Medicare in Washington State: Plans and Coverage (2026)

Medicare in Washington comes with two things many beneficiaries don't know about. Washington gives existing Medigap holders the right to switch plans year-round with no written health screening questionnaire, and its free SHIBA counseling program, part of the Office of the Insurance Commissioner, was the very first such program in the nation. This guide covers Medicare in Washington for 2026: what each part costs, the plan choices available here, and how to get help paying.1,2

In This Guide

• Key Takeaways
• Original Medicare: Parts A and B
• Medicare Advantage in Washington State (Part C)
• Medicare Part D: Prescription Drugs
• Medigap in Washington
• Help Paying for Medicare in Washington State
• Medicare Enrollment Periods
• Free Medicare Help: Washington SHIBA
• Frequently Asked Questions

About these numbers: The premiums and deductibles below come from CMS for calendar year 2026, effective January 1. Medicare costs change every year, so for a later year check the figures published at medicare.gov.3 To talk to someone, call 1-800-MEDICARE (1-800-633-4227), staffed 24 hours a day, 7 days a week; TTY users call 1-877-486-2048.7 Washington SHIBA gives free, unbiased help with Medicare at 1-800-562-6900, Monday through Friday, 8:30 a.m. to 4:30 p.m.6

Original Medicare: Parts A and B

Original Medicare is run directly by the federal government and comes in two parts. The costs and coverage rules are the same in Washington as in every other state.

Part A (Hospital Insurance)

Part A covers inpatient hospital stays, limited skilled nursing facility care, hospice, and some home health care.3

The hospital deductible is per benefit period, not per calendar year. A benefit period starts the day you're admitted and ends once you have gone 60 days in a row without inpatient hospital care or skilled care in a SNF. Get readmitted after the gap closes and the $1,736 deductible applies again.3

Part B (Medical Insurance)

Part B covers doctor visits, outpatient care, preventive services, durable medical equipment, and mental health care. Original Medicare does not cover routine dental, vision, or hearing.3,8

• Monthly premium: $202.90 (higher if your 2024 income was above $109,000 single or $218,000 married, under the income-related adjustment)3
• Annual deductible: $2833
• After the deductible: you pay 20% of the Medicare-approved amount for most services3

Part B is technically optional, but nearly everyone takes it. Delay past your enrollment window without qualifying for a Special Enrollment Period or a Medicare Savings Program and you'll owe a late penalty of 10% for every 12 months you could have had Part B, carried for as long as you keep it.9

Medicare Advantage in Washington State (Part C)

Medicare Advantage plans are sold by private insurers as an alternative to Original Medicare. They cover everything Parts A and B do, except hospice, which Original Medicare continues to cover. Most plans bundle in Part D drug coverage along with extras like dental, vision, and hearing.8

Washington residents in the Seattle-Tacoma metro and the Puget Sound corridor generally see the widest choice of plans. Rural parts of eastern Washington and the Olympic Peninsula tend to have fewer options. Plan availability, networks, and prices vary by county and change every year, so compare what's actually offered at your address before you decide.

How These Plans Work

• You keep paying your Part B premium ($202.90) on top of any plan premium. The CMS estimate for the average Medicare Advantage premium in 2026 is about $14 a month, and many plans charge $0 extra. CMS also notes that some plans may help pay all or part of your Part B premium itself.3,8
• Plans run on networks (HMO or PPO). Confirm your doctors and hospitals are in-network before enrolling. Emergency care, out-of-area urgent care, and temporary out-of-area dialysis are covered whether you get them in or out of the plan's network.8
• Plans usually require prior authorization for certain services, which Original Medicare generally does not.8
• Every plan caps your annual in-network out-of-pocket spending (federally limited to $9,250 in 2026; many plans set it lower). Original Medicare has no such cap of its own, and CMS names supplemental coverage as what bounds that spending: Medigap, Medicaid, employer, retiree, or union coverage.8

Use the Medicare Plan Finder at medicare.gov to compare plans by ZIP code. Washington SHIBA volunteers can help you compare health care plans and prescription drug plans.6

Medicare Part D: Prescription Drugs

Part D covers outpatient prescription drugs. You can get it as a standalone plan alongside Original Medicare, or built into a Medicare Advantage plan.

The Inflation Reduction Act eliminated the old coverage gap (the donut hole), so that higher-cost middle stage is gone.4 Part D now moves through three phases:

1. Deductible: you pay full price until you meet your plan's deductible (up to $615 in 2026).10
2. Initial coverage: you pay copays or coinsurance while your plan and drug makers cover the rest.
3. Catastrophic: once your out-of-pocket spending reaches $2,100, you pay $0 for covered drugs the rest of the year.4

That $2,100 cap is the number that matters most. It was $2,000 in 2025 and adjusts each year with drug-spending growth. The average standalone Part D premium for 2026 is about $34.50 a month, though actual plan premiums vary widely.3 Every plan also has to offer the Medicare Prescription Payment Plan, which lets you spread your out-of-pocket drug costs into capped monthly payments across the year instead of paying the full amount at the pharmacy.4 People who qualify for Extra Help often pay much less, sometimes nothing.

Medigap in Washington

Medigap policies are sold by private insurers to fill the gaps in Original Medicare: the deductibles, coinsurance, and copays. They work with Original Medicare, and a Medigap policy can't pay a Medicare Advantage plan's copays, coinsurance, deductibles, or premiums.8

Washington offers the federally standardized plans, labeled A-D, F, G, and K-N, and the Washington State Office of the Insurance Commissioner (WA OIC) publishes the state's guidance on switching between them.2 Plans C and F are closed to anyone who became Medicare-eligible on or after January 1, 2020.11 Plan G is the closest available substitute for Plan F: it covers the Part A deductible, Part A and Part B coinsurance, and skilled nursing coinsurance, leaving only the $283 Part B deductible on you.12,3

Your strongest opening is the federal Medigap Open Enrollment Period, the six months that begin when you're 65 and enrolled in Part B. During that window an insurer must sell you any plan at the standard rate with no health screening.12

Washington's Year-Round Same-Group Switching Right

Washington goes beyond the federal window. Where a birthday-rule state like California or Illinois opens a set window once a year, Washington's switching right is not tied to a date at all.2

Under Washington's rules, you can apply to switch Medigap plans at any time of year. More importantly, if you stay within the same plan group, the switch carries no medical underwriting:

• A holder of any Plan B through N can switch to any other Plan B through N plan, year-round, without a health screening.
• A holder of Plan A can switch to another Plan A, year-round, without a health screening.

Three caveats. This right is for people already in a Medigap plan. The OIC says that if you are switching from some other type of health insurance to a Medigap plan, rules can vary and an insurer may require you to pass a written health screening questionnaire.2 Whether the right also covers moving up from the A group into the B-through-N group is not clearly settled by the OIC's guidance or by RCW 48.66.045, so ask the OIC or a free SHIBA counselor about that specific move rather than assuming either way. And if you became eligible for Medicare on or after January 1, 2020, the statute's guaranteed-issue list for replacement policies covers plans B, D, G, G with high deductible, K, L, M and N, and does not include Plan C or Plan F. For the many Medigap holders who simply want to change carriers or find a lower premium within their current tier, though, Washington's rule means you are not locked in.

This matters in practice. Federal law offers no guaranteed switching right outside the initial enrollment window.12 Washington's rule lets you shop premiums each year without risking rejection.

Medigap or Medicare Advantage?

While you're in a Medicare Advantage plan it's illegal for anyone to sell you a Medigap policy unless you're switching back to Original Medicare. Choose Medigap and you stay on Original Medicare with the freedom to see any provider who takes Medicare nationwide, at a higher monthly premium. Choose Medicare Advantage and you trade some of that freedom for a network and a lower upfront cost. For a side-by-side look, see our guide to Original Medicare vs. Medicare Advantage.8

Help Paying for Medicare in Washington State

If you're on a fixed income, two programs can cut your Medicare costs sharply.

Medicare Savings Programs (via Apple Health)

Washington administers the Medicare Savings Programs through the Washington State Health Care Authority (Apple Health). Two features make Washington more generous than the federal baseline: it applies no resource (asset) test to these programs, and it uses broader income tiers, with the Qualified Medicare Beneficiary (QMB) program reaching 110% of the Federal Poverty Level, the Specified Low-Income Medicare Beneficiary (SLMB) program 110 to 120%, and the Qualifying Individual (QI-1) program 120 to 138%.5

QMB is the most generous tier. It covers your Part B premium plus your deductibles and coinsurance, and federal law bars providers from billing a QMB enrollee for that cost-sharing.13 Because Washington runs no asset test, only your monthly income counts toward eligibility. Those income limits took effect April 1, 2026, tie to the Federal Poverty Level, and update each year.5 They are not a hard cutoff to screen yourself against, so apply if you are anywhere close. QI-1 also has to be reapplied for every year; being approved one year does not carry you into the next.13

Apply online through Washington Connection (washingtonconnection.org) or get help from your local SHIBA office.6 Enrolling in QMB, SLMB, or QI-1 automatically qualifies you for Extra Help with Part D; QDWI, the fourth savings program, does not.13

Extra Help for Part D

Extra Help, also called the Low-Income Subsidy, pays Part D premiums, deductibles, and copays for people with limited income and resources.14 Since 2024 the partial-subsidy tier is gone, so everyone who qualifies now gets the full subsidy.

• Income limit (2026): up to about $1,995 a month for an individual, $2,705 for a couple, the figures for the 48 contiguous states and DC (Alaska and Hawaii are higher)14
• Resource limits: $16,590 for an individual, $33,100 for a married couple, or $18,090 and $36,100 if you tell SSA you expect to use some of your resources for burial expenses14
• Qualifying for QMB, SLMB, or QI-1 automatically enrolls you in Extra Help13

Apply through the Social Security Administration (SSA) at ssa.gov or call 1-800-772-1213.14

Medicare Enrollment Periods

Miss a deadline and you can face coverage gaps or permanent late penalties. These dates are federal and the same in Washington as everywhere else.15

Changes made during Annual Open Enrollment take effect January 1. If you're already collecting Social Security before 65, you're enrolled in Parts A and B automatically; if not, you sign up through Social Security.15 Note that Washington's year-round Medigap switching right, covered above, sits outside these federal windows and applies any time of year.

Free Medicare Help: Washington SHIBA

You don't have to figure this out alone. Washington's Statewide Health Insurance Benefits Advisors program, known as SHIBA, is one of the nation's State Health Insurance Assistance Programs (SHIPs), and it is part of the Office of the Insurance Commissioner.1 SHIBA volunteers provide free, unbiased and confidential help with Medicare.6 They are trained to give you the latest Medicare and health care coverage information.6

A SHIBA counselor can help you:

• Understand the different parts of Medicare6
• Compare health care plans and prescription drug plans6
• Get help applying for the Medicare Savings Programs and Extra Help6
• Understand the appeals process and your rights6

Call 1-800-562-6900, Monday through Friday, 8:30 a.m. to 4:30 p.m., and ask to be connected with your local SHIBA office to schedule an appointment.6

Key Washington Medicare Contacts

Learn More

Find personalized help with Medicare in Washington at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.