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 reimburses the cost of private health insurance premiums for certain individuals who would cost more for the state to cover under Apple Health.
This program is for individuals who:
- receive Apple Health (Medicaid); AND
- have private medical insurance available (e.g., through the individual’s employer or parent’s insurance) that is not purchased from Champus or Tricare, or with a subsidy through the Washington Health Benefit Exchange.
Benefits May Include:
- Reimbursement for premiums, co-pays, and any related expenses incurred through private insurance.
- Access to a private insurer’s provider network of specialists not covered
under Apple Health (e.g., naturopathic doctors) - A much larger provider network for services Apple Health does covers, like Applied Behavior Analyst (ABA), speech therapy, occupational therapy, neurology, psychology, and much more.
- Premium reimbursement for non-Apple Health family members, if determined cost-effective.
- Continued Apple Health eligibility.
How The Program Works
Private insurance is the primary payor and Apple Health is secondary, covering copays and coinsurance costs. Apple Health clients participating in the program will be reimbursed according to each family’s actual costs. A reimbursement check will be issued when the Health Care Authority (HCA) receives proof of private premium payment (typically, on a monthly basis).
How do I apply for premium payment assistance?
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:
Premium Payment Program
Health Care Authority
PO Box 45518
Olympia, WA 98504-5518
Fax: 877-893-3810 (toll free)
It can take up to 30 days to process your application after we receive all the necessary paperwork.
Questions? Contact Melissa Bruce: melissa.bruce@hca.wa.gov or (360)725-1572.
What if my insurance is denying or has an unreasonably low limit on benefits?
WAAA offers robust insurance navigation resources, including an online insurance portal and legal support to appeal denials and unreasonable caps on medically necessary services.