If you live in Washington state (or will soon), and are approaching Medicare eligibility—or just want to understand what your options will look like in 2026—this article is for you. Medicare can feel complicated: multiple parts, premiums, rules, coverage differences. My goal is to walk you through what’s changing, what stays the same, and how to choose the Medicare plan that fits your health, financial, and lifestyle situation in 2026.
What Is Medicare, in a Nutshell
Before digging into Washington-specifics and 2026 changes, a quick refresher:
Original Medicare (Part A & Part B): Part A covers hospital stays, skilled nursing, inpatient things; Part B covers doctor visits, outpatient care, preventive services, etc.
Part D: Prescription drug coverage (you can add this to Original Medicare or get it bundled via some Medicare plans).
Medicare Advantage (Part C): Private-insurance alternative to Original Medicare. Usually bundles Part A, B, and often Part D, plus sometimes extras (vision, dental, etc.).
Medigap (Supplemental Insurance): Helps cover the “gaps” in Original Medicare (coinsurance, deductibles, etc.).
Understanding these pieces is key to comparing plan options in any state, including Washington.
Big Picture: What’s New & What’s Changing for Medicare in 2026
2026 will bring several changes nationally, many of which affect Washington residents too. Knowing them helps you anticipate what your premiums, costs, and coverage might look like.
Key 2026 Medicare Changes to Watch
Here are some of the important federal changes coming in 2026:
Change
What It Means
Sources
Higher caps and cost limits for Part D drug plans
The out-of-pocket limit for Medicare Part D (drug) coverage will be $2,100 in 2026. Once you spend that much on your covered prescriptions (including co-pays, etc.), you won’t have to pay for covered drugs the rest of the year.
Part D deductible increase
The maximum deductible that plans may charge goes up (e.g. from ~$590 to ~$615) depending on the plan.
Prescription Payment Plan updates
For those who use the Medicare Prescription Payment Plan (helps you spread drug costs over time instead of paying all at once), there are tweaks, including auto-renewal if you stay in the same plan, and clearer information.
Premiums, deductibles, IRMAA adjustments rising
Across Parts B, D, etc., costs are increasing. That includes monthly premiums, deductibles, extra charges for high income (IRMAA = Income-Related Monthly Adjustment Amount). Washingtoners will feel this like everyone else.
Changes in Washington state plan premiums and benefits
The Washington Public Employees’ Benefits Board (PEBB) has already authorized 2026 premiums for the Medicare plans it offers (UnitedHealthcare, Kaiser, etc.), as well as “enhancements” and benefit adjustments.
Washington-Specific Medicare Landscape in 2026
Let’s move from federal changes to what’s happening in Washington state specifically.
State-run Plans & Premium Authorizations
Washington has certain plans run or overseen by state authorities (or which the state helps regulate), including plans for PEBB (Public Employees’ Benefits Board), Uniform Medical Plan, etc.
The PEB Board authorized 2026 premiums for multiple Medicare-related plans (UnitedHealthcare, Kaiser Foundation Health Plans, Premera, UMP) meaning we know how much some plans are going to cost already.
There are “enhancements” proposed for UMP: one significant example is removing certain dollar limits on hearing aids benefits to align with state and federal laws.
What Washington’s Seniors & Beneficiaries Should Expect
Putting together the federal changes + state-plan details:
Drug coverage (Part D) will likely continue to be a big factor in monthly costs, because of rising deductibles and the drug out-of-pocket cap. Washington plans will have Part D options (either standalone or bundled) and differences in formularies (which drugs covered) will affect your costs.
Premiums for state/PEB plans will go up. If you’re in one of those, or considering one, expect some increase. But knowing that the state has authorized the 2026 amounts helps you plan.
Benefit changes or limits: like hearing aids (see above) are being adjusted. That means some services formerly limited might be more covered, but also, plans may narrow networks or adjust what “extras” are included.
Types of Medicare Plans Available in Washington in 2026
Here are your main categories of plans. As you compare, think of what’s most important to you (cost, provider choice, drug coverage, extra benefits, etc.).
Original Medicare + Part D + Medigap
Original Medicare gives you broad access: you can see almost any provider that accepts Medicare. It tends to give you freedom. But you’re responsible for deductibles, 20% coinsurance on a lot of services, and for drugs (which is where Part D comes in).
Part D plans will cover your prescription drugs. In 2026, they’ll have that $2,100 out-of-pocket cap. Shop the formulary: different plans cover different drugs and charge differently depending on whether you’re using preferred vs non-preferred pharmacies.
Medigap (supplemental insurance): helps fill in gaps (deductibles, coinsurance) in Original Medicare. If you want more predictable costs and lower surprises for hospital stays or frequent doctor visits, a Medigap plan may help. Keep in mind: Medigap premiums can be higher, and they don’t generally cover drugs (you’ll still need Part D if your Medigap doesn’t include it).
Medicare Advantage Plans
These are bundled private plans (covering Parts A, B, and often Part D + extras). In Washington, as elsewhere, you’ll find a variety of Medicare Advantage options: HMO-type, PPO-type, etc.
Advantages: Extra benefits (vision, hearing, dental, sometimes transportation or wellness extras), sometimes lower cost or lower premiums vs combining Original Medicare + Medigap + Part D. Also, out-of-pocket maximums, which Original Medicare doesn’t offer (without a plan that helps fill it in).
Trade-offs: Network restrictions (some doctors may not be in your plan’s network or you pay more out of pocket), prior authorization requirements, possibly more complex rules for specialist visits.
Cost Drivers: What Affects Your Medicare Costs in Washington
To zero in on what your actual costs will be—beyond just looking up a premium number—these are the levers and details that tend to make big differences.
Premiums & Part B Costs
Part B premium always applies (unless you have special coverage). In 2026 it’s expected to increase (the estimated Part B premium is ~$206.50/month). That’s up from ~$185 in 2025.
If your income is above certain thresholds, you may pay more via IRMAA (Income-Related Monthly Adjustment Amount). Washington residents aren’t exempt: the federal rules apply.
Drug Costs (Part D)
Deductible: up to ~$615 for 2026 if your plan has a deductible.
The formularies: what drugs are covered, what “tier” they are in (generic vs brand vs specialty), which pharmacies are preferred.
Out-of-pocket cap: $2,100 for covered drugs. Once reached, drugs covered in your plan cost you $0 for rest of year.
Benefits, Extras, and Network Access
Some plans include dental, vision, hearing, wellness, fitness, etc. Whether these are included, or offered as a separate add-on, will affect total cost. Washington state plans may be modifying hearing aid benefit limits.
Network size matters: especially if you have preferred doctors/hospitals. Know whether your providers are “in network” or whether you’ll pay extra.
Limits, Deductibles, Coinsurance
Original Medicare + Medigap: you’ll have deductibles, coinsurance (often 20% after Part B deductible), etc. If you use Medigap, it helps lower those out-of-pocket expenses but increases premium costs.
Medicare Advantage plans will typically have an out-of-pocket maximum. Once you hit that, they pay for covered services for the rest of the year (for in-network services typically).
Washington State & Local Considerations
When you’re comparing plans in Washington, it helps to know about state-rules, local variations, and public programs.
PEBB / State Employees & Retirees
If you are a state employee, retiree, or otherwise under a state program (or your spouse is), check what plans are offered via PEBB/Uniform Medical Plan etc. Their authorizations for 2026 premiums give you early insight into changes and what benefit enhancements (or limitations) may apply.
Extra Help & Low-Income Programs
If your income / resources are low, there are federal and state programs designed to help:
The “Extra Help” program (federal) helps with Part D costs (premiums, deductibles, co-pays) for drug coverage.
Washington may also have state-based assistance or special Medicare Savings Programs that reduce or cover Part B premiums, deductibles. It’s worth investigating with the Washington State Health Care Authority or local SHIP (State Health Insurance Assistance Program).
Regional Differences
Even within Washington, plan premiums, provider networks, drug formularies, etc., can differ a lot depending on county. Rural vs urban tends to make a big difference:
Urban areas (Seattle, Tacoma, Spokane) may have more Advantage plan options, larger networks.
Rural areas may have fewer options, possibly higher cost if transportation or provider visit distances come into play.
How to Compare & Pick the Right Medicare Plan in Washington in 2026
You know the pieces; here’s a step-by-step thinking strategy to compare and select.
1. Start with Your Health & Drug Needs
Which prescriptions do you take now? Do you expect changes? Bring a list.
How often do you see specialists/hospitals/dentists/vision/hearing? Are your providers important to you (do you want to keep them)?
Are you okay with possibly switching providers to save money, or do you prefer large networks?
2. Estimate Your Financial Situation
What is your income, and will you be subject to IRMAA?
How much can you afford in monthly premiums vs how much risk of large out-of-pocket costs are you okay with? Sometimes a higher premium gives you more predictable costs.
Think long term: a plan with more benefits or lower drug costs might cost a bit more monthly but save you money if your needs grow.
3. Review 2026 Plans as Soon as They’re Release/Authorized
Plans for 2026 are already being authorized in Washington (for some state-offered plans). Even before open enrollment, many carriers publish what will be changing: premiums, networks, formularies.
Use plan comparison tools (e.g. Medicare’s plan finder, Washington state plan finders) once updated for 2026.
4. Compare All the Pieces: Premiums + Deductibles + Out-of-Pocket Maximums + Drug Costs + Extras
Don’t just focus on the monthly premium. A “cheap” monthly cost might hide high deductibles or drug costs. Conversely, higher monthly premiums can reduce surprise bills.
5. Check Enrollment Periods & Deadlines
Initial Enrollment Period (IEP): when you first become eligible (e.g. when you turn 65).
Annual Election Period: every year in the Fall (Oct. 15 – Dec. 7) you can switch Medicare Advantage plans, or switch from Original Medicare to Advantage (or vice versa), or pick or change Part D.
Special Enrollment Periods: may apply in case of certain life changes (moving, loss of other coverage, etc.).
6. Use Trusted Resources
Official sources: Medicare.gov, Washington State Health Care Authority, SHIP programs.
Independent comparison tools.
Ask questions: “Does this plan cover all my prescriptions?”, “Are my doctors included?”, “What will my maximum out-of-pocket be if I have a hospitalization next year?”
Example Scenarios: How Different Types of Washington Residents Might Choose
Here are some hypothetical scenarios to illustrate how plan choice might differ depending on needs.
Person
Key Priorities
Likely Best Fit
Retiree with several chronic conditions + expensive prescriptions
Lower out-of-pocket drug costs, predictable total costs, keeping current specialists
Original Medicare + Part D plan with generous formulary + Medigap or a robust Medicare Advantage plan with low drug co-pays and many in-network providers
Someone who travels a lot, or visits doctors in multiple counties
Broad provider flexibility, good out-of-network coverage
Possibly Original Medicare + Part D, or Advantage plan with PPO features, or plan with good provider network in multiple areas
Low income / fixed budget
Low monthly cost, maximum financial assistance, minimal surprises
Explore Extra Help programs, low-premium Advantage plans, consider Original Medicare + Medigap (if cost-effective), check state assistance; prioritize plans with low drug and service cost sharing
Things to Watch Out For / Watchdog Alerts
When you are comparing options, here are some pitfalls or “fine print” things people often miss, especially in Washington.
Formulary changes: A drug you take now might be on a lower cost tier this year, but plans may change formularies each year. If they move your drug to a higher tier, costs go up.
Provider networks narrowing: Especially Advantage plans may change which doctors or hospitals are “in network”. If your primary doctor goes out of the network, costs may increase or you’ll need to switch providers.
Benefit caps or limitations: Some plans limit certain types of services (e.g., hearing, vision, or other extras). Washington’s removal of certain benefit caps (e.g., hearing aids in UMP) is an example—but not all plans will do that, and some may still have limits.
Increased cost sharing in some plans: Co-payments, coinsurance amounts might go up. Always check the Evidence of Coverage/Annual Notice of Change.
Overlap or redundancy: If you have other insurance (employer retiree, union, VA, etc.), check how that interacts with Medicare. Sometimes you have coverage that duplicates what Medicare covers but doesn’t reduce your costs enough to justify maintaining both.
Washington Medicare Plan Options: Specifics & Premiums for 2026
While I can’t list every single plan (they vary by ZIP code, county, provider network, etc.), here’s what is relatively known now in Washington, with examples to help you benchmark.
The PEB Board has authorized premiums for 2026 for UnitedHealthcare, Kaiser Foundation Health Plans (in WA & Northwest), Premera, and UMP Medicare plans.
One tangible change: UMP proposes removing the specified dollar-amount benefit limit for hearing aids. That’s a benefit enhancement for those who use hearing aids.
Keep an eye on the final premium tables once carriers publish them for your county—they’ll show what you’ll pay monthly for different plan tiers (e.g. base plans, richer plans) as well as what you’ll pay out-of-pocket for common services and drugs.
Three Action Steps You Should Take Now (Even Before Open Enrollment)
If I were you prepping for 2026 decisions, here’s what I’d do today to be ready:
Gather your current data: Your list of prescriptions, your doctors/hospitals you prefer, your recent bills for hospital visits or specialist care. Having this makes side-by-side comparisons accurate.
Monitor plan updates: Watch for plan announcements in Washington (carrier sites, state health authority, PEBB). Look for changes to premiums, drug formularies, networks, extra benefits. Sometimes they publish draft or proposed changes before final enrollment.
Use comparison tools & get help: Use Medicare’s Plan Finder when 2026 plans are live. Also, reach out to Washington’s State SHIP or similar pro bono counselling (free, unbiased) to run through options. If you are low income, check whether you’re eligible for Extra Help or Washington subsidies.
What You Absolutely Can’t Ignore
If you want to make a decision you’re comfortable with (not surprised later), make sure you check and understand:
Total prescription drug costs for your medications (including deductible, tiers, and pharmacies)
Monthly premium + part B + any extra charges (like IRMAA)
Out-of-pocket maximums (especially if you pick a Medicare Advantage plan)
Whether your doctors/hospitals are in that plan’s network
What extra benefits (vision, hearing, dental, wellness) are included or not
What kind of assistance you might qualify for
Advisor Health Benefits & Kevin Husted: A Trusted Washington Medicare Broker for 20+ Years
When you’re early in the research phase—typing things like “Washington Medicare plan options 2026,” “Medicare Advantage vs Medigap WA,” or “best Medicare drug plan Washington”—it’s easy to get lost in tabs. This is exactly where Advisor Health Benefits and Kevin Husted come in. Kevin has helped Washington residents compare Medicare Advantage, Medigap (Medicare Supplement), and Part D plans for over 20 years, and his whole approach is built for people who are just getting started and want plain-English answers before they make decisions.
Why Washington Medicare Shoppers Work With Kevin
Local, Washington-specific guidance: County-by-county networks, plan nuances, and 2026 benefit changes can vary. Kevin focuses on Washington Medicare plans, so you’re not wading through irrelevant national noise.
Clear explanations without the jargon: Coinsurance vs copays, Part D tiers, IRMAA, MOOP—he translates the alphabet soup into “what it actually means for your wallet and doctors.”
Side-by-side comparisons: See Medicare Advantage vs Original Medicare + Medigap + Part D in a straight, apples-to-apples layout that reflects your prescriptions and providers.
Decision support, not pressure: The goal is confident choices—selecting a plan you feel good about on January 1, not a plan you regret in March.
What You Can Expect From Advisor Health Benefits
A quick intake built around your real-life use: your doctors and clinics, your prescription list (dosage + frequency), and your “must-haves” (like dental/vision/hearing or travel flexibility).
2026-ready plan comparison: You’ll see how 2026 Washington Medicare plan options handle your meds (formulary + pharmacy preference), provider networks, prior authorizations, dental/vision/hearing add-ons, and out-of-pocket maximums.
Total cost picture, not just premiums: Monthly premium + expected drug costs + typical visit costs + worst-case MOOP—so there are fewer surprises after you enroll.
Timing and enrollment help: Reminders and guidance for the Annual Election Period (Oct 15–Dec 7), Open Enrollment, Special Enrollment Periods (moves, plan terminations, LIS/Extra Help changes), and Initial Enrollment around age 65 or qualifying disability.
Who Gets the Most Value Working With Kevin
Comparers: If you’re weighing Medicare Advantage vs Medigap for Washington in 2026 and want a neutral pro/con breakdown anchored to your doctors and prescriptions.
Prescription-heavy shoppers: If your medications are non-generic or specialty and you need a Part D or MAPD strategy that avoids tier shocks and non-preferred pharmacy pricing.
Travelers and snowbirds: If you split time or travel frequently, Kevin helps you find plans that make sense for out-of-area access or flexible networks.
Budget-focused households: If you need help exploring Extra Help (LIS) or Medicare Savings Programs and strategies to control monthly spend and reduce worst-case exposure.
How Kevin Helps You Compare Washington Medicare Plans for 2026
Map your must-keep providers: Check whether your primary care, key specialists, and preferred hospitals are in network for 2026.
Run your medications through 2026 formularies: Identify preferred vs standard pharmacies, tier placements, prior auths/step therapy, and how the 2026 Part D OOP cap interacts with your list.
Stack up the plan math: Compare premium + deductible + typical visit copays + drug spend + MOOP—not just the headline premium.
Highlight meaningful extras: Dental/vision/hearing allowances, OTC benefits, transportation, fitness—what’s real vs marketing.
Right-size the risk: If you value predictable costs, see what a Medigap path looks like in 2026; if you value conveniences and extras, check strong Medicare Advantage options with sensible MOOPs.
Getting Ready: What to Bring So Your 2026 Comparison is Spot-On
Prescription list: name, dosage, frequency, and preferred pharmacies (if you have one).
Provider list: primary care and specialists (plus clinics/hospitals you want to keep).
Care patterns: typical visits per year, recurring therapies, devices (e.g., CPAP, hearing aids).
Budget preferences: lower monthly premium vs lower worst-case exposure, or a balance.
Final Thoughts
Medicare in 2026 will be a bit more expensive in many respects, but there are also more protections (like the Part D cap on out-of-pocket drug costs) and benefit enhancements (e.g. hearing aid limits being lifted in some state plans). If you begin early, compare carefully, and keep your own health and financial situation front and center, you can pick a plan that gives you peace of mind and avoids nasty surprises.
If you want, I can put together a Washington-county-specific comparison (premiums + network) for 2026 so you can see what options look like where you live. Want me to draft that?
Frequently Asked Questions About Washington Medicare Plan Options for 2026
Q: What are the biggest Medicare changes in 2026 for Washington residents?
A: Expect higher Part B and Part D costs overall, plus a firm annual cap on out-of-pocket spending for covered Part D prescriptions. Washington plan lineups, premiums, and extras (like hearing, dental, and vision) also update each year—compare 2026 details by county before you switch.
Q: What’s the difference between Medicare Advantage and Original Medicare with Medigap in Washington?
A: Medicare Advantage (Part C) bundles hospital, medical, and often drug coverage with plan networks and an annual out-of-pocket max. Original Medicare + Medigap + Part D offers broad provider choice and predictable cost-sharing, but usually higher monthly premiums. Your drugs, doctors, and risk tolerance should drive the choice.
Q: When can I change my Medicare plan for the 2026 plan year?
A: Most people use the Annual Election Period (Oct 15–Dec 7, 2025) to change Medicare Advantage or Part D plans. You’ll also have your Initial Enrollment Period around your 65th birthday and Special Enrollment Periods after qualifying life events (like moving to a new Washington county).
Q: How do I compare Medicare Part D drug plans in Washington for 2026?
A: Make a medication list (name, dosage, frequency) and check each plan’s formulary tiers and preferred pharmacies. Then compare the deductible, monthly premium, typical copays, and your estimated annual drug spend under each plan.
Q: Will my doctors and hospitals take my Medicare plan in 2026?
A: Original Medicare is widely accepted. For Medicare Advantage, always verify your primary care, specialists, and hospitals are in-network for 2026—networks vary by county in Washington and can change year to year.
Q: How much will Medicare cost me in Washington in 2026?
A: Budget for the Part B premium, any IRMAA surcharges if your income is higher, and either a Medigap + Part D premium or a Medicare Advantage premium. Add expected copays/coinsurance and—if on Advantage—the in-network out-of-pocket maximum to understand your worst-case costs.
Q: Do Washington Medicare Advantage plans cover dental, vision, and hearing in 2026?
A: Many do, but coverage levels vary widely. Compare annual allowances, covered services (cleanings vs major dental), hearing aid benefits, and network or reimbursement rules so you know what’s actually included.
Q: What if I split time between counties or travel a lot?
A: Consider Original Medicare + Medigap for broader access, or a PPO-style Medicare Advantage plan with out-of-network options. Always check how your plan treats non-local care and emergency/urgent coverage when you’re away from your Washington home base.
Q: Are there programs that help lower Medicare costs in Washington?
A: Yes. Extra Help can reduce Part D costs, and Medicare Savings Programs may help with Part B premiums and other expenses. Washington’s SHIBA program offers free, unbiased guidance to check your eligibility.
Q: Can I keep my 2025 plan for 2026?
A: Often yes, but review the Annual Notice of Change. Formularies, networks, premiums, and copays shift each year—if your prescriptions or doctors are affected, it may be smart to switch during the fall window.
Q: Which is cheaper in Washington—Medicare Advantage or Medigap in 2026?
A: It depends on your usage. Advantage plans can have lower premiums but variable visit costs; Medigap typically has higher premiums but steadier, lower cost-sharing. Run the numbers for your doctors, visits, and medications.
Q: How do I figure out my total 2026 Medicare costs before enrolling?
A: Add (1) Part B premium (+ IRMAA if applicable) to (2) your chosen plan’s monthly premium, (3) expected Part D or bundled drug costs for your meds, and (4) typical visit copays. For Advantage, also note the annual in-network out-of-pocket max as your worst-case.
Q: What if my preferred doctor leaves my Medicare Advantage network mid-year?
A: You can still see them out of network (usually at higher cost) or switch to an in-network provider. Certain network changes may trigger Special Enrollment Period options—check your plan’s notice and Medicare rules.
Q: What documents should I gather before comparing 2026 Washington Medicare plans?
A: A current medication list (with dosages), your provider list (PCP, specialists, preferred hospitals/clinics), your pharmacy preference, and a rough count of typical visits/therapies. This lets you estimate real annual costs across plans.
