Medicaid Eligibility in Washington: Income Limits & How to Apply
Medicaid Eligibility in Washington
Washington has expanded Medicaid under the Affordable Care Act. This means adults aged 19-64 with household income at or below 138% of the federal poverty level (FPL) qualify for Apple Health. This is approximately $21,597 per year for an individual or $44,367 per year for a family of four in 2026.
Key threshold: If your income is below $21,597 (individual) or $44,367 (family of 4), you likely qualify for Apple Health with free or very low-cost coverage. No premiums, no deductibles.
Under Washington's expanded program, coverage extends to:
- Adults aged 19-64 with income up to 138% FPL
- Children in families with income up to 200-300% FPL (varies by age)
- Pregnant women with income up to 185-200% FPL
- Seniors and people with disabilities who meet income and asset requirements
About Apple Health
In Washington, Apple Health is the name for your state's Medicaid program, offering free or low-cost health insurance. You may qualify for Apple Health if you are an adult with an income up to 138% of the Federal Poverty Level (FPL). For 2025, this translates to about $21,597 for a single person or $44,367 for a family of four. Eligibility extends to children, pregnant individuals, parents or caretakers, seniors, and individuals with disabilities. As of October 2025, over 1.7 million Washingtonians were covered by Medicaid/CHIP, demonstrating it's a widely utilized program.
If your income is near the Apple Health cutoff, you might transition to coverage through Washington Healthplanfinder, the state's insurance marketplace. For those who no longer qualify for Apple Health, losing coverage is considered a "Qualifying Life Event," allowing you to enroll in a marketplace plan outside of the usual open enrollment period. Many people losing Apple Health can find high-quality Cascade Care plans for under $10 a month with subsidies. The benchmark Silver plan in Washington costs around $519 per month, and subsidies can significantly reduce what you actually pay. It's crucial to sign up within 60 days of losing Apple Health to avoid a gap in coverage. If your income changes, you can always reapply for Apple Health.
Apple Health provides comprehensive benefits, including preventative care like cancer screenings, treatment for chronic conditions such as diabetes and high blood pressure, emergency visits, maternity services, pediatric care, dental services, vision care, and prescription medications. Generally, there is no cost-sharing for many Apple Health services. Washington also offers unique programs and waivers. For instance, the New Freedom Waiver assists elderly and disabled residents in specific counties with in-home services to promote independence. There are also waivers for individuals with intellectual or developmental disabilities, including the Basic Plus and Individual and Family Services waivers, which are based on the child's income only, without regard to parent income.
One common "gotcha" during the recent Medicaid unwinding period, which resumed in April 2023 after the COVID-19 Public Health Emergency, was the importance of updating your contact information with the Health Care Authority. If your contact details aren't current, you might miss crucial notices about your renewal and risk losing coverage. While asset tests generally do not apply for most Apple Health programs for adults under 65, they can apply for specific long-term care programs. If you are denied Apple Health, you can still apply for marketplace plans with potential subsidies. As a concrete action step, make sure your contact information is always up-to-date with Washington Healthplanfinder to ensure you receive all important communications about your coverage.
Washington Medicaid Income Limits 2026
The following table shows the key income thresholds for Washington in 2026:
| Household Size | 100% FPL | 138% FPL (Medicaid Limit) | 400% FPL (Subsidy Limit) |
|---|---|---|---|
| 1 | $15,650 | $21,597 | $62,600 |
| 2 | $21,150 | $29,187 | $84,600 |
| 3 | $26,650 | $36,777 | $106,600 |
| 4 | $32,150 | $44,367 | $128,600 |
| 5 | $37,650 | $51,957 | $150,600 |
| 6 | $43,150 | $59,547 | $172,600 |
If your household income falls below the 138% FPL column, you qualify for Apple Health. If your income is between 138% and 400% FPL, you qualify for ACA marketplace subsidies to help pay for private insurance.
At $519/month, Washington's benchmark Silver plan premium is comparable to the national average of ~$525. Subsidies make marketplace coverage accessible for most income levels between Medicaid and 400% FPL.
Marketplace Insurance in Washington
Washington residents who do not qualify for Medicaid can purchase private health insurance through Washington Healthplanfinder. The average benchmark (second-lowest cost Silver) plan in Washington costs approximately $519/month for a 40-year-old in 2026.
Premium tax credits (subsidies) are available for households with income between 100% and 400% FPL. Here is what a 40-year-old individual in Washington might pay after subsidies:
| Income Level | Annual Income | Expected Contribution | Estimated Monthly Premium |
|---|---|---|---|
| 150% FPL | $23,475 | 4.01% of income | ~$78/mo |
| 200% FPL | $31,300 | 6.52% of income | ~$170/mo |
| 250% FPL | $39,125 | 8.33% of income | ~$272/mo |
| 300% FPL | $46,950 | 9.83% of income | ~$385/mo |
| 400% FPL | $62,600 | 9.83% of income | ~$513/mo |
These are estimates for an individual. Actual premiums depend on your age, household size, tobacco use, and the specific plan you choose. Households with income between 100-250% FPL also qualify for cost-sharing reductions (CSR) on Silver plans, which lower deductibles and copays.
Washington operates its own state-based marketplace, Washington Healthplanfinder, which manages enrollment and plan selection independently from HealthCare.gov. This can mean different plan options and deadlines than the federal marketplace.
Washington's Medicaid program goes beyond the ACA's minimum requirements. Apple Health includes comprehensive benefits, and the state's investment in its own marketplace reflects a broader commitment to accessible healthcare coverage.
How to Apply for Apple Health
- Start online at Washington Healthplanfinder — the application automatically screens for Apple Health eligibility based on your household income.
- Go through the state directly — Washington's Medicaid office accepts applications year-round with no enrollment window.
- Get phone support — Washington's Medicaid hotline can walk you through the process and verify eligibility.
- In-person options — Local social services offices and community health navigators can assist with your application.
Gather your documents before applying: proof of income (W-2s, pay stubs, or tax returns), proof of Washington residency, Social Security numbers for all household members, and any current insurance information.
Calculate Your Subsidy in Washington
Enter your income, age, and household size to see if you qualify for Medicaid or marketplace subsidies in Washington.
Check Your Eligibility →Frequently Asked Questions
What is the income limit for Medicaid in Washington?
In 2026, the Medicaid income limit in Washington is 138% of the federal poverty level: $21,597 per year for an individual, $29,187 for a household of 2, $36,777 for 3, and $44,367 for a family of 4.
Has Washington expanded Medicaid under the ACA?
Yes, Washington has expanded Medicaid under the ACA. Adults aged 19-64 earning up to 138% of the federal poverty level qualify for Apple Health.
Am I eligible for health insurance subsidies in Washington?
Yes. Washington residents with household income between 100% and 400% FPL ($15,650 to $62,600 for an individual in 2026) qualify for premium tax credits that reduce the cost of marketplace health insurance. Apply through Washington Healthplanfinder.
What is the name of Washington's Medicaid program?
Washington's Medicaid program is known as Apple Health. It provides health coverage for eligible low-income residents including children, pregnant women, seniors, and adults up to 138% FPL.
What should I do if my Apple Health coverage is ending?
If your Apple Health coverage ends due to income changes or redetermination, you qualify for a Special Enrollment Period on the marketplace. This gives you 60 days to sign up for a private plan through Washington Healthplanfinder. If your income is between 100-400% FPL, you'll likely qualify for subsidies to help cover the cost.
Am I eligible for Apple Health if I'm employed?
Yes. Medicaid eligibility in Washington is based on your Modified Adjusted Gross Income (MAGI), not your employment status. If your household income is at or below 138% FPL ($21,597 for an individual), you qualify for Apple Health even if you work full-time. Many Apple Health enrollees are working adults.
Apple Health vs. marketplace insurance — which is better?
Medicaid (Apple Health) is free or near-free with no premiums or deductibles. Marketplace plans in Washington average $519/month before subsidies. If you qualify for Medicaid, it's the more affordable option. If your income puts you just above the cutoff, subsidized Silver plans with cost-sharing reductions are the next best thing.
Medicaid Eligibility in Nearby States
- Idaho Medicaid Eligibility — Expansion state
- Oregon Medicaid Eligibility — Expansion state