What's New in Medicare 2026: A Washington Beneficiary's Guide

Part B premium and deductible

The standard Medicare Part B premium for 2026 is $202.90 a month, up $17.90 from $185 in 2025. The Part B yearly deductible rose to $283, up $26 from 2025.

If you get Social Security, the premium is taken from your benefit, and your 2026 notice showed the new amount next to your cost-of-living adjustment. Washington's Medicare Savings Programs can pay the premium for people with income up to 138% of the federal poverty level; see Medicare Savings Programs in Washington.

Part A deductible and coinsurance

Most people don't pay a Part A premium because they or their spouse paid Medicare taxes for at least 40 quarters (about 10 years). Learn more about Part A.

Part D: the second year of the out-of-pocket cap

2025 was the first year of the Part D out-of-pocket cap, at $2,000. In 2026, the cap is $2,100. Once your out-of-pocket costs for covered drugs reach it in a calendar year, you pay nothing more for covered Part D drugs for the rest of the year.

There is no longer a "donut hole" or coverage gap. For Washington residents who take expensive specialty drugs, that is a large change from the rules before 2025, when Part D had no out-of-pocket cap at all.

The highest deductible a Part D plan can charge in 2026 is $615; some plans charge less or none. Covered insulin stays at no more than $35 for a month's supply.

The Medicare Prescription Payment Plan, which lets you spread your out-of-pocket Part D costs across the year in monthly payments, continues in 2026. See full Part D drug cost details.

Negotiated drug prices start

On January 1, 2026, the first Medicare-negotiated prices took effect for 10 brand-name drugs covered by Part D, under the Medicare Drug Price Negotiation Program created by the Inflation Reduction Act. Negotiated prices for 15 more Part D drugs take effect January 1, 2027. What you pay for a negotiated drug still depends on your plan's copay or coinsurance, but coinsurance is figured from the lower price.

IRMAA brackets adjusted for inflation

The 2026 IRMAA threshold rose to $109,000 for single filers and $218,000 for married couples filing jointly (based on 2024 MAGI), from $106,000 and $212,000 in 2025. The lower brackets are adjusted for inflation each year; under current law, the top bracket ($500,000 single, $750,000 joint) isn't indexed until 2028.

People who pay IRMAA have a total Part B premium of $284.10 to $689.90 a month in 2026, plus $14.50 to $91 a month for Part D. See the full 2026 IRMAA guide.

Telehealth: extended through 2027

The pandemic-era Medicare telehealth flexibilities lapsed briefly in late 2025 and were then extended by Congress. Medicare.gov now says that through December 31, 2027, Medicare covers telehealth services you get from anywhere in the U.S., including your home. Mental and behavioral health visits by telehealth from home were already allowed on a permanent basis, and some services can be audio-only.

Medicare Advantage plans can offer additional telehealth benefits; check your plan's Evidence of Coverage. Telehealth extensions have come one or two years at a time, so watch for changes before the end of 2027. See telehealth and rural access in Washington.

Mental health coverage

Since 2024, Medicare covers services from marriage and family therapists and mental health counselors, and that continues in 2026. Original Medicare covers outpatient mental health care, with you generally paying 20% of the Medicare-approved amount after the Part B deductible. Medicare Advantage plans set their own cost sharing. Apple Health (Medicaid) can add coverage for people who qualify. See Mental health and Medicare in Washington.

WA Cares Fund: benefits begin

Washington's WA Cares Fund, which is separate from Medicare, collects 0.58% of each worker's wages. After a pilot in Lewis, Mason, Spokane and Thurston counties that began in January 2026, WA Cares benefits became available statewide on July 1, 2026, for people who meet the contribution requirements. The lifetime benefit is set by state law and grows with inflation. This is a state long-term care benefit, not a Medicare program. See full WA Cares details.

Medicare Advantage in 2026

In 2026, a Medicare Advantage plan's in-network out-of-pocket limit can be no more than $9,250 ($13,900 combined for PPO plans); each plan sets its own limit at or below that. Plans change every year, so re-check your plan's:

• Premium and copays
• Provider network (your doctors and hospitals)
• Drug list and pharmacy network
• Extra benefits. 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.

Plan changes take effect January 1, and your plan's Annual Notice of Change spells them out. Many Washington Medicare Advantage plans end on December 31, 2026; if yours is one of them, you can choose new coverage through February 28, 2027 (choose by December 31 to avoid a gap) and may have a guaranteed right to buy a Medigap policy until 63 days after the plan ends. See Washington Medicare plans ending in 2027.

Medigap in Washington: rules unchanged

Washington's Medigap rules are unchanged for 2026. People who already have a Medigap policy can replace it without health questions with a plan that has the same or fewer benefits, under RCW 48.66.045; Plan A can be replaced only with Plan A. Washington also requires a company to charge everyone with the same plan the same premium rather than pricing by age, with limited exceptions. See the full Medigap Washington guide.

What hasn't changed in 2026

• The 7-month Initial Enrollment Period around your 65th birthday
• The Annual Enrollment Period: October 15 to December 7
• The Medicare Advantage Open Enrollment Period: January 1 to March 31
• The 8-month Special Enrollment Period for Part B after job-based coverage ends
• The 6-month Medigap Open Enrollment Period that starts when you're 65 or older and enrolled in Part B
• The structure of Medicare Parts A, B, C and D

Action items

1. Check your Part B premium on your Social Security notice or Medicare bill.
2. Read your Annual Notice of Change if you have a Medicare Advantage or Part D plan; the Annual Enrollment Period for 2027 coverage runs October 15 to December 7, 2026.
3. Check that your doctors are still in network if you have Medicare Advantage.
4. Check your plan's drug list against your current prescriptions.
5. Check whether your plan is ending on Washington Medicare plans ending in 2027.
6. If your income dropped in 2025 and you're paying IRMAA based on 2024, file Form SSA-44.
7. If you're newly eligible, mark your Initial Enrollment Period dates now; see Turning 65 in Washington.
8. Look ahead: see the 2027 amounts published so far on Medicare costs in 2027.

Help in Washington

• 1-800-MEDICARE (1-800-633-4227, TTY 1-877-486-2048): the official federal Medicare helpline, and Medicare.gov
• Social Security (1-800-772-1213): Part B premiums, IRMAA and Extra Help
• Community Living Connections (1-855-567-0252): long-term care and aging services
• Apple Health and Medicare Savings Programs: apply through Washington Connection

A licensed insurance agent with Benefits Life can review 2027 plans from the companies they work with, at no cost to you. Call (206) SENIORS (206-736-4677), TTY 711, find an agent, or see plans in your ZIP code.

This page covers 2026 and is reviewed each fall when CMS publishes the next year's Medicare amounts. Last reviewed: November 2026.

Sources

• CMS — 2026 Medicare Parts A & B premiums and deductibles (including IRMAA)
• CMS — CY 2026 Rate Announcement (Part D benefit parameters)
• Medicare.gov — Costs for Medicare drug coverage
• CMS — Medicare Drug Price Negotiation Program
• Medicare.gov — Telehealth
• Medicare.gov — Mental health care (outpatient)
• WA Cares Fund — How the fund works
• WA Cares Fund — Benefits now available statewide
• RCW 48.66.045 — Medicare supplement policies: replacement and premiums
• Washington Health Care Authority — Medicare Savings Program

Frequently asked questions

What is the 2026 Medicare Part B premium?

The standard Part B premium for 2026 is $202.90 a month, up from $185 in 2025. Higher-income beneficiaries pay IRMAA on top, from $81.20 to $487 more a month.

What is the 2026 Part D out-of-pocket cap?

$2,100, up from $2,000 in 2025. Once your out-of-pocket costs for covered Part D drugs reach the cap in a calendar year, you pay nothing more for covered drugs for the rest of the year. There is no coverage gap (donut hole) anymore.

How much did the Part A deductible increase in 2026?

The 2026 Part A hospital deductible is $1,736 per benefit period, $60 more than in 2025. Daily coinsurance is $434 for hospital days 61 to 90 and $217 for skilled nursing facility days 21 to 100.

Did Washington's Medigap rules change for 2026?

No. Washington still lets people who have a Medigap policy replace it without health questions with a plan that has the same or fewer benefits, under RCW 48.66.045, and still requires a company to charge the same premium to everyone with the same plan rather than pricing by age. Washington doesn't have a birthday rule; its replacement right isn't tied to your birthday.

When did WA Cares Fund benefits become available?

WA Cares benefits became available statewide on July 1, 2026, after a pilot in Lewis, Mason, Spokane and Thurston counties that began in January 2026. WA Cares is a Washington long-term care program, separate from Medicare, and eligibility depends on your contribution history.

Medicare in your Washington county

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