Medicare in Washington: Plans and Coverage (2026)

Medicare in Washington comes with two state-specific advantages most beneficiaries don't know about. Washington gives Medigap holders the right to switch plans year-round with no health screening, and its free SHIBA counseling program sits inside the insurance regulator rather than an aging agency. 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 (Part C)
• Medicare Part D: Prescription Drugs
• Medigap in Washington
• Help Paying for Medicare in Washington
• 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. For the most current figures, contact Medicare at 1-800-633-4227 (1-800-MEDICARE) or Washington SHIBA at 1-800-562-6900.

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 60 days after you leave. 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. It does not cover routine dental, vision, or hearing.3

• 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 other creditable coverage 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.6

Medicare Advantage in Washington (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.7

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.3,7
• Plans run on networks (HMO or PPO). Confirm your doctors and hospitals are in-network before enrolling.
• Plans usually require prior authorization for certain services, which Original Medicare generally does not.7
• 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.7

Use the Medicare Plan Finder at medicare.gov to compare plans by ZIP code. A Washington SHIBA counselor will go through the results with you for free and can help you sort out which plans cover your doctors and prescriptions.

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).8
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 $40 to $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 only with Original Medicare, not with Medicare Advantage.

Washington offers the federally standardized plans, labeled A through N, and they're regulated by the Washington State Office of the Insurance Commissioner (WA OIC).2 Plans C and F are closed to anyone who became Medicare-eligible on or after January 1, 2020.9 Plan G is the most popular choice for people newly eligible: 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.9,3

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.9

Washington's Year-Round Same-Group Switching Right

Washington goes well beyond the federal window, and its rule is more generous than any birthday-rule state like California or Illinois.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.

The limitation: moving up from the A group into the B-through-N group, which means gaining benefits, can still require underwriting. But for the vast majority of Medigap holders who want to change carriers or find a lower premium within their current tier, Washington's rule means you're not locked in.

This matters in practice. Most states offer no guaranteed switching right outside the initial enrollment window. Washington's rule lets you shop premiums each year without risking rejection.

Medigap or Medicare Advantage?

You can't hold both. 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.

Help Paying for Medicare in Washington

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), with eligibility processed by the Department of Social and Health Services (DSHS). 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% (against a federal QI ceiling of 135%).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.10 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

Apply online through Washington Connection (washingtonconnection.org) or get help from your local SHIBA office. Enrolling in any of these programs automatically qualifies you for Extra Help with Part D.10

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.11 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 couple11
• Resource limits: $16,590 for an individual, $33,100 for a married couple11
• Qualifying for any MSP tier automatically enrolls you in Extra Help

Apply through the Social Security Administration (SSA) at ssa.gov or call 1-800-772-1213.11

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.12

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.12 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, and you don't need to pay a broker. Washington runs the Statewide Health Insurance Benefits Advisors program, known as SHIBA. It's Washington's version of the federal State Health Insurance Assistance Program (SHIP), but Washington places it inside the Office of the Insurance Commissioner rather than an aging agency, which is unusual among states. Counselors are trained volunteers who give free, unbiased help and do not sell insurance.1

A SHIBA counselor can help you:

• Understand what each part of Medicare covers and what it costs
• Compare Medicare Advantage, Part D, and Medigap plans side by side
• Apply for the Medicare Savings Programs and Extra Help
• Sort out billing questions, claim denials, and appeals

Call 1-800-562-6900, Monday through Friday, 8:30 a.m. to 4:30 p.m. The hotline connects you to your local SHIBA office.1

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.