Choosing coverage

Original Medicare vs. Medicare Advantage in Washington: A Side-by-Side Guide

The biggest decision in Medicare is whether to keep Original Medicare (Parts A and B), usually with a Medigap policy and a Part D plan, or join a Medicare Advantage plan that covers your care through a private company's network. In Washington, Medicare Advantage choices range from 35 plans in Pierce County to 1 in Clallam County for 2027, and state law lets people who already have Medigap switch Medigap plans at any time without health questions.

By the Benefits Life Editorial Team, licensed insurance agents · Reviewed November 9, 2026

The two paths at a glance

	Original Medicare + Medigap + Part D	Medicare Advantage
Network	Any U.S. provider who accepts Medicare	The plan's network (HMO or PPO); PPOs cover some out-of-network care at a higher cost
Referrals	Not required	Often required, especially in HMOs
Monthly cost	Part B premium ($202.90 standard in 2026) + Medigap premium + Part D premium	Part B premium + the plan's premium, if any
Cost when you get care	Little or nothing for many services, depending on the Medigap plan letter	Copays and coinsurance, up to the plan's yearly limit
Out-of-pocket limit	None in Original Medicare alone; Medigap pays most or all of the coinsurance	Yearly limit set by each plan, no higher than $9,250 in-network in 2026
Drug coverage	Separate Part D plan	Usually included (MAPD)
Extra benefits	None	May offer dental, vision, hearing or fitness; varies by plan
Travel	Anywhere in the U.S.	Network rules apply; emergencies covered anywhere in the U.S.
Switching later	Changing Medigap plans: any time in Washington, no health questions. Getting a first Medigap policy after open enrollment: may require a health review	Each year during the Annual Enrollment Period, plus the January–March window

Original Medicare + Medigap: what you get

With Original Medicare, you can use any doctor or hospital in the U.S. that accepts Medicare. No referrals, no networks, and no prior authorization for most services.

Medigap (Medicare Supplement) plans pay deductibles and coinsurance that Original Medicare leaves to you. For example, Plan G pays every gap except the Part B deductible ($283 in 2026). After that, your share of most Medicare-covered care is small or nothing. In Washington, Medigap premiums are community-rated, so they can't rise because you get older (RCW 48.66.045; WAC 284-66-310).

You add a standalone Part D plan for prescription drugs. In 2026, what you pay for covered Part D drugs is capped at $2,100 for the year. See Medigap details.

May fit you if:

You travel often (snowbirds, RV travel, long visits with family in other states)
You have complex medical needs and specialists you want to keep
You value predictable costs over a lower monthly premium
You live in a county with few Medicare Advantage plans for 2027, such as Clallam (1), Klickitat (3), Pacific (3), Stevens (4) or San Juan (4)
You use providers in several regional medical hubs or across state lines

Medicare Advantage: what you get

Medicare Advantage (Part C) plans cover everything Parts A and B cover, and most include Part D, through one private plan. You still pay your Part B premium ($202.90 standard in 2026), and the plan may charge its own premium.

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.

The trade-off is the network. HMO plans require you to use the plan's providers, except in emergencies, and often require referrals. PPO plans cover out-of-network care at a higher cost.

Every plan has a yearly maximum out-of-pocket (MOOP) limit for covered Part A and Part B services. Once you reach it, the plan pays 100% of covered services for the rest of the year. For 2026, the in-network limit could be no higher than $9,250; check each plan's own limit. More on Medicare Advantage in Washington.

May fit you if:

You live where your doctors and hospital are in a plan's network, for example in counties with more choices for 2027, such as Pierce (35), Thurston (32), Snohomish (31), King (30) or Spokane (25)
A lower monthly premium matters more to you than fixed costs when you get care
You want your medical and drug coverage in one plan
You're comfortable getting care in a network and don't travel much outside Washington

The decision framework

Question 1: Do you travel?

If you spend a lot of time outside Washington, such as winters in Arizona or California, summers with family elsewhere or long RV trips, Original Medicare with Medigap travels with you. Medicare Advantage networks generally don't, apart from emergency and urgent care. See our snowbirds guide.

Question 2: Where do you live in Washington?

Plan choices differ a lot by county. For 2027, CMS lists 35 plans open to everyone in Pierce County and 30 in King County, but 9 in Benton County, 5 in Yakima County and 1 in Clallam County. Where there are few plans, check networks carefully; Original Medicare may be the more practical choice. See your county page.

Question 3: Do you have specialists you want to keep?

If you see specialists at a particular hospital or clinic, check whether each plan includes them in its network for the coming year. Networks can change every year. Original Medicare avoids this question.

Question 4: How important is predictability?

Original Medicare with Medigap means a predictable monthly premium and little or nothing to pay for most covered care, depending on the plan letter. Medicare Advantage often means a lower monthly cost but copays for visits, tests and procedures, up to the plan's yearly limit.

Question 5: Will you ever want to switch?

Leaving Medicare Advantage for Original Medicare is allowed each year, but getting a first Medigap policy afterward can require a health review, and a company can turn you down, unless you have a guaranteed-issue right (such as your plan ending) or a trial right. Once you have Medigap, Washington's switching right lets you change to another company's plan any day of the year with no health questions: Plan A to Plan A, or any other plan to Plan B through N (RCW 48.66.045). That makes the Original Medicare path more flexible in Washington than in most states. See full Medigap details.

The cost reality

Don't pick a plan on premium alone. Think through a realistic year:

How many doctor visits do you usually have?
Any planned surgeries or procedures?
Are your prescriptions on the plan's drug list, and at what tier?
What is the plan's out-of-pocket limit, and how likely are you to reach it?

For some people, a lower monthly cost outweighs the copays. For others, especially people with ongoing care needs, Original Medicare with Medigap can cost less over a year.

Switching between them

You can switch during the Annual Enrollment Period (October 15 to December 7). You can also leave Medicare Advantage for Original Medicare, or change Medicare Advantage plans, during the Medicare Advantage Open Enrollment Period (January 1 to March 31). See every enrollment window.

The Medigap catch: outside your 6-month Medigap open enrollment period at 65, a Medigap company can review your health when you first apply, unless you have a guaranteed-issue right or a 12-month trial right. See switching back to Original Medicare.

Is your plan ending? CMS data shows many Washington Medicare Advantage plans end on December 31, 2026. If yours is one of them, you have a special enrollment period to February 28, 2027 and a guaranteed right to buy certain Medigap policies until 63 days after the plan ends. See plans ending in 2027.

Where to get help deciding

This decision deserves a careful conversation:

1-800-MEDICARE (1-800-633-4227, TTY 1-877-486-2048) and the plan finder at Medicare.gov, for information on all your options.
A licensed insurance agent with Benefits Life, at no cost to you: call (206) SENIORS (206-736-4677), TTY 711 about plans from the companies they work with, or find a licensed insurance agent in Washington.
Plans where you live: see plans in your ZIP code.

Sources

Frequently asked questions

Which is better in Washington, Original Medicare or Medicare Advantage?

Neither is better for everyone. Original Medicare with Medigap lets you use any provider in the U.S. who accepts Medicare and makes costs more predictable, for a higher monthly premium. Medicare Advantage puts your coverage in one plan with a network and a yearly out-of-pocket limit, with copays when you get care. Your choice depends on travel, where you live in Washington, your doctors and your health.

Can I switch between Original Medicare and Medicare Advantage?

Yes, during the Annual Enrollment Period (October 15 to December 7), and from Medicare Advantage to Original Medicare during the Medicare Advantage Open Enrollment Period (January 1 to March 31). Getting a Medigap policy after leaving Medicare Advantage may require a health review unless you have a guaranteed-issue right or a trial right. Once you have Medigap, Washington's switching right (RCW 48.66.045) lets you change Medigap plans at any time.

Does Medicare Advantage work when I travel outside Washington?

Medicare Advantage plans cover emergency and urgently needed care anywhere in the U.S., but routine care usually must be in the plan's network, and an HMO generally won't cover routine care elsewhere. People who spend long stretches away often find Original Medicare with Medigap more practical.

Does Washington have a Medigap birthday rule?

No. Washington has no birthday rule. Instead, under RCW 48.66.045, if you have a Medigap Plan B through N you can switch to another company's Plan B through N at any time without evidence of insurability, and Plan A can be switched to another Plan A. The law sets no waiting time to switch; the 3-month rule only affects waiting periods for pre-existing conditions.

Are dental and vision included in Original Medicare?

No. Original Medicare doesn't cover routine dental, vision or hearing care. Some Medicare Advantage plans offer these extra benefits, which vary by plan and county and may have limits and costs. You can also buy separate dental or vision coverage, and Apple Health covers dental care for adults who qualify.

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

Licensed insurance agents for Washington

These independent insurance agents are licensed in Washington and work with Benefits Life, the publisher of this site. When they enroll you in a plan, the agent and Benefits Life may be paid by the insurance company. Learn more.