Annual Physical Exam (EPSDT Exam)

Your health is important. When you don’t feel well, you don’t feel like going to school or making plans for the future. One of the ways that your health insurance can help make sure you are healthy is by making sure you have access to health care whenever you need it. But, did you know that it is also important for you to see a doctor at least once a year to make sure you are healthy? This type of doctor’s visit is called an “Annual Physical Exam” or “EPSDT” (Early and Periodic Screening, Diagnostic and Treatment).

The EPSDT program ends on your 21st birthday, however as an adult you are eligible for annual well person exams. If you are between the ages of 21 and 26, you should continue to see your doctor at least once a year for a wellness check-up. These wellness visits are still covered by your Medicaid benefits. These wellness visits, are covered at no cost to you through your Medicaid or private insurance benefits!

Coordinated Care’s Apple Health Core Connections members over the age of 18 can get money for staying healthy. Earn CentAccount dollar rewards on a prepaid card for going to your well-visits each year. Use this card to purchase healthy food, personal care, and household items.

EPSDT is a special Apple Health program for children and youth (ages 0-20). It makes sure everyone gets the right preventive, dental, behavioral health, developmental, and specialty services. An EPSDT exam is different from going to the doctor when you are sick. An annual physical/EPSDT exam looks at how you are growing and developing in comparison to other people your age.

The American Academy of Pediatrics recommends seeing the doctor for an EPSDT at least once per year between the ages of 3 and 20. Check with your doctor if you have a child under the age of 3 to determine how often they should have an EPSDT exam.

Your EPSDT benefit covers all medically necessary care, such as:

  • Well-child visits and annual young adult check-ups
  • Developmental evaluation
  • Behavioral evaluation
  • Immunizations (shots) and vaccines
  • Lab tests
  • Health and preventive education
  • Vision services
  • Dental services
  • Hearing services

If you are age 12 to 18, you may ask to have a private conversation with your medical provider at any time to discuss behavioral health and substance use. You may have a private conversation at any age to talk about sex.

Talk to your caregiver or another adult you trust to think about questions you want to ask during the EPSDT exam. The EPSDT is a great opportunity for you to begin taking control of your own health care needs. It is important that you learn ways to become your own best advocate in keeping yourself healthy!

Extra Benefits for Apple Health Core Connections (AHCC) Members

If you are 18-26 years of age, you can choose to stay in AHCC (no action is needed) or change your Apple Health coverage to “fee for service.” Contact the Foster Care Adoption Support team (FCAS) at 1-800-562-3022 or FCAS@HCA.WA.GOV to help you decide what type of coverage is best for you.

AHCC has extra programs available to you as an adult. These extra benefits include:

  • SafeLink: A free smart phone with 350 minutes per month and unlimited texting. Calling AHCC does not count against your minutes.
  • CentAccount: Earn dollar rewards on a pre-paid card for completing healthy activities like well-visits. The card can be used to buy groceries, personal care items, and more.
  • Care Management: AHCC care managers can help you understand and manage your chronic health conditions like diabetes and asthma. Nurses and social workers work with you and your doctors to help you get the care you need.
  • 24 hour Nurse Advice Line: Call anytime for medical and mental health support to get help deciding if you should go to an ER or urgent care.
  • For more information, go to the Coordinated Care AHCC website.

Dental Care

You should see a dentist every six months for cleaning and check-up. Your dental care is free under Medicaid, but is not a benefit that is paid through Coordinated Care/AHCC, but you can call them to get help finding a dentist in your community! Call AHCC at 1-844-354-9876 and ask for help finding a dentist. 

Not a Coordinated Care member? Call FCAS for help finding a dentist at 1-800-562-3022.

Medicaid Eligible dental care is also covered at no cost to you. Covered services include fluoride treatment, dental sealants, space maintainers, oral examination, X-rays, dental fillings, crowns, oral surgery procedures, extractions, root canal treatment, gum treatment, and dentures (false teeth).

When you turn 21, Apple Health Dental benefits become more limited but still include annual teeth cleaning exam, x-rays, fillings, extractions, and more.

What about braces?

Apple Health does not usually pay for orthodontia (braces).

However, when orthodontia is determined to be “medically necessary” and you are under 20 years of age, Apple Health will cover the services using your ProviderOne card. Coordinated Care members can call for help coordinating this service: 1-844-354-9876

Not a Coordinated Care member? Call FCAS for help at 1-800-562-3022.

Helpful Websites


Coordinated Care Apple Health Core Connections (AHCC)

AHCC – Yep, You’re Covered