Apple Health Managed Care Explained
Most Apple Health clients have “managed care,” which means Apple Health pays a health plan a monthly fee for care, including preventive, primary, specialty and other health services. Services are provided through the plan’s own provider network. The health plan then pays the provider that cared for you.
It used to be that all Medicaid health care was provided through a fee-for-service model, using a medical coupon with any provider who accepted Medicaid. Today, most Apple Health clients don’t get fee-for-service for their regular health care. Most get “managed care” through their health plans for most of their services.
Fee-for-service benefits include dental care, long-term care, and in-patient psychiatric care for physician services. Your primary care provider or health plan will help you find these benefits and coordinate your care.
All plans cover the same basic services, but they have some differences in the way they provide services. The Welcome to Washington Apple Health booklet lists the basic services. Each health plan has its own network of providers. Please verify with the health plan that the providers you prefer are in the plan’s network.
Managed Care Plans in Your Area
The Washington State Health Care Authority contracts with five different managed care plans for its Medicaid Apple Health program. Although not all five are offered in every area, everyone will have at least two plans to choose from.
To ensure that your provider participates in your plan, ask your provider which plans they are part of (or are willing to bill) or contact your plan for specific information about its provider network:
Amerigroup (AMG): 1-800-600-4441
Community Health Plan of Washington (CHP): 1-800-440-1561
Coordinated Care of Washington (CCW): 1-877-644-4613
Molina Healthcare of Washington, Inc. (MHC): 1-800-869-7165
United Healthcare Community Plan (UHC): 1-877-542-8997
Medicaid Plan Selection