The Medicaid program in Washington, known as Apple Health, offers free or affordable health insurance to the state residents in need. Income thresholds can be determined in 2025, but using revised Federal Poverty Level (FPL) figures.
The maximum FPL of adults is 138 percent, with better limits on children and pregnant women.
Key Takeaways
- Apple Health is available until 138 percent FPL.
- Pregnant women and children are eligible at a higher income threshold.
- Washington provides a program of Medically Needy Spenddowns to individuals who are slightly above the poverty line.
- Applications are filled in using Washington Healthplanfinder.
Apple Health in Context
Since Medicaid expansion was enacted in Washington in 2014, there has been a significant growth of Apple Health.
There are over 2 million insured citizens, and it is currently one of the biggest public insurance programs in the state.
Washington serves adults without children, unlike other non-expansion states.
Apple Health is unique as it combines behavioral care and preventive care. Mental health and substance use services are included in the standard coverage of enrollees, and this demonstrates the attempt by Washington to treat the overall wellness, not only the physical illness.
Apple Health for Kids provides excellent coverage to children who are specifically covered by the program, which provides overall benefits to them with increased income thresholds.
The other special provision is the Medically Needy Spenddown program, which enables individuals earning excessive amounts to be able to qualify for Medicaid by balancing their income against medical expenses.
As an example, a senior or someone with chronic health problems can use their large medical bills to spend down income and become temporarily eligible. This flexibility assists in ensuring areas that would have been uncovered.
Today, the amount of income earned by households has increased by a significant margin.
Income Limits by Household Size (2025)
| Household Size | 100% FPL (Annual) | 138% FPL (Adults) | 200%+ (Kids/Pregnancy) |
| 1 people | $15,650 | $21,597 | ~$31,300+ |
| 2 people | $21,150 | $29,187 | ~$42,300+ |
| 3 people | $26,650 | $36,777 | ~$53,300+ |
| 4 people | $32,150 | $44,367 | ~$64,300+ |
Source: HHS 2025 Poverty Guidelines
What this implies: One adult with an income of 21,600 or smaller will be eligible for Apple Health. A household having an income of 44,000 or less would be qualified. Children and pregnant women receive more income levels (up to some point, above 200% of FPL) so that they are not left uninsured.
Who is eligible for Apple Health?
- Adults 19-64: Expanding Medicaid to cover 138 percent FPL.
- Children (Apple Health for Kids): Qualify at better income levels, most commonly 200 percent FPL or higher.
- Pregnant Women: This is covered on higher income levels, and 12 months postpartum cover is provided.
- Seniors and People with Disabilities: Income and resource tests are used, but the Medically Needy spenddown is an option.
Application: How to apply to Apple Health in 2025.
- Go to Washington Healthplanfinder.
- Assess with a screening tool to find out whether you are qualified.
- Provide the necessary papers, such as:
- Documents of income (pay stubs or tax return)
- Document of residence (Washington ID or lease, or utility bill)
- Household social security numbers.
- Documents of immigration were necessary.
- Either select a managed care plan, or it will be assigned automatically.
- Re-enroll every year.
Alternatives in case You Do Not Qualify.
- CHIP/Apple Health to Kids: Provides insurance to children who have surpassed the standard Medicaid requirements.
- Marketplace Plans: Under the Healthplanfinder, you can get subsidies provided you earn too much to be listed on the Apple Health.
- Community Health Centers: Community health centers offer care at subsidized prices depending on income.
- Medically Needy Program: Allows you to temporarily qualify in case your medical costs cause your countable income to decrease.
FAQs
Q1: What will be the income cap among the adults in the year 2025 in Washington?
Adults are eligible up to 138 percent FPL, which is around $21,600 a year in the case of a single individual.
Q2: Are children eligible even where their parents are not?
Yes. Apple Health for Kids tends to cover much higher income levels in children.
Q3: What is the SpendDown program?
It enables individuals whose earnings are too high to qualify for Medicaid to calculate the expenses on medical care minus their income.
Q4: What is the duration of postpartum in Washington?
There is a 12-month newborn cover for pregnant women.
Q5: Does Apple Health cover behavioral health?
Yes. Washington has mental health and substance use treatment as part of the regular benefits.
Q6: What do I do to apply to Apple Health?
Complete the process via the Washington Healthplanfinder and upload the required documents.
Conclusion
Apple Health in Washington has a wide area of coverage of adults, children, pregnant women, seniors, and disabled residents. The adults are assisted up to 138 percent of the FPL, and children and pregnant mothers are assisted at a greater threshold. Even individuals beyond the limits are occasionally eligible for such programs as the Medically Needy program.
You can begin the application using the Washington Healthplanfinder in case you think you are eligible. Otherwise, affordable alternatives exist in the form of CHIP, marketplace subsidies, and community health centers.
