Washington has roughly 1.4 million Medicare enrollees, with about 42% currently on Medicare Advantage — a lower MA share than the national average and well below states like Florida or Alabama.1 That reflects the market structure: King, Snohomish, and Pierce counties have deep competitive MA markets, while many rural Eastern Washington counties have only one or two Advantage plans available.
What Medicare covers, and what it doesn’t
Medicare is health insurance. It is not long-term-care insurance. The most expensive misconception in caregiving, and especially common in Washington where adult children of out-of-state parents assume Medicare will pay for in-home aide hours or memory care. It will not.
What Medicare does cover:
- Part A (Hospital).Inpatient stays, skilled nursing rehab for up to 100 days after a qualifying hospital admission (first 20 days fully covered; days 21–100 subject to copay ~$200/day in 2026), hospice, and limited home health.
- Part B (Medical). Doctor visits, outpatient procedures, durable medical equipment, mental health, preventive care, ambulance.
- Part D (Drugs). Prescription drug coverage. The 2025 Inflation Reduction Act capped Part D out-of-pocket at $2,000/year.
What Medicare does not cover:
- Assisted living (any state, any setting)
- Memory care
- Custodial nursing-home care beyond the 100-day rehab window
- Long-term in-home aide hours (Medicare covers brief skilled home health, not ongoing custodial support)
- Dental, vision, or hearing under Original Medicare — though many Advantage plans add some of these as bundled extras
Original Medicare vs. Medicare Advantage in Washington
Every Medicare-eligible person chooses between two broad structures: Original Medicare (Parts A and B, usually with a Medigap supplement and a Part D drug plan) or Medicare Advantage (Part C, a private plan that bundles A, B, and usually D plus extras). Washington’s split is roughly 58% Original / 42% Advantage in 2025.2
The geography matters. In King, Snohomish, and Pierce counties, 40+ Advantage plans typically compete — plenty of $0-premium options with rich extras. In rural counties like Garfield, Ferry, Pend Oreille, and parts of Okanogan, two or three plans is the norm. The Advantage choice can be much better in metro Western Washington than in Eastern Washington, simply because of the competition.
When Original Medicare + Medigap usually beats Advantage
- Your parent travels frequently or has a part-time residence elsewhere. Original Medicare works nationally with any Medicare-accepting provider; MA plans have networks.
- Your parent has complex conditions and wants unrestricted specialist access without referrals or prior authorizations.
- Your parent lives in a rural Eastern Washington county with a thin MA market. The Original + Medigap path provides broader provider access than the available MA plans.
When Advantage usually beats Original Medicare
- Your parent lives in King, Snohomish, or Pierce county year-round and is generally healthy.
- The combined cost of Original Medicare Part B premium + Medigap premium + Part D premium exceeds the budget, and a $0-premium Advantage plan with adequate network is available.
- The extras matter — dental, vision, hearing, gym memberships, sometimes grocery delivery — that Advantage plans bundle in.
Medigap in Washington
If your parent chooses Original Medicare, a Medigap policy covers the deductibles and coinsurance that Original Medicare leaves behind. Medigap plans are federally standardized— Plan G in Washington offers the same benefits as Plan G anywhere — but Washington has specific rating and enrollment rules:
- Washington is an age-rated state.Premiums rise as your parent ages. Some states (Connecticut, New York, Massachusetts) require community rating where premiums don’t rise with age. Washington does not.
- Guaranteed issue applies during the 6-month Initial Enrollment Period when your parent turns 65 or first enrolls in Part B. Outside that window, insurers can use medical underwriting to deny coverage or charge more.
- Washington has a specific Medigap birthday rule— rules vary by state, and Washington’s structure differs from California or Oregon. Verify the current annual switching rule with a SHIBA counselor before relying on it.
Apple Health Medicare Savings Programs (MSPs)
Washington dual-eligibles — people with both Medicare and Apple Health — can have Medicare costs paid by the state through MSPs. Three tiers:3
- QMB (Qualified Medicare Beneficiary). Pays Part A and Part B premiums, deductibles, and coinsurance. Income limit ~$1,255/month individual (2026).
- SLMB (Specified Low-Income Beneficiary). Pays Part B premium. Income limit ~$1,506/month.
- QI (Qualifying Individual). Pays Part B premium. Income limit ~$1,695/month. First-come first-served annual funding.
Many Washington seniors who qualify never apply because the application is opaque and outreach is limited. A SHIBA counselor can walk your parent through the process for free.
Annual Enrollment Period (AEP) in Washington
Medicare AEP runs from October 15 through December 7 each year. During this window your parent can:
- Switch from Original Medicare to Medicare Advantage (or vice versa)
- Switch from one Advantage plan to another
- Add, drop, or switch a standalone Part D plan
Washington’s AEP marketing is lighter than in heavily- retired states like Florida or Arizona, but Seattle metro still sees significant television and direct-mail spend. The right comparison tool is Medicare.gov’s Plan Finder, which lets you enter your parent’s ZIP code, prescriptions, and preferred providers, then ranks every plan by total annual cost.4
A Medicare Advantage Open Enrollment Period (MA OEP) runs January 1 through March 31 each year — a second chance for someone already on Advantage to switch or move back to Original Medicare with Part D.
Where to get free help in Washington
SHIBA(Statewide Health Insurance Benefits Advisors) is Washington’s federally-funded State Health Insurance Assistance Program (SHIP), operated by the Office of the Insurance Commissioner. Volunteers across every Washington county provide free, unbiased Medicare counseling — they don’t sell plans, take commissions, or represent any insurer. Call 1-800-562-6900 or visit insurance.wa.gov/shiba.
For Medicaid-related questions where Medicaid and Medicare interact (dual-eligibility, LTC benefits), see our Washington Apple Health guide.