Written by a parent, not a doctor. Nothing here is medical advice.

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Washington program

Apple Health for Kids with premiums ($20 or $30 a child)

The same children’s coverage for families above the free line.

What it is

The same children’s coverage for families above the free line.

Apple Health for Kids with premiums is the same coverage for families above the free line, at $20 or $30 a child a month, never more than two children charged. One application checks the free tier first. This paid tier generally cannot sit alongside other insurance your child actually has; families eligible through a state-agency, college, school-district or charter-school plan (PEBB or SEBB) have exceptions.

Eligibility rules
  • Children under 19; the $20 band runs to 265% of poverty and the $30 band to 317%.
  • Other insurance is generally a bar, with exceptions for children eligible through state-employee (PEBB) or school-employee (SEBB) plans. Coverage cannot start before the month after other coverage ends.
  • An employer plan that was offered but not taken is not existing creditable coverage; ask Healthplanfinder how it treats your situation.
What you get
  • Hospital and doctor care, cancer treatment, prescriptions, dental and vision, for a small monthly premium.
Costs
  • The first premium is due the month after approval.
If you decide to apply
  1. If income rises above the free line, the same Healthplanfinder application moves your child to this tier; ask the financial counselor to confirm the start date and whether other insurance affects it.
If it becomes relevant
  • Do not cancel existing insurance to try to qualify.
Good to know

Do not drop work insurance to get into this tier without the financial counselor checking the treatment team against the Apple Health plan.

Other details
  • The premium tier and the free tier are one program with one application.

Federal background: CHIP.

Official sources
Ask your social worker

“If our income changes, what happens to our child’s coverage, and would the paid tier be open to us while we keep work insurance?”

Why I’m asking: We want to understand what changes if our income changes.

More background and detailed requirements

How this could help

This is the children’s coverage program for families who earn more than the free Apple Health limit. It includes hospital and doctor care, prescriptions, dental and vision services. The monthly premium is the main difference from free children’s coverage.

Apply through the same Washington Healthplanfinder application. You do not need to choose the income category yourself: the application first checks free coverage, then the premium program.

What to know before you apply

  • The effective income limits include Washington’s five-point allowance: the $20 tier goes to 265% of the federal poverty level and the $30 tier to 317%.
  • Children with other health insurance generally cannot enroll in this premium program. Special rules apply to children eligible for state or school employee coverage (PEBB or SEBB).
  • Do not cancel existing insurance to try to qualify. First confirm eligibility, the new start date and your oncology team’s participation.
  • The first premium is due in the month after approval; you can use approved coverage before the premium bill arrives.

Your next steps

  1. Apply on Washington Healthplanfinder and report any existing insurance and its end date.
  2. Ask which monthly premium applies and whether all current treating providers accept the assigned or chosen plan.

age 18 or younger

above 210% and up to 312% of the federal poverty level before the five-point reduction (WAC 182-505-0100)

creditable coverage is a bar, with exceptions where the child is eligible through public-employee (PEBB) or school-employee (SEBB) coverage

Additional program information and published rules

Who does what

The three parts, side by side. The agency decides; nobody on this page does.

You

Apply once and answer honestly about other insurance; the state sorts the tier.

Your social worker

The hospital financial counselor can check which tier the income lands in before you apply.

The care team

Nothing is needed from the doctor.

Who decides
The Health Care Authority through Washington Healthplanfinder, on the same application as the free tier.
Ask your social worker
“If we earn too much for free Apple Health, could my child qualify for the low-cost option?”

How to apply

First step: Apply on Washington Healthplanfinder and report any existing insurance and its end date.

  1. Apply on Healthplanfinder once; the state works out which tier your child lands in.
  2. Say whether your child is enrolled in other insurance, and when it ends if it is ending.
  3. Expect the first premium the month after the decision.

Official application / program page ↗

Where it starts: The same Healthplanfinder application. The state screens for the free tier first and moves the child into the premium tier if income is above it.

What to gather

  • This month's household income
  • Insurance cards and the end date of any coverage that is stopping

How long: The same Apple Health timetable. The first premium is due the month after the decision.

What a yes looks like

A notice naming the premium and the coverage start date, and a choice of Apple Health plan.

What a no looks like, and the next move

If the no is about other insurance, ask which coverage they counted and whether an exception applies to a state or school employee's plan.

Watch out

  • Being enrolled in other insurance is a bar here, even though it is not on the free tier.
  • Coverage cannot start before the month after the other insurance ends.
  • Only two children are charged, so a third and fourth child cost nothing extra.

Dates that change this

2026-09-10: No buy-in or full-price tier above 317% of poverty was found. If you are told one exists, it is newer than this page.

The numbers and the rules

The arcane layer, kept on purpose. Checked September 11, 2026.

What it is worth

The same full children's coverage for $20 a child a month above 215% and up to 265% of poverty, or $30 above 265% and up to 317%, with no more than two children charged.

  • $20/month — Monthly premium a child, income above 210 and up to 260 percent of poverty
  • $30/month — Monthly premium a child, income above 260 and up to 312 percent of poverty
  • $2/month — Most children charged a premium in one household

Covers: The same coverage as the free tier: hospital, chemotherapy, medicines, nursing at home and rides

Legal protection: Twelve months of continuous coverage, or to the end of the sixth-birthday month for a child under six · No premium is charged for the month of the decision or any earlier month

What it costs the family: $20 or $30 a child a month, capped at two children. The first premium is due the month after approval.

The eligibility facts, as published

Age
age 18 or younger
Age max exclusive
19
Income
above 210% and up to 312% of the federal poverty level before the five-point reduction (WAC 182-505-0100)
Insurance status condition
creditable coverage is a bar, with exceptions where the child is eligible through public-employee (PEBB) or school-employee (SEBB) coverage
Residency
Washington
Continuous eligibility
twelve months, and through the sixth-birthday month for a child under six
Retroactive months
unknown: no rule on backdating the premium tier was found
Processing standard
same Apple Health standard as the free tier

Decisions this site cannot make: Health Care Authority MAGI determination

Expect friction on: Proving when other insurance ends

The trap: The premium tier generally requires that the child not have other creditable insurance, with PEBB and SEBB exceptions. Do not cancel an existing plan before confirming eligibility and the new coverage start date.

Where I read this

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