If you live in Washington, 2026 is one of those “quietly important” years for health coverage. Some changes hit on January 1, 2026 (mostly Medicare costs and drug rules). Others are Washington Medicaid (Apple Health) changes that start later in 2026—and 2026 is the year people should prepare for them, because the biggest Apple Health shifts arrive in 2027 and beyond.
This guide focuses on what’s expected in 2026 for Washington residents, plus the near-term runway into 2027 so you’re not blindsided.
Medicare is primarily for people 65+ and some younger people with qualifying disabilities. It’s the same nationwide, but how you experience it in Washington depends on the plans available in your county, local provider networks, and Washington-regulated Medigap options.
Medicaid is a state-federal program. In Washington it’s called Apple Health, run through the Washington Health Care Authority (HCA). Apple Health rules can change because of federal law and state implementation choices.
These are the “baseline” Original Medicare costs many people feel immediately.
For 2026, the Part A inpatient hospital deductible is $1,736 (up from $1,676 in 2025). Daily coinsurance amounts also increase (for longer hospital and skilled nursing stays).
For 2026:
Why this matters in Washington: even if you’re on a Medicare Advantage plan, you generally still pay Part B unless you qualify for assistance (like a Medicare Savings Program). Higher Part B costs can also change the math of “Original Medicare + Medigap” versus Medicare Advantage.
One of the biggest Medicare improvements is the prescription drug out-of-pocket cap—but in 2026 that cap is slightly higher than 2025.
If you have Part D coverage (standalone Part D or Medicare Advantage with drug coverage), your yearly out-of-pocket cost for covered Part D drugs is capped at $2,100 in 2026. After you hit it, you generally pay $0 for covered Part D drugs for the rest of the year.
The Medicare Prescription Payment Plan (often described as “smoothing”) lets you spread out-of-pocket drug costs across the year rather than getting hit all at once at the pharmacy counter. CMS used the Contract Year 2026 rule to codify and standardize requirements moving forward.
Practical takeaway: If you take a high-cost medication early in the year, the payment plan can help with cash flow. It doesn’t necessarily lower what you owe overall—but it can make budgeting possible.
CMS finalized Contract Year 2026 policy and technical changes for Medicare Advantage (MA) and Part D. Many of these are “plumbing” rules, but they can show up as real-world differences in: plan communications, special needs plan administration, and how drug benefits are handled.
In plain English, here’s what tends to matter most at the consumer level in 2026:
Plans can change their provider networks and covered drugs year to year. The headline rule changes may be federal, but the pain (or savings) is local: whether your clinic in Spokane or specialist in Seattle is still in-network, whether your pharmacy is preferred, and whether your drug moved tiers.
If you’re “dual eligible” (you have Medicare and Apple Health/Medicaid), 2026 continues a multi-year push toward better integration and clearer rules for D-SNPs (Dual Eligible Special Needs Plans).
Washington is a bit different from many states because it has distinct consumer protections and an active SHIBA program (the state’s Medicare counseling network). One concrete 2026 resource: Washington’s Office of the Insurance Commissioner (OIC) publishes a 2026 approved Medigap plan list with premiums and notes.
You can only buy Medigap Plan C or Plan F if you were eligible for Medicare before January 1, 2020.
The OIC notes companies can change rates at various times, and their chart is updated quarterly—so the “approved” list is a starting point, not your final price.
Practical takeaway: If you’re comparing “Original Medicare + Medigap” to Medicare Advantage for 2026, don’t rely on last year’s premium. Use current, Washington-approved filings and verify with the carrier.
Washington HCA is explicitly warning Apple Health clients about federal changes known as H.R. 1, also called the “One Big Beautiful Bill Act (OBBA)”, and publishing an “expected changes” timeline.
According to Washington HCA’s timeline, changes to eligibility for refugee, asylee, and other noncitizen adults are expected to start October 1, 2026.
That’s the clearest “2026” Apple Health date on the state’s consumer-facing timeline—and it matters because it can affect:
If this might affect you or a family member: treat 2026 as a documentation-and-deadlines year. Make sure your contact info in your Apple Health account is current and watch for HCA mail/email notices.
Even though these aren’t “effective January 2026,” they are absolutely 2026 planning issues because people will need time to comply.
Washington HCA’s expected timeline includes:
To remain eligible, Apple Health for Adults enrollees are expected to be required to work, train, or do community engagement 80 hours per month (with some exceptions) starting January 1, 2027.
Apple Health for Adults enrollees are expected to need to renew every six months instead of annually starting January 1, 2027.
Retroactive coverage is expected to be shortened:
For Apple Health for Adults, cost-sharing is expected up to $35 for many services, with carve-outs (HCA notes it does not include primary care, behavioral health, emergency services, and certain rural settings). Start date shown is October 1, 2028.
Why include 2027–2028 in a 2026 article? Because the first time many people hear about these shifts is when they lose coverage for paperwork reasons. 2026 is when you can set yourself up to avoid that.
Separate from eligibility rules, Apple Health managed care plans can update formularies and criteria. For example, Washington-based Community Health Plan of Washington (CHPW) posts 2026 Apple Health Preferred Drug List changes effective 01/01/26.
Practical takeaway: If a medication is critical for you, re-check coverage every year—even if your eligibility doesn’t change.
Use the updated Part B premium and deductible (and Part A deductible if you anticipate inpatient care).
Start with the Washington OIC’s 2026 Medigap approvals and verify current premiums with the company.
HCA is clear that notices will come by mail/email depending on your preferences, and you should keep your contact information current.
If you’re potentially in an affected immigration category (or helping someone who is), assume there will be paperwork. Start early so you can respond fast when state notices arrive.
Even with exceptions, the people most likely to lose coverage are often those who qualify but miss a deadline. Build a simple system now:
