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First-timers’ Guide to Washington Apple Health (Medicaid)
Part 1 of this guide gets you started. It answers some basic questions.
Part 2 gives advice about your rst visit to a medical provider.
Part 1: After you enroll in Apple Health
We will mail you a booklet, called Welcome to Washington Apple Health, with important information about your
coverage. You can also nd it on our website at www.hca.wa.gov/assets/free-or-low-cost/22-1298.pdf.
Your health plan will send you information, too.
This is your Services Card
About two weeks after you enroll in Washington
Apple Health, you will receive a Services Card (also
called a ProviderOne card) like the one pictured
here. Keep this card. Your Services Card shows your
client number, which you need to receive health
services. You do not need to activate your new
Services Card. It is activated before it’s mailed to you.
Each member of your household who is eligible for
Apple Health receives their own Services Card. Each
person has a dierent client number that stays with
them for life.
If you have had Apple Health coverage in the past (or
had Medicaid before it was known as Apple Health),
we won’t mail you a new card. Your old card is still
valid, even if you weren’t covered continuously. Your
client number remains the same.
You’ll see “ProviderOne” on your Services Card
ProviderOne is the computer system that coordinates
with the health plans. It also sends you letters
and handbooks. The number on the card is your
ProviderOne client number.
HCA 19-024 (12/16)
The Health Care Authority administers
Washington Apple Health (Medicaid)
First-timers’ Guide to Washington Apple Health (Medicaid) First-timers’ Guide to Washington Apple Health (Medicaid)
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Protecting your privacy
Your Services Card does not contain any personal
information except your name, your ProviderOne client
number, and the issue date. Your privacy is maintained
if the card is lost or stolen.
Neither Apple Health nor your health plan will contact
you directly to ask for your personal information to
get or replace a Services Card. Never give your personal
information, such as your Social Security number,
to someone who calls or emails you to ask for it. If
someone asks you for your Social Security number,
please ask for their name and contact information,
and report that to our Customer Service Center
at 1-800-562-3022.
If you don’t receive the card
If you don’t receive your Services Card by the end
of two weeks after completing your Apple Health
application, please visit the ProviderOne client portal
at https://www.waproviderone.org/client to get a free
replacement card.
Enrolling in your health plan
If you applied for Apple Health online through
www.wahealthplannder.org, you probably enrolled in
one of the health plans available in your area. If you did
not enroll in a health plan at that time, we’ll choose one
for you.
If another plan is available in your area, you can switch
at any time by visiting www.wahealthplannder.org.
The change in your health plan is eective on the rst
day of the following month.
(See “Can I change my health plan?” on page 4 for other
ways to change your plan.)
Renewing your coverage
Your enrollment in Apple Health usually lasts for one
year. We will send you a letter to remind you to renew
your Apple Health coverage, so it’s important that you
keep your mailing address updated. The letter may say
that you will be automatically renewed, and you won’t
have to do anything unless information in the letter is
not correct. If you do need to renew your Apple Health,
you can renew at www.wahealthplannder.org , by
mail, or over the phone. The letter will tell you all your
options in detail.
Here are the ve health plans and their contact informaon. Not all plans are available in all areas of the state.
Managed care health plan Main phone Nurse Helpline
Amerigroup Washington, Inc. (AMG)
www.myamerigroup.com/wa/pages/welcome.aspx 1-800-600-4441 1-800-600-4441
Community Health Plan of Washington (CHPW)
www.chpw.org 1-800-440-1561 1-866-418-1002
Coordinated Care Corporaon (CCC)
www.coordinatedcarehealth.com 1-877-644-4613 1-877-644-4613
Molina Healthcare of Washington (MHC)
www.molinahealthcare.com/members
/wa/en-us/Pages/home.aspx
1-800-869-7165 1-888-275-8750
Spanish 1-866-648-3537
UnitedHealthcare Community Plan (UHC)
www.uhccommunityplan.com 1-877-542-8997 1-877-543-3409
First-timers’ Guide to Washington Apple Health (Medicaid) First-timers’ Guide to Washington Apple Health (Medicaid)
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Your health plan card
Your health plan will send you an ID card like one of
those shown above. Keep this card. Take both your
Services Card and your health plan card with you when
you go to a doctor, pharmacy, or other health care
provider. You may also need a photo ID.
Questions you might have
How do I get my client number if I don’t have my
card yet?
If you need to see a doctor or ll a prescription before
your cards arrive, you have two ways to receive services:
• Visit the ProviderOne client portal at
https://www.waproviderone.org/client to get
your client number. Give that to the provider or
pharmacist.
• Tell a provider or pharmacist your name, date of
birth, and Social Security number. They can look you
up online and nd your client number.
What if I lose my Services Card?
There are several ways to request a replacement:
• Use the ProviderOne client portal at
https://www.waproviderone.org/client .
• Call our Customer Service Center at 1-800-562-3022.
• Request a change online at https://fortress.wa.gov/
hca/p1contactus/client_webform . Select the topic
“Services Card.”
There is no charge for a new card. It takes seven to 10
days to get the new card in the mail. Your old card will
stop working when you ask for a new one.
What if I lose my health plan card?
Call your health plan and request a new card. (See
contact information for health plans, page 2.)
How do I check to see if I’m signed up for Apple
Health coverage or enrolled in a health plan?
You can check to see if your coverage has started by
visiting the ProviderOne client portal at
https://www.wa.providerone.org/client or call our
Customer Service Center at 1-800-562-3022. You will
need to know your Services Card number or Social
Security number.
1. From the main menu, select your language and then
follow the telephone prompts. The answer to the
rst prompt is “Client services.”
2. The answer to the next one is “Check eligibility.”
3. Next, when prompted, say “Continue.”
4. On the next prompt, answer either “DSHS Services
Card” (this means your Services Card) or “Social
Security card,” depending on which number you
know. You can say the number or dial it.
5. The prompt will ask for your ZIP Code.
6. Next, the prompt will ask whether you want
information about yourself or another family
member.
7. Finally, when prompted, say whether you want to
check enrollment status for today or a dierent date.
The automated service tells you your enrollment
status (whether you’re signed up) and what health
plan you are enrolled in for that date.
First-timers’ Guide to Washington Apple Health (Medicaid) First-timers’ Guide to Washington Apple Health (Medicaid)
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Do I have to be enrolled in a health plan?
Yes, with few exceptions. For more details see the
Welcome to Washington Apple Health booklet at
www.hca.wa.gov/assets/free-or-low-cost/22-1298.pdf .
Can I see any provider I want?
No, you must see providers in your health plan’s
network, unless the health plan gives you written
permission to see a specialist, either within or outside
the health plan network.
If you want to use a specic doctor or health care
provider, ask the doctor or provider which health plan
he or she is in. If that doctor or provider is in a health
plan that’s available in your area, you can change health
plans. Some services are not covered by your health
plan, but are covered under Apple Health fee-for-
service, and you will need to see a provider who accepts
Apple Health fee-for-service. (See “What is fee-for-
service?” on page 5.)
What is a primary care provider?
Your primary care provider is the doctor, nurse
practitioner, other health care professional, or clinic you
see for most or all of your health care. Your primary care
provider must be in your health plan network.
How do I nd a primary care provider?
Your primary care provider must be in your health plan
network. Choose a primary care provider from your
current health plan’s network, or the plan will help you
choose one. Visit your health plan’s website to choose
a primary care provider. There’s more about choosing a
provider in Part 2 of this guide.
How do I make an appointment?
Your health care plan will send you information on how
to make an appointment. Or, call your health plan and
they can get you started. Also see Part 2 of this guide for
information about making your rst appointment.
Does everyone in my household need to have
the same health plan?
Yes. In general, everyone in your household has the
same health plan, unless they are American Indian
or Alaska Native. The Welcome to Washington Apple
Health booklet www.hca.wa.gov/assets/free-or-low-
cost/22-1298.pdf has more information.
What is the dierence in the plans?
All plans cover the same basic services, but they have
some dierences in the way they provide services.
The Welcome to Washington Apple Health booklet
www.hca.wa.gov/assets/free-or-low-cost/22-1298.pdf
lists the basic services.
Each health plan has its own network of providers.
Please verify with the health plan if the providers you
prefer are in the plan’s network.
Can I change my health plan?
Yes, at any time. The change will be eective on the
rst day of the next month. There are several ways to
switch your plan:
• Change it on the Washington Healthplannder
website. www.wahealthplannder.org
• Visit the ProviderOne Client Portal website.
https://www.waproviderone.org/client
• Request a change online at https://fortress.wa.gov/
hca/p1contactus/client_webform/ . Select the topic
“Enroll/Change Health Plans.”
• Call our Customer Service Center at 1-800-562-3022.
Which pharmacy or drug store do I use?
Your health plan will give you information about which
pharmacies and drug stores to use.
What if I need care after hours?
Your health plan has a toll-free number you can call to
speak to a nurse 24 hours a day, seven days a week. The
phone number is in the information your health plan
sends you and is listed on page 2.
What if I have an emergency?
If you have a sudden or severe health problem that you
think is an emergency, call 911 or go to the nearest
location where emergency providers can help you. As
soon as possible afterward, call your health plan and let
them know that you had an emergency and where you
received care.
If you need urgent care, but your life is not in danger,
call your primary care provider, your health plan, or the
24-hour nurse’s line. See page 2 for phone numbers.
(continued)
First-timers’ Guide to Washington Apple Health (Medicaid) First-timers’ Guide to Washington Apple Health (Medicaid)
4 5
Do I have to pay to see a provider or get
prescriptions lled?
No—as long as you follow the rules set by your
health plan.
You might have to pay if:
• You get a service that is not covered, such as
chiropractic care or cosmetic surgery.
• You get a service that is not medically necessary.
• You don’t know the name of your health plan, and
a service provider you see does not know who to
bill. This is why you must take your Services Card
and health plan card with you every time you need
services. (See information about these cards on
pages 1-3).
• You get care from a service provider who is not in
your health plan’s network, unless it’s an emergency
or has been pre-approved by your health plan.
• You don’t follow your health plan’s rules for getting
care from a specialist.
What is fee-for-service?
That’s what we call it when Apple Health pays doctors
and providers directly for each service they do. 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. (See the
next question, “What is managed care?”)
Certain benets available to you are called “fee-for-
service benets.” These are covered by the state, not
through your health plan, and are provided by other
community-based services and programs. See the
ProviderOne Find a Provider search tool at
https://fortress.wa.gov/hca/p1ndaprovider to nd a
fee-for-service provider.
Fee-for-service benets include dental care, alcohol and
substance use disorder services, long-term care, and
in-patient psychiatric care. Your primary care provider
or health plan will help you nd these benets and
coordinate your care.
For a list of some fee-for-service benets, see the
Welcome to Washington Apple Health booklet
www.hca.wa.gov/assets/free-or-low-cost/22-1298.pdf.
What is managed care?
Most Apple Health clients have “managed care,” which
means Apple Health pays a health plan a monthly fee
for your care. The health plan then pays the provider
that cared for you. Most Apple Health clients receive
managed care for most services, but some services are
paid through “fee-for-service.” (See previous question,
“What is fee-for-service?”)
How do I get dental care?
You get dental care from a provider who accepts Apple
Health fee-for-service. See the ProviderOne Find a
Provider search tool at https://fortress.wa.gov/hca/
p1ndaprovider to nd a fee-for-service provider.
What dental services and treatments are
covered?
See an overview of dental services for all adults age 21
and older who are covered by Apple Health at www.
hca.wa.gov/assets/free-or-low-cost/22-811.pdf .
How do I get eye exams and eye glasses?
Eye exams, including tests for refraction and visual
elds, are provided through your health plan.
• For children up to 20 years old — eyeglass frames,
lenses, contact lenses, and tting services are
covered by Apple Health fee-for-service.
• For adults — eyeglass frames, lenses, and contact
lenses are not covered by Apple Health, but if you
wish to buy them, you can order them through
participating providers at a discounted price. You’ll
nd a list of participating providers at
www.hca.wa.gov/assets/free-or-low-cost/optical_
providers_adult_medicaid.pdf .
What’s the dierence between Washington
Apple Health and Medicaid?
Washington Apple Health is the name for Medicaid in
Washington State. Your provider or the receptionist may
call it Medicaid. They mean the same thing.
What else do I need to know?
More information is included in the Welcome to
Washington Apple Health booklet at www.hca.wa.gov/
assets/free-or-low-cost/22-1298.pdf and in the
materials you receive from your health plan.
First-timers’ Guide to Washington Apple Health (Medicaid)
6
Important Webpages and URLs
Web Page URL
Find a Provider (fee-for-service only) https://fortress.wa.gov/hca/p1ndaprovider
ProviderOne client portal https://www.waproviderone.org/client
Washington Healthplannder www.wahealthplannder.org
Welcome to Apple Health booklet www.hca.wa.gov/assets/free-or-low-cost/22-1298.pdf
