Did you know that there’s a way to have the flexibility of private health insurance and get reimbursed for premiums from Apple Health (Medicaid)?
The Washington State Premium Payment Program may provide reimbursement for private health insurance coverage for those receiving Apple Health Medicaid.
What is a Premium Payment Program?
- Helps people on Apple Health take advantage of private health insurance in a way that saves the state money.
- Reduces health care costs to the state.
- Provides reimbursement for private health insurance coverage when an Apple Health client can access qualifying private health insurance coverage, such as through an employer or private policy.
How can the Premium Payment Program help?
- Keep Apple Health Private health insurance
- If it is determined to be cost-effective, family members not covered by Apple Health may also be included in the premium payment.
- Apple Health coverage does not terminate when enrolling in the program.
Who Qualifies for Premium Payment Assistance?
You must have Apple Health coverage before applying for the Premium Payment Program.
Private health insurance that qualifies for the Premium Payment Program includes:
- Employer-sponsored insurance available through your employer
- COBRA continues your employer-sponsored health insurance if you become unemployed or have retired
- Private health insurance purchased through the Health Benefit Exchange
Types of private health insurance that do not qualify for the Premium Payment Program may include:
- A health savings account or flexible health spending arrangement
- A high-deductible plan
- A limited or supplemental plan, including a Medicare supplemental plan
- A Medicare Advantage plan (Medicare Part C)
- An individual health plan purchased through the Health Benefit Exchange with a premium tax credit
- An individual health insurance plan that was not purchased through the Washington Health Benefit Exchange
If no one in your family receives Apple Health coverage, go to wahealthplanfinder.org to see if you qualify.
How to Apply
Complete, print out, and sign this intake form for premium assistance.
Complete, print out, and sign the IRS W-9 form. This form is required information for the subscriber’s private insurance plan.
Mail these documents to:
Health Care Authority
Premium Payment Program
P.O. Box 45518
Olympia, WA 98504
Fax: 1-877-893-3810; Phone:1-800-562-3022 Ext. 15473
It can take up to 30 days to process your application after all necessary paperwork is received.
A case manager will determine premium reimbursement based on:
- Cost and type of insurance.
- Age and gender of family members with active Apple Health (Medicaid) coverage.
- Type of Apple Health (Medicaid) program.
Effective March 1, 2024, new Premium Payment Program applicants who are enrolled in an individual health plan purchased through the Health Benefit Exchange must complete an eligibility telephone consultation. The eligibility phone consultation must occur within 30 calendar days of submitting a completed intake form.
Questions?
Email Melissa Bruce at the Washington State Health Care Authority or call (360)725-1572.
Washington Autism Alliance and Advocacy (WAAA) is also available to help. WAAA is a non-profit organization that support families who need to access medically necessary services through their private health insurance. If you need help with insurance call the WAAA helpline Monday-Friday from 9:00 am to 1:00 pm, at 1-425-894-7231 ext. 102 (Screening Intake). Generally, callers are first screened for income eligibility and type of legal or advocacy need. For answers to questions and requests for print copies of Insurance Navigation materials, visit the WAAA Insurance Portal or send an email.
