Medicare and Apple Health: the Medicare Savings Programs and dual-eligible plans

Some Washingtonians qualify for both Medicare and Apple Health — often called being “dual eligible.” When that happens, Medicare pays first, and Apple Health may help with costs Medicare leaves behind, like premiums, deductibles and coinsurance, plus services Medicare does not cover at all, such as long-term care at home or in a nursing facility.

How Apple Health works for seniors

Apple Health is administered by the Washington State Health Care Authority (HCA). Washington expanded Medicaid for adults under 65, and it also runs a state-funded Apple Health Expansion program with capped enrollment for adults who do not qualify for the federally funded program because of immigration status. For adults 65 and over, and for people on Medicare because of a disability, eligibility follows the aged, blind and disabled rules (income and resources), and it is determined by DSHS — not by an insurance agency. You apply online through WashingtonConnection.org, by phone through Apple Health customer service at 1-800-562-3022, or at a DSHS Community Services office. Long-term services and supports — in-home care, assisted living, nursing-facility care — run through DSHS’s Aging and Long-Term Support Administration. Unlike some states, Washington does not enroll seniors in a separate Medicaid managed-care program: Medicare stays the primary payer, Apple Health pays second, and coordination happens on the Medicare side through a Dual Special Needs Plan if you choose one.

Programs that can lower your costs

• Medicare Savings Programs (MSPs) — QMB, SLMB and QI-1 — pay the Part B premium ($202.90 in 2026) and, for QMB, Medicare’s deductibles, copays and coinsurance as well. HCA’s income and resource standards for 2026 set QMB at 110% of the federal poverty level, SLMB at 120% and QI-1 at 138%, with income limits only; Washington does not apply a resource test to these programs. You apply through DSHS, and you do not have to be on full Apple Health to qualify.
• Extra Help (Low-Income Subsidy) lowers what you pay for Part D premiums, deductibles and copays. If you qualify for an MSP or Apple Health you get Extra Help automatically; otherwise apply through Social Security.
• Dual Special Needs Plans (D-SNPs) are Medicare Advantage plans designed for people with both Medicare and Apple Health; they coordinate the two programs, usually at $0 plan premium, and often add extras while keeping your Apple Health benefits intact. Availability varies by county and is deepest in the Puget Sound counties, Spokane, Yakima and Clark County.

Free, unbiased state counseling on all of this is available from Washington SHIBA — the Statewide Health Insurance Benefits Advisors, run by the Office of the Insurance Commissioner — at 800-562-6900. When you are ready to talk through the Medicare side, we are here at (702) 706-6564.

How we help

We help you understand whether a D-SNP is available and a good fit where you live, how a Medicare Savings Program and Extra Help could reduce your costs, and how to keep your Apple Health benefits working alongside Medicare. Eligibility decisions rest with DSHS, HCA and CMS; our job is to make the Medicare side clear.

ECOS Medicare Solutions is a private insurance agency and is not connected with or endorsed by Apple Health, the Washington State Health Care Authority, the Department of Social and Health Services, or the federal Medicare program.