Medigap in Washington State

What Medigap is

Medigap (Medicare Supplement Insurance) is a separate insurance policy you buy from a private company. It pays some or all of the gaps in Original Medicare, such as the Part A hospital deductible ($1,736 per benefit period in 2026), the 20% Part B coinsurance and skilled nursing facility coinsurance. With Original Medicare and a Medigap policy you can see any provider in the country who accepts Medicare: there are no networks and no referrals.

• Medigap works only with Original Medicare (Part A and Part B). You can't use it with a Medicare Advantage plan.
• It doesn't include drug coverage, so most people also join a Part D drug plan.
• You pay the Medigap premium on top of your Part B premium ($202.90 a month standard in 2026).
• Each policy covers one person. Spouses buy separate policies.

Standardized plans (A through N)

Medigap plans are standardized by federal law and named by letter, and Washington adopts the same plans in WAC 284-66-067 and 284-66-068. A Plan G from one company covers the same things as a Plan G from another; companies differ in premium and service. The Office of the Insurance Commissioner (OIC) publishes a list of the Medigap plans approved for sale in Washington and their monthly premiums (linked in Sources).

Plans people often compare:

Plan G

Plan G pays every gap in Original Medicare except the Part B deductible ($283 in 2026). After you pay that deductible, it pays its share of Medicare-covered care for the rest of the year, including Part B excess charges.

High-Deductible Plan G

The same benefits as Plan G, but you first pay a yearly deductible of $2,950 (2026) before the plan pays. Compare the premium difference with the deductible you could owe.

Plan N

Plan N pays the Part B coinsurance except for a copayment of up to $20 for some office visits and up to $50 for emergency room visits that don't lead to an inpatient admission. It doesn't pay the Part B deductible or Part B excess charges (amounts up to 15% above the Medicare-approved amount that some doctors may bill).

Plan K and Plan L

These plans pay 50% (K) or 75% (L) of most costs and have a yearly out-of-pocket limit. The 2026 limits are:

• Plan K out-of-pocket limit: $8,000
• Plan L out-of-pocket limit: $4,000

After you reach the limit, the plan pays 100% of covered services for the rest of the year.

Plans C and F can't be sold to people who became eligible for Medicare on or after January 1, 2020. If you were eligible before then, you can keep or buy these plans.

What Medigap costs in Washington

Washington law controls how Medigap premiums are rated:

• Community rating. For every policy issued since January 1, 1996, insurers must set rates only on a community-rated basis. Premiums must be equal for all policyholders under the same standardized plan form, except that an insurer may vary premiums for spousal discounts, how often you pay and how you pay (such as automatic payment), and may use no more than two rating pools: one for people on Medicare because of age and one for people on Medicare because of disability or end-stage renal disease (RCW 48.66.045(3); WAC 284-66-243(6)).
• No attained-age rating. Washington bans using your increasing age as the basis for raising your premium (WAC 284-66-310). Your premium won't go up because you have a birthday. It can still go up for inflation and the company's claims.
• Rates are filed and approved. An insurer can't use or change Medigap premium rates in Washington until the insurance commissioner approves them (WAC 284-66-243(2)).

The same plan letter can still cost different amounts from different companies. Compare the premium for the same letter from several companies, and ask how each company's rates have changed over time. To see Medigap policies sold where you live, see plans in your ZIP code.

Washington's switching rules: friendlier than most states

In most states, once your Medigap open enrollment period ends, a company can review your health before it sells you a new Medigap policy. Washington has stronger rules.

The Medigap open enrollment period

Your Medigap open enrollment period lasts 6 months and starts the first month you are both 65 or older and enrolled in Part B. During it, a company can't deny you a policy or charge you more because of your health, and every policy it sells must be available to you (RCW 48.66.025). If you had at least 3 months of continuous creditable coverage (such as employer coverage) before you apply, the company can't exclude pre-existing conditions; if you had less, any wait for pre-existing conditions is shortened by the coverage you had.

If you delay Part B because you are still working with employer coverage, this window starts when your Part B starts. See working past 65.

Washington's any-time switching right (no birthday rule needed)

Neighboring Oregon and Idaho have birthday rules that let people change Medigap policies during a window around their birthday each year. Washington does not have a birthday rule. Instead, RCW 48.66.045 and WAC 284-66-064(4) let you replace your Medigap policy at any time of year, without evidence of insurability (no health screening questions):

• If you have Plan A, a company must sell you its Plan A. Plan A can be replaced only by another Plan A.
• If you have a plan other than Plan A, a company must sell you any of its Plans B, D, G, high-deductible G, K, L, M or N, or, if you were eligible for Medicare before January 1, 2020, also its Plans C, F and high-deductible F. You can change letters, for example from Plan G to Plan N.
• The right covers only plans the new company sells in Washington, and it applies whether you have Medicare because of age, disability or end-stage renal disease.
• The law sets no waiting time before you can switch. What the 3-month rule changes is coverage for pre-existing conditions: if the policy you're replacing has been in effect for at least 3 months, the new policy can't impose any waiting period for pre-existing conditions; if less, the time you spent under the old policy counts toward any wait (RCW 48.66.130(4)–(6); WAC 284-66-170).
• In any case, a Washington Medigap policy can't exclude a pre-existing condition for more than 3 months after coverage starts (RCW 48.66.130(1)).

The statute also applies when the new Medigap policy replaces "other more comprehensive coverage." The OIC gives retiree or employer coverage and COBRA as examples. For other kinds of coverage, the OIC says rules can vary and a company may require a written health screening, so check before you drop anything.

How to use the switching right

When your premium goes up, compare what other companies charge for the same plan letter, or a different letter if your needs have changed. If a company sells the plan you want, it must accept your application under the switching right no matter your health. Because Washington premiums are community-rated, switching doesn't put you into a higher age-based rate.

The switching right is for moving from one Medigap policy to another. To get into Medigap from Medicare Advantage you generally need your Medigap open enrollment period, a trial right or another guaranteed-issue right (below), or to pass the company's health screening. Once you have any Medigap policy, the switching right applies from then on. See switching back to Original Medicare.

Guaranteed-issue rights in Washington

RCW 48.66.055 gives you the right to buy certain Medigap plans, with no health questions and no pre-existing condition exclusion, in situations such as these:

• Your employer or union coverage that pays after Medicare ends or stops providing supplemental benefits.
• Your Medicare Advantage plan leaves Medicare or stops serving your area, or you move out of the plan's service area.
• Trial rights: you joined a Medicare Advantage plan (or PACE) when you first became eligible for Part A at 65 and leave within 12 months (you can then buy any Medigap policy), or you dropped a Medigap policy to join Medicare Advantage for the first time and leave within 12 months (you can return to your old policy if the same company still sells it).
• Your Medigap company becomes insolvent, your coverage ends through no fault of your own, or the company broke the rules or misled you.

In most of these situations you can buy Plan A, B, D, G, K or L if you became eligible for Medicare on or after January 1, 2020, or Plan A, B, C, D, F, K or L if you were eligible before then (RCW 48.66.055(4)). You must apply no later than 63 days after your old coverage ends; if you leave a plan voluntarily you can apply as early as 60 days before it ends. Send proof of the date your coverage ends with your application.

Underwriting in Washington

If you don't have Medigap yet and none of the rights above applies, a company can ask about your health, prescriptions and medical history, and it can decline you. If a company rejects you for health reasons, requires restrictive riders, charges more or limits pre-existing conditions, it must tell you in writing and give you information about Medicare Advantage plans in your area and the Washington State Health Insurance Pool (RCW 48.66.057). The pool (WSHIP) sells a Medicare Basic plan to people on Medicare who were turned down by a Medigap plan for health reasons, if they meet its requirements.

This is why timing matters: the easiest time to get Medigap is your open enrollment period at 65 or a guaranteed-issue window.

If you're under 65

Washington law doesn't require companies to sell Medigap to people under 65 who have Medicare because of a disability or end-stage renal disease; the Medigap open enrollment right in RCW 48.66.025 starts at 65. The OIC says that if you are under 65, you might not be able to buy the Medigap plan you want, or any Medigap plan, until you turn 65, and that you can ask companies directly whether they will sell you one. Companies that do may price people on Medicare because of disability in a separate rating pool (RCW 48.66.045(3)).

When you turn 65, you get a full 6-month Medigap open enrollment period starting the month you turn 65. Until then, look at Medicare Advantage, special needs plans, the WSHIP Medicare Basic plan, and help with costs through the Medicare Savings Programs or Apple Health. More on Medicare under 65.

Who Medigap fits in Washington

Original Medicare with Medigap may fit if:

• You travel often or split time between states, since it works with any provider in the U.S. who accepts Medicare. See snowbirds and Medicare.
• You want to choose any doctor or hospital that accepts Medicare, with no network or referrals.
• You have specialists you want to keep wherever they practice.
• You prefer a predictable monthly premium over paying copays and coinsurance when you get care.
• You are in your Medigap open enrollment period or have a guaranteed-issue right.

Medicare Advantage may fit better if a lower monthly premium matters most to you or you want your coverage in one plan. 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. Compare the two on our Original Medicare vs. Medicare Advantage page.

Buying Medigap in Washington

You can buy Medigap directly from an insurance company or through a licensed insurance agent. 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 policies from the companies they work with, or find a licensed insurance agent in Washington. For questions about Washington insurance law or a complaint about an insurer, contact the Office of the Insurance Commissioner. Medicare's own help line is 1-800-MEDICARE (1-800-633-4227, TTY 1-877-486-2048).

Sources

• Washington State Legislature — RCW 48.66.045, Mandated coverage for replacement policies; rates on a community-rated basis (last amended 2019 c 38)
• Washington State Legislature — RCW 48.66.025, Restrictions on issuers; age of applicants; preexisting conditions
• Washington State Legislature — RCW 48.66.055, Guaranteed issue: eligible persons, types of policies, time periods
• Washington State Legislature — RCW 48.66.057, Rejection of Medicare eligible person; notice required
• Washington State Legislature — RCW 48.66.120, Return of policy and refund of premium
• Washington State Legislature — RCW 48.66.130, Preexisting condition limitations
• Washington State Legislature — WAC 284-66-064, Benefit standards for policies issued on or after June 1, 2010 (replacement without evidence of insurability)
• Washington State Legislature — WAC 284-66-067, Standard Medicare supplement plans issued on or after June 1, 2010
• Washington State Legislature — WAC 284-66-068, Standard plans for people newly eligible for Medicare on or after January 1, 2020
• Washington State Legislature — WAC 284-66-170, No preexisting condition or waiting periods in replacement policies
• Washington State Legislature — WAC 284-66-243, Filing and approval of policies and premium rates
• Washington State Legislature — WAC 284-66-310, Attained age rating prohibited
• Washington Office of the Insurance Commissioner — Medigap (Medicare Supplement) plan coverage and costs
• Washington Office of the Insurance Commissioner — Approved Medigap plans and monthly premiums (PDF)
• Washington Office of the Insurance Commissioner — What you need to know about Medigap (Medicare Supplement) plans (PDF)
• Washington Office of the Insurance Commissioner — Is your Medicare Advantage plan changing or leaving?
• Washington Office of the Insurance Commissioner — The Washington State Health Insurance Pool (WSHIP)
• NAIC — State Medigap rules: "Birthday Rule" and coverage for under 65, as of May 11, 2026 (PDF)
• Medicare.gov — Compare Medigap plan benefits
• CMS — Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare (PDF)

Frequently asked questions

Does Washington have a Medigap birthday rule?

No. Washington has no birthday rule. Instead, RCW 48.66.045 requires insurers to sell their Medigap Plans B through N without evidence of insurability (no health questions) to a Washington resident who is replacing another Medigap policy, at any time of year. If you have Plan A, you can switch only to another Plan A. You can switch only to plans the new company actually sells.

Is there a 90-day wait before I can switch Medigap plans in Washington?

Not to switch. Washington law sets no waiting time before you can use the switching right. The 3-month (about 90-day) rule is about pre-existing conditions: if the policy you are replacing has been in effect for at least 3 months, the new policy can't make you wait for coverage of pre-existing conditions (RCW 48.66.130 and WAC 284-66-170). If it has been in effect for less time, that time still counts toward any wait.

When can I buy Medigap without health questions in Washington?

During your 6-month Medigap open enrollment period, which starts the first month you are 65 or older and enrolled in Part B (RCW 48.66.025); in guaranteed-issue situations such as your Medicare Advantage plan ending or your employer coverage ending (RCW 48.66.055); and, once you have a Medigap policy, any time you switch to another Medigap policy under Washington's switching right.

Can I buy Medigap in Washington if I'm under 65?

Washington law doesn't require insurers to sell Medigap to people under 65 who have Medicare because of a disability or end-stage renal disease, so your choices may be limited. If you already have a Medigap policy, the switching right applies to you too. When you turn 65, you get your own 6-month Medigap open enrollment period.

My Medicare Advantage plan ends December 31, 2026. Can I get a Medigap policy?

Usually yes. When a Medicare Advantage plan stops serving your area, Washington and federal law give you a guaranteed right to buy certain Medigap plans with no health questions: Plan A, B, D, G, K or L if you became eligible for Medicare in 2020 or later, or Plan A, B, C, D, F, K or L if you were eligible before 2020. You can apply up to 63 days after your plan coverage ends, and the policy starts when your plan ends.

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