment and supplies are covered when medically necessary and prescribed by your health care provider. We must pre-approve most medical equipment and supplies before we will pay for them. 

Covered equipment and supplies include but are not limited to:

  • Incontinence supplies
  • Blood monitoring and testing supplies
  • Continuous positive airway pressure machine (CPAP)
  • Hospital beds
  • Oxygen equipment and supplies 
  • Wheelchairs or walkers

Pregnancy care

Pregnant individuals are not eligible for Apple Health Expansion. Pregnant individuals should enroll in the Apple Health for Pregnant Individuals which provides coverage regardless of immigration status.

Go to Washington Healthplanfinder to enroll at wahealthplanfinder.org or call 1-855-923-4633, TTY 1-855-627-9604. 

 

 

Preventive care (Well visits)

Well visits with your doctor can help you stay healthy. These visits can catch health problems early, so they can be treated. 

Covered services include but are not limited to: 

  • Annual wellness exams and screenings
  • Routine shots and tests

Quitting tobacco

Tobacco and smoking cessation services helps people quit using all forms of tobacco, including vaping, smoking and chewing tobacco. It helps you learn skills to overcome cravings and improve your health.

Covered services include:  

  • Personal, one-on-one coaching support
  • Free 8-week supply of nicotine replacement therapy (patch or gum)
  • Bupropion/Chantix decision support (prescription required)

To enroll or for more information, call 1.866.Quit.4.LIFE (866-784-8454) TTY (877-777-6534) or go online: www.myquitforlife.com/uhcwa.

Skilled Nursing Facility (SNF)

A Skilled Nursing Facility (SNF) is an inpatient facility that provides rehabilitation and medical treatment. It helps person to recover from surgery or illness before going home.

Care at a Skilled Nursing Facility is covered when it is decided that the nursing facility care is the right place for care instead of a hospital. Pre-approval is required.

Therapy services

Physical, occupational and speech therapy can help you recover from a serious injury or illness, or simply reach your full potential.

Covered services include but are not limited to:

  • Occupational therapy
  • Physical therapy
  • Speech therapy
  • Cardiac rehabilitation

Transhealth services

Service related to transhealth and the treatment of gender dysphoria. 

Covered services include but are not limited to:

  • Physician services
  • Hormone therapy
  • Puberty suppression therapy
  • Behavioral health services

Contact Member Services at 1-877-542-8997, TTY 711.

Gender reassignment surgery is covered by Washington Health care Authority Fee-for-Service). To learn more go to:  http://www.hca.wa.gov/transhealth, or email: transhealth@hca.wa.gov

Member resources

Member resources (opens modal window)

Enrollment information

Visit Washington Healthplanfinder site for more information on eligibility and enrollment. 

Washington Healthplanfinder

Call us:
1-855-923-4633 / 1-855-627-9604 / TTY: 711

Steps to enroll
Get the details

Apple Health Expansion specialists can answer questions and help you enroll.

Call us:
1-877-542-8997 / TTY: 711

8:00 am to 5:00 pm pacific time, Monday – Friday

Interpreter services
We can also assist with interpreter services, including American Sign Language. 

Call us:
1-877-542-8997 / TTY: 711

8:00 am to 5:00 pm local time, Monday – Friday

Member information

You have access to our member-only website. Print ID cards and more. View our handbook below.

Member website

Member Handbooks

Getting started guides

See what UnitedHealthcare has to offer.


Disclaimer information
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Looking for the federal government’s Medicaid website? Look here at Medicaid.gov.

UnitedHealthcare Dual Complete plans

Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies, a Medicare Advantage organization with a Medicare contract and a contract with the State Medicaid Program. Enrollment in the plan depends on the plan’s contract renewal with Medicare. This plan is available to anyone who has both Medical Assistance from the State and Medicare. Benefits, features and/or devices vary by plan/area. Limitations, exclusions and/or network restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year.

Premium disclaimer

Dual Special Needs plans have a $0 premium for members with Extra Help (Low Income Subsidy).

Benefit disclaimer

Benefits, features, and/or devices vary by plan/area. Limitations, exclusions and/or network restrictions may apply.

Nurse Hotline disclaimer

This service should not be used for emergency or urgent care needs. In an emergency, call 911 or go to the nearest emergency room. The information provided through this service is for informational purposes only. The nurses cannot diagnose problems or recommend treatment and are not a substitute for your provider's care. Your health information is kept confidential in accordance with the law. The service is not an insurance program and may be discontinued at any time. Nurse Hotline not for use in emergencies, for informational purposes only.

UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid plan)

UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid plan) is a health plan that contracts with both Medicare and Ohio Medicaid to provide benefits of both programs to enrollees. 

UnitedHealthcare Connected® (Medicare-Medicaid plan)

UnitedHealthcare Connected® (Medicare-Medicaid plan) is a health plan that contracts with both Medicare and Texas Medicaid to provide benefits of both programs to enrollees.

UnitedHealthcare Connected® for One Care (Medicare-Medicaid plan)

UnitedHealthcare Connected® for One Care (Medicare-Medicaid plan) is a health plan that contracts with both Medicare and MassHealth (Medicaid) to provide benefits of both programs to enrollees. 

UnitedHealthcare Connected® general benefit disclaimer

This is not a complete list. The benefit information is a brief summary, not a complete description of benefits. For more information contact the plan or read the member handbook. Limitations, copays and restrictions may apply. For more information, call UnitedHealthcare Connected® Member Services or read the UnitedHealthcare Connected® member handbook. 

UnitedHealthcare Senior Care Options (HMO SNP) plan

UnitedHealthcare Senior Care Options (SCO) is a Coordinated Care plan with a Medicare contract and a contract with the Commonwealth of Massachusetts Medicaid program. Enrollment in the plan depends on the plan’s contract renewal with Medicare. This plan is a voluntary program that is available to anyone 65 and older who qualifies for MassHealth Standard and Original Medicare and does not have any other comprehensive health Insurance, except Medicare. If you have MassHealth Standard, but you do not qualify for Original Medicare, you may still be eligible to enroll in our MassHealth Senior Care Option plan and receive all of your MassHealth benefits through our Senior Care Options (SCO) program.

Star ratings disclaimer

Every year, Medicare evaluates plans based on a 5-Star rating system. The 5-Star rating applies to plan year 2024.

Important provider information

The choice is yours

We will provide you with information to help you make informed choices, such as physicians' and health care professionals' credentials. This information, however, is not an endorsement of a particular physician or health care professional's suitability for your needs.

The providers available through this application may not necessarily reflect the full extent of UnitedHealthcare's network of contracted providers. There may be providers or certain specialties that are not included in this application that are part of our network. If you don't find the provider you are searching for, you may contact the provider directly to verify participation status with UnitedHealthcare's network, or contact Customer Care at the toll-free number shown on your UnitedHealthcare ID card. We also recommend that, prior to seeing any physician, including any specialists, you call the physician's office to verify their participation status and availability.

Some network providers may have been added or removed from our network after this directory was updated. We do not guarantee that each provider is still accepting new members.

Out-of-network/non-contracted providers are under no obligation to treat UnitedHealthcare plan members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost- sharing that applies to out-of-network services.

American Disabilities Act notice

In accordance with the requirements of the federal Americans with Disabilities Act of 1990 and Section 504 of the Rehabilitation Act of 1973 ("ADA"), UnitedHealthcare Insurance Company provides full and equal access to covered services and does not discriminate against qualified individuals with disabilities on the basis of disability in its services, programs, or activities.

Referrals

Network providers help you and your covered family members get the care needed. Access to specialists may be coordinated by your primary care physician.

Paper directory requests

Paper copies of the network provider directory are available at no cost to members by calling the customer service number on the back of your ID card. Non-members may download and print search results from the online directory.

Inaccurate information

To report incorrect information, email provider_directory_invalid_issues@uhc.com. This email box is for members to report potential inaccuracies for demographic (address, phone, etc.) information in the online or paper directories. Reporting issues via this mail box will result in an outreach to the provider’s office to verify all directory demographic data, which can take approximately 30 days. Individuals can also report potential inaccuracies via phone. UnitedHealthcare Members should call the number on the back of their ID card, and non-UnitedHealthcare members can call 1-888-638-6613 / TTY 711, or use your preferred relay service.

Declaration of disaster or emergency

If you’re affected by a disaster or emergency declaration by the President or a governor, or an announcement of a public health emergency by the Secretary of Health and Human Services, there is certain additional support available to you.

  • Part A, Part B, and supplemental Part C plan benefits are to be provided at specified non-contracted facilities (note that Part A and Part B benefits must be obtained at Medicare certified facilities);
  • Where applicable, requirements for gatekeeper referrals are waived in full;
  • Plan-approved out-of-network cost-sharing to network cost-sharing amounts are temporarily reduced; and
  • The 30-day notification requirement to members is waived, as long as all the changes (such as reduction of cost-sharing and waiving authorization) benefit the member.

If CMS hasn’t provided an end date for the disaster or emergency, plans will resume normal operation 30 days after the initial declaration.