Medicare Advantage in Washington State

What Medicare Advantage is

Medicare Advantage (Part C) plans are a way to get your Medicare benefits through a private insurance company approved by Medicare. The plan covers everything Part A and Part B cover, and most plans include Part D drug coverage. Medicare pays the company to provide your benefits. You are still in Medicare, but your day-to-day care follows the plan's network and rules.

You keep paying your Part B premium ($202.90 a month standard in 2026), and the plan may charge its own premium. To join, you need Part A and Part B and must live in the plan's service area.

How plan availability differs across Washington

This is one of the most important things to understand about Medicare Advantage in Washington: the plans you can buy depend on the county you live in. The Washington Office of the Insurance Commissioner says at least one Medicare Advantage plan is available in every county in 2027.

Source: CMS 2027 Medicare Advantage Landscape file. Special needs plans are open only to people who qualify (see below). Every county is on our Washington counties page.

A plan sold in your county may still have few doctors or hospitals near your town, especially in rural and island counties. Before you join, check that your own doctors, the hospital you would use and your pharmacy are in the plan's network for the coming year.

The two main plan types in Washington

HMO plans (Health Maintenance Organization)

HMO plans require you to use providers in the plan's network, except for emergencies, urgent care and out-of-area dialysis, and usually require a referral from your primary care provider to see a specialist. They work best where most of the doctors and hospitals you use are in the network, which can be harder in rural counties.

PPO plans (Preferred Provider Organization)

PPO plans have a network, but they also cover out-of-network care, usually at a higher cost, if the provider agrees to treat you. A PPO has two out-of-pocket limits: one for in-network care and a higher combined limit for in-network and out-of-network care together (up to $13,900 in 2026). A PPO can fit people who travel between regions or who may need specialty care in Seattle, Spokane or Portland from providers outside a local network.

Special Needs Plans (SNPs)

Special needs plans are Medicare Advantage plans limited to people with particular needs, and they include Part D drug coverage. For 2027, CMS lists 43 special needs plans in Washington. There are three kinds:

• D-SNPs (Dual Eligible Special Needs Plans), for people who have both Medicare and Apple Health (Medicaid). In Washington, these plans are called Apple Health Medicare Connect. More on D-SNPs
• C-SNPs (Chronic Condition SNPs), for people with certain serious chronic conditions, such as diabetes, chronic heart failure or end-stage renal disease
• I-SNPs (Institutional SNPs), for people who live, or are expected to live, in a nursing home or similar facility, or need that level of care at home

What's included beyond Parts A and B

• Part D prescription drug coverage is included in most plans (these are called "MAPD" plans). Drug costs have their own yearly cap of $2,100 in 2026.
• Medicare Advantage plans may offer extra benefits that Original Medicare doesn't cover, such as dental, vision, hearing or fitness. Extra benefits vary by plan and county, may have limits and costs, and not every plan offers them. Check a plan's Summary of Benefits or Evidence of Coverage.

Extra benefits aren't standardized. Two plans that both list "dental" can cover very different services and amounts, so read the details.

The trade-offs to understand

Medicare Advantage isn't better or worse than Original Medicare; it's different:

Network considerations specific to Washington

• Cross-state care: Vancouver residents who use Portland providers, Clarkston residents who use Lewiston, Idaho, hospitals and Pullman residents who use Moscow or Lewiston need to check that out-of-state providers are in the plan's network.
• San Juan Islands: much specialty care is on the mainland. Check whether the specialists you'd see in Anacortes, Bellingham or Seattle are in the network. See ferry-dependent health care.
• Military retirees: TRICARE For Life works with Original Medicare. If you have TRICARE For Life and are thinking about Medicare Advantage, learn how the two work together first. More
• Tribal health: Indian Health Service and tribal facilities have their own Medicare rules. More
• Snowbirds: if you leave your plan's service area for more than 6 months in a row, the plan must disenroll you unless it has a visitor or traveler program. Ask the plan, or consider whether a PPO or Original Medicare fits better. More

Out-of-pocket limits (the safety net)

Every Medicare Advantage plan has a yearly out-of-pocket maximum (MOOP) for covered Part A and Part B services. For 2026, plans could not set an in-network limit higher than $9,250; a plan can set a lower one, shown in its Evidence of Coverage. Original Medicare alone has no yearly limit, which is one reason people without Medigap look at Medicare Advantage. Plan premiums and Part D drug costs don't count toward the MOOP.

Plans ending December 31, 2026

Disenrolling and switching

You can leave a Medicare Advantage plan and return to Original Medicare, or change plans, during:

• Annual Enrollment Period (October 15 to December 7), with changes starting January 1
• Medicare Advantage Open Enrollment Period (January 1 to March 31, one change)
• Special enrollment periods for situations such as a move, your plan ending, getting Apple Health or Extra Help, or a declared disaster such as a wildfire (wildfire SEPs)

If you leave Medicare Advantage and want a Medigap policy, a company can review your health unless you have a guaranteed-issue right, such as your plan ending, a move out of the service area, or a 12-month trial right if you joined Medicare Advantage when you first became eligible at 65. Once you have Medigap, Washington lets you switch Medigap plans at any time without health questions. More on Medigap rights and every enrollment window.

Getting help choosing

To see the Medicare Advantage plans sold where you live, see plans in your ZIP code. To talk it through, call (206) SENIORS (206-736-4677), TTY 711 to reach a licensed insurance agent with Benefits Life, at no cost to you, about plans from the companies they work with. For information on all your options, call 1-800-MEDICARE (1-800-633-4227, TTY 1-877-486-2048) or use the plan finder at Medicare.gov.

Sources

• Medicare.gov — Your coverage options (Medicare Advantage plan types)
• Medicare.gov — Special Needs Plans (SNP)
• Medicare.gov — Special Enrollment Periods
• CMS — Medicare Advantage and Part D Landscape files, contract year 2027
• eCFR — 42 CFR 422.74, disenrollment by the MA organization (6-month absence rule)
• Washington Office of the Insurance Commissioner — Is your Medicare Advantage plan changing or leaving?
• Washington State Health Care Authority — Apple Health Medicare Connect
• Medicare.gov — Medicare & You handbook (PDF)

Frequently asked questions

How many Medicare Advantage plans are available in Washington for 2027?

CMS's 2027 plan data lists 71 Medicare Advantage plans open to everyone in Washington, from 14 companies, plus 43 special needs plans. You can join only plans sold in your county: Pierce County has 35 and King County 30, while Clallam County has 1 Klickitat County 3 and Pacific County 3.

Can I have both Medicare Advantage and Medigap?

No. Medigap works only with Original Medicare; Medicare Advantage replaces Original Medicare while you're enrolled. You use one or the other.

Is there a limit on what I pay in a Medicare Advantage plan in 2026?

Yes. Every Medicare Advantage plan has a yearly limit on what you pay for covered Part A and Part B services. For 2026, Medicare allowed in-network limits of up to $9,250, and a plan can set a lower limit. Your plan's Evidence of Coverage shows its own limit; premiums and drug costs don't count toward it.

Can I switch back to Original Medicare?

Yes, during the Annual Enrollment Period (October 15 to December 7), the Medicare Advantage Open Enrollment Period (January 1 to March 31) or a special enrollment period. Getting a Medigap policy afterward may require a health review unless you have a guaranteed-issue right, such as your plan ending or a 12-month trial right.

Do Medicare Advantage plans cover care across state lines?

It depends on the plan. Every plan covers emergency and urgently needed care anywhere in the U.S. A PPO may cover routine out-of-network care at a higher cost; an HMO usually doesn't. People in Vancouver, Clarkston or Pullman who use doctors and hospitals in Oregon or Idaho should check that those providers are in the plan's network.

Medicare in your Washington county

Plans, local agents and help, county by county: Adams · Asotin · Benton · Chelan · Clallam · Clark · Columbia · Cowlitz · Douglas · Ferry · Franklin · Garfield · Grant · Grays Harbor · Island · Jefferson · King · Kitsap · Kittitas · Klickitat · Lewis · Lincoln · Mason · Okanogan · Pacific · Pend Oreille · Pierce · San Juan · Skagit · Skamania · Snohomish · Spokane · Stevens · Thurston · Wahkiakum · Walla Walla · Whatcom · Whitman · Yakima