What Medicare is, in one paragraph
Medicare is the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease or ALS. The program is run by the Centers for Medicare & Medicaid Services (CMS) and pays for hospital stays, doctor visits, prescription drugs and certain other services through four "parts": A, B, C and D.
The four parts of Medicare
It helps to think of Medicare as having two halves. Original Medicare is Parts A and B, the federal program itself, which you can use with any doctor or hospital in the country that accepts Medicare. Medicare Advantage (Part C) and Part D drug coverage are sold by private insurance companies that contract with Medicare. Most people in Washington end up with one of two combinations:
- Original Medicare + Part D + (often) a Medigap policy: the traditional path. You can see any provider that takes Medicare, anywhere in the country.
- Medicare Advantage, usually with drug coverage built in: a private plan that covers Part A and Part B services and usually Part D. Networks and prior-authorization rules apply.
Part A: hospital insurance
Part A covers inpatient hospital stays, skilled nursing facility care after a qualifying hospital stay, hospice, and some home health care. Most people get Part A with no premium because they (or a spouse) paid Medicare taxes for at least 40 quarters (about 10 years) of work. The 2026 hospital deductible is $1,736 per benefit period.
Part B: medical insurance
Part B covers doctor visits, outpatient care, durable medical equipment, preventive services and many other services. The 2026 standard premium is $202.90 a month, and the yearly deductible is $283. Washington residents with higher incomes pay more through IRMAA (the Income-Related Monthly Adjustment Amount).
Part C: Medicare Advantage
Medicare Advantage plans are sold by private insurance companies and cover everything Part A and Part B cover, usually with Part D drug coverage in the same plan. Most use HMO or PPO networks. 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.
What you can choose from depends on your county. CMS's 2027 plan data shows 30 Medicare Advantage plans open to everyone in King County, but 6 in Ferry County.
Medicare Advantage in Washington →
Part D: prescription drug coverage
Part D plans cover outpatient prescription drugs. In 2026, once your out-of-pocket costs for covered drugs reach $2,100, you pay nothing more for covered Part D drugs for the rest of the year. The yearly cap started in 2025 and is one of the biggest changes to Medicare in decades. The highest deductible a Part D plan can have in 2026 is $615.
Medigap (Medicare Supplement Insurance)
Medigap policies are separate policies that help pay the costs Original Medicare leaves to you: coinsurance, copayments, the Part A deductible and so on. They are standardized, which means Plan G from one company covers the same things as Plan G from another. Washington law gives people who already have a Medigap policy some rights to replace it without health questions; see Medigap in Washington for how they work.
Who pays for what
This is one of the most confusing parts of Medicare for new beneficiaries. Here's the short version:
- Original Medicare alone: you pay deductibles plus 20% coinsurance for most Part B services. There is no yearly out-of-pocket limit on Parts A and B by themselves.
- Original Medicare + Medigap: the Medigap policy pays most or all of your share, in exchange for a monthly premium to the Medigap company.
- Medicare Advantage: you pay the plan's copayments and coinsurance, and each plan has a yearly limit on what you pay for covered in-network services. In 2026 that limit can be no higher than $9,250; each plan sets its own limit at or below it.
For the full list of 2026 amounts, see Medicare costs in 2026.
How Washington shapes your Medicare
Federal rules apply everywhere, but several Washington programs affect how you'll actually use Medicare:
Apple Health (Medicaid) and Medicare Savings Programs
If your income and resources are limited, you may qualify for both Medicare and Apple Health, or for a Medicare Savings Program. People who have both Medicare and Medicaid are called "dual eligible." Depending on the program, it can pay your Medicare premiums and some or all of your deductibles and coinsurance.
WA Cares Fund (separate from Medicare)
Washington's long-term care program, funded by a premium on workers' wages, is not Medicare and doesn't change your Medicare benefits. It can help pay for long-term care that Medicare doesn't cover. Read more.
Tribal health and Medicare
Washington has 29 federally recognized tribes. American Indian and Alaska Native people can keep using Indian Health Service and tribal health programs and use Medicare as well. Learn more.
What to do next
- Check your eligibility. Most people qualify at 65, but disability and certain conditions can qualify you earlier. Eligibility details →
- Know your enrollment window. Missing your Initial Enrollment Period can mean late penalties that last for life. Enrollment periods →
- Compare your options. Plans in your county may differ from plans across the Cascades or across the Sound. See plans in your ZIP code, or use the Plan Finder at Medicare.gov.
- Get help if you need it. Call 1-800-MEDICARE (TTY 1-877-486-2048) with questions about Medicare itself, or Social Security about signing up.
To talk through plans from the companies they work with, call (206) SENIORS (206-736-4677), TTY 711 to reach a licensed insurance agent with Benefits Life, at no cost to you, or find a licensed insurance agent in Washington.
Sources
- Medicare.gov — Parts of Medicare
- CMS — 2026 Medicare Parts A & B premiums and deductibles
- Medicare.gov — Medicare costs
- Medicare.gov — Working past 65
- CMS — CY2027 Medicare Advantage and Part D Landscape files
- Washington State Legislature — RCW 48.66.045 (Medicare supplement guaranteed issue)
- Washington Health Care Authority — Apple Health (Medicaid) coverage
- Washington DSHS — Medicare Savings Program
- WA Cares Fund — Fact sheet
- Washington Governor's Office of Indian Affairs — Tribal directory
Frequently asked questions
Do I have to enroll in Medicare at 65 if I'm still working?
Not necessarily. If you or your spouse are still working and have group health coverage from an employer with 20 or more employees, you can usually delay Part B without a penalty and sign up later during a Special Enrollment Period. Check with your employer's benefits office before you turn 65 to confirm how its plan works with Medicare.
Can I have both Medicare and Apple Health?
Yes. People who qualify for both are called dual eligible. Depending on the program, Apple Health can pay your Medicare premiums and some or all of your deductibles and coinsurance. You apply through Washington Connection or your local DSHS Community Services Office.
What's the difference between Medicare Advantage and Medigap?
Medicare Advantage (Part C) is a private plan you get instead of Original Medicare; it covers Part A and Part B services, usually with drug coverage. Medigap is a separate policy that works alongside Original Medicare and helps pay its deductibles and coinsurance. You can't use a Medigap policy with a Medicare Advantage plan.
Does Medicare cover long-term care or assisted living?
Generally no. Medicare covers limited skilled nursing facility care after a qualifying hospital stay, plus hospice, but not long-term custodial care. In Washington, the WA Cares Fund and Apple Health long-term services and supports are the main public programs that help with those costs.
Are Medicare premiums based on income?
The standard 2026 Part B premium is $202.90 a month. People with higher incomes pay more for Part B and Part D through IRMAA, which is based on the tax return you filed two years earlier.
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
