Washington state has a competitive Medicare Advantage market, with 126 plans available for 2026 from a mix of regional and national carriers. About 748,000 Washingtonians were enrolled in Medicare Advantage as of the latest CMS data, a 48% penetration rate that places Washington close to the national average. Plan availability ranges from 37 plans in King County to just 12 in rural Klickitat County, with premiums and carrier selection varying significantly by ZIP code.
One key Washington distinction: the state brands its Dual Special Needs Plans (D-SNPs) as Apple Health Medicare Connect. Apple Health is Washington's Medicaid program, but Apple Health Medicare Connect is a Medicare Advantage product, not a Medicaid plan. Residents who qualify for both Medicare and Apple Health can enroll in Apple Health Medicare Connect plans for $0 premiums and near-zero cost-sharing. Kaiser Permanente, UnitedHealthcare, Community Health Plan of Washington (CHPW), and Molina all offer D-SNP products in the state.
This guide covers the 2026 Washington Medicare Advantage market: plan count, top carriers, plan types, county-level variance, what to look for when shopping, and key enrollment dates. The Annual Election Period is October 15 to December 7, 2026, for coverage starting January 1, 2027. Washington's SHIBA program (Statewide Health Insurance Benefits Advisors) provides free, unbiased counseling at 1-800-562-6900.
2026 Medicare Advantage Market Overview in Washington
In 2026, Washington has 126 Medicare Advantage plans available, with 748,158 beneficiaries enrolled (48% MA penetration). The average monthly premium is $18 and the statewide average Star Rating is 3.8.
Top Medicare Advantage carriers in Washington (2026)| Carrier | Plans | Avg Star Rating | Avg Premium |
|---|
| UnitedHealthcare | 22 | 4.0 | $12/mo |
| Kaiser Permanente Washington | 14 | 4.0 | $0/mo |
| Humana | 18 | 3.6 | $10/mo |
| Aetna | 16 | 4.0 | $22/mo |
| Molina Healthcare of Washington | 10 | 3.5 | $18/mo |
| WellCare (Centene) | 12 | 3.5 | $8/mo |
| Regence BlueShield | 10 | 3.1 | $85/mo |
| Community Health Plan of Washington (CHPW) | 5 | 3.5 | $5/mo |
| HealthSpring (HCSC) | 8 | 3.5 | $15/mo |
Source: CMS Medicare Plan Finder Q4 2025; KFF Medicare Advantage 2026 Spotlight; healthinsurance.org Medicare in Washington; Healthline Medicare in Washington 2026
Plan Types in Washington: HMO vs PPO vs SNP
Medicare Advantage plan-type breakdown in Washington| Plan Type | Plans Available | Avg Premium | Best For |
|---|
| HMO | 55 | $14/mo | Lower premiums, willing to use in-network providers, Kaiser enrollees |
| PPO | 42 | $35/mo | Flexibility to see out-of-network providers without referrals |
| Special Needs Plan (SNP) | 17 | $0/mo | Dual-eligible (Apple Health + Medicare), chronic conditions, institutional care |
| HMO-POS | 12 | $17/mo | HMO with limited out-of-network access at higher cost-share |
HMO plans make up the largest share of Washington Medicare Advantage plans. PPO plans offer more flexibility but at higher premiums. SNP counts include D-SNPs (Apple Health Medicare Connect), C-SNPs, and I-SNPs. Plan type counts are approximate from CMS landscape data and may vary by county.
Source: CMS Medicare Plan Finder Q4 2025, medicareadvantage.com 2026 Washington data
County-Level Variance in Washington
Washington's plan availability varies considerably by county. Puget Sound metro counties (King, Snohomish, Pierce) have the most options with 30+ plans each. Eastern Washington cities like Spokane offer strong urban markets. Rural and eastern rural counties may have only 12-15 plans, often with fewer $0-premium options.
Plan count and average premium by county in Washington| County | Plans Available | Avg Premium |
|---|
| King County | 37 | $40/mo |
| Spokane County | 38 | $13/mo |
| Pierce County | 30 | $22/mo |
| Yakima County | 20 | $16/mo |
| Klickitat County | 12 | $13/mo |
Plan counts and premiums are from CMS Medicare Plan Finder Q4 2025 and medicareadvantage.com 2026 county data. King County average premium reflects a blended average across HMO, PPO, and HMO-POS plan types, which vary significantly within the county. Use medicare.gov to search your specific ZIP code.
Source: CMS Medicare Plan Finder Q4 2025; medicare.org Washington county pages 2026
What to Look For in a Medicare Advantage Plan in Washington
Choosing a Medicare Advantage plan in Washington requires more than comparing premiums. Here are the six factors that matter most for 2026:
- Provider network. Confirm your primary care physician, specialists, and preferred hospital are in-network before enrolling. Kaiser operates a closed HMO: if you enroll, you use Kaiser doctors and facilities. Non-Kaiser HMOs and PPOs have varying network breadth by county.
- Prescription drug coverage (formulary). Most Washington MA plans include Part D. The 2026 Part D out-of-pocket cap is $2,100. Verify your specific drugs are covered at an affordable tier before enrolling. The $35/month insulin cap applies under all MA-PD plans.
- Star Ratings. CMS rates plans 1-5 stars annually on care quality, member experience, and customer service. Washington's statewide weighted average is about 3.8, close to the national average of 3.66. Kaiser Washington and Aetna's top plans in Spokane reach 4.0-4.5 stars. Plans with 4+ stars get CMS quality bonuses that fund richer benefits. Regence BlueShield rates 3.07, below average.
- Extras (dental, vision, hearing, fitness, transportation). MA plans in Washington often include preventive dental through Delta Dental of Washington, vision exams, hearing benefits, and gym access. CHPW's dual-eligible plans also include grocery benefits. Compare the Evidence of Coverage for annual dollar limits.
- Maximum out-of-pocket (MOOP). The 2026 federal MOOP ceiling for in-network MA services is $9,250 (down $100 from $9,350 in 2025). Spokane County plans average about $6,307; Klickitat County averages $8,608. Original Medicare has no MOOP, making MA's annual cap a meaningful protection for high-utilizers.
- Prior authorization. Washington MA plans can require prior authorization for imaging, surgeries, and specialist referrals. Review CMS prior authorization transparency data when choosing between plans. HMOs generally have more PA requirements than PPOs.
Key Medicare Dates in Washington
Medicare Advantage enrollment is tied to specific windows. Missing a period can delay coverage or trigger penalties.
- Annual Election Period (AEP): October 15 - December 7, 2026 — Switch between Original Medicare and MA, change MA plans, or change Part D plans. Coverage starts January 1, 2027.
- Medicare Advantage Open Enrollment Period (MA OEP): January 1 - March 31, 2026 — Already in an MA plan? You can switch to a different MA plan or return to Original Medicare once during this window.
- Initial Enrollment Period (IEP): 7-month window around your 65th birthday — Starts 3 months before your 65th birthday month, includes the birth month, and ends 3 months after. Enroll in Medicare Parts A and B, then choose MA or Original Medicare plus standalone Part D.
- Special Enrollment Periods (SEPs): Varies by qualifying event — Moving out of your plan's service area, losing employer coverage, qualifying for Apple Health (dual eligible), or other life events trigger a SEP. Dual-eligible residents can switch MA plans once per quarter in Q1, Q2, and Q3.
Notable Extras in Washington Plans
Washington has several state-specific Medicare Advantage features worth understanding before you shop for 2026:
- Apple Health Medicare Connect (D-SNPs): Washington brands its Dual Special Needs Plans as Apple Health Medicare Connect. These are Medicare Advantage plans, not Apple Health (Medicaid) plans, designed for residents enrolled in both. They typically feature $0 premiums, $0 primary care copays, zero drug costs, and extras like grocery allowances and transportation. Carriers offering Apple Health Medicare Connect plans in 2026 include UnitedHealthcare, Kaiser Permanente, CHPW, Molina, and WellCare. Eligibility is determined by Apple Health, not Medicare.
- Washington Medigap: year-round guaranteed-issue switching: Washington gives Medigap policyholders stronger switching rights than federal law. After 90 days of continuous Medigap coverage, you can switch to a different Medigap plan at any time on a guaranteed-issue basis, without medical underwriting. This is different from most states, where guaranteed-issue rights are limited. Pre-existing condition waiting periods are capped at 3 months (federal law allows 6). This matters when leaving Medicare Advantage: if you return to Original Medicare and want Medigap, Washington's rules give you more flexibility than other states.
- SHIBA: free Medicare counseling: Washington's SHIBA (Statewide Health Insurance Benefits Advisors) program provides free, unbiased Medicare counseling from trained volunteers. SHIBA counselors can help you compare plans, understand your rights, and navigate Apple Health Medicare Connect enrollment. Call 1-800-562-6900 or visit insurance.wa.gov to find a local counselor.
- Delta Dental preventive coverage on many WA MA plans: Many individual Medicare Advantage HMO plans in Washington include preventive dental benefits administered by Delta Dental of Washington at no additional premium. Coverage typically includes cleanings, exams, and X-rays. Comprehensive dental (crowns, dentures, implants) is less common and usually requires a separate rider or a plan with richer benefits.
Medicare Advantage vs Original Medicare in Washington
Original Medicare (Parts A and B) plus a Medigap supplement and a standalone Part D plan gives you nationwide provider freedom with no prior authorization for most services. The trade-off: your monthly cost in Washington typically runs $200-$400/month for Medigap plus Part D premiums. Medicare Advantage plans bundle hospital, medical, and usually drug coverage into one plan, averaging $18/month statewide in Washington for 2026, with many HMO plans at $0 premium. The trade-off is a defined network and prior authorization for many procedures.
Washington's stronger Medigap rules change this calculus somewhat. Unlike most states, Washington allows guaranteed-issue Medigap switching year-round after 90 days of continuous coverage. If you choose Original Medicare + Medigap today and later want to switch to MA, you retain the ability to return with Medigap options. In most other states, that return path is more restricted. Still, the choice between MA and Original Medicare + Medigap comes down to your care patterns, travel habits, and tolerance for network restrictions.
For Washington residents who split time between states or need out-of-state specialists, Original Medicare + Medigap typically provides better nationwide access. For residents who stay primarily in Washington and want lower premiums plus extras like dental and vision, Medicare Advantage often delivers better value on total annual cost.
Medicare Advantage vs Original Medicare in Washington detail| Feature | Medicare Advantage (WA avg) | Original Medicare + Medigap |
|---|
| Monthly premium | ~$18/mo (many $0) | $200-$400/mo (Medigap + Part D) |
| Network | In-network required (HMO) or preferred (PPO) | Any Medicare-accepting provider nationwide |
| Annual OOP cap | $9,250 federal max (many plans set lower) | None (Medigap covers most gaps) |
| Dental/vision/hearing | Usually included (varies by plan) | Not covered by Original Medicare |
| Prior authorization | Yes, for many services | Rarely required |
Medigap premium estimate for Washington residents age 65-70, Plan G. Actual costs vary by age, tobacco use, and insurer. Washington's community-rating and guaranteed-issue rules affect pricing.
How Star Ratings work and what they mean for Washington shoppers
CMS publishes Medicare Advantage Star Ratings each October, rating plans 1 to 5 stars based on roughly 40 quality measures: management of chronic conditions, customer service, member complaints, and Part D drug safety. Plans that earn 4 or more stars receive quality bonus payments from CMS, which carriers typically reinvest into richer benefits the following plan year.
Washington's 2026 weighted-average Star Rating is about 3.8, just above the national average of 3.66 per CMS. Kaiser Permanente Washington earns 4.0 stars, and Aetna's top plan in Spokane reaches 4.5 stars. Regence BlueShield rates 3.07 across its WA, OR, and UT contracts, with only 1% of members in plans rated 4+ stars. When comparing plans in Washington, prioritize 4-star plans for the best value: better benefits, often at similar or lower premiums than 3-star alternatives.
A rare 5-star plan activates a Special Enrollment Period allowing you to switch into it at any point during the year, outside of AEP. Check medicare.gov each October after new Star Ratings are released to see if any Washington plans earn 5 stars for 2027.
Apple Health, dual eligibility, and D-SNPs in Washington
Apple Health is the name for Washington's Medicaid program. Apple Health Medicare Connect is a separate, Medicare-funded product: it is a Dual Special Needs Plan (D-SNP) designed for people enrolled in both Medicare and Apple Health. The distinction matters because many Washington residents confuse the two. You do not enroll in Apple Health Medicare Connect through the Apple Health office. Check whether you qualify for Extra Help with drug costs; you enroll through the MA carrier directly or with help from SHIBA.
Washington has 17 SNP plans in 2026 including D-SNPs, C-SNPs (chronic condition plans), and I-SNPs (institutional plans). D-SNPs typically offer $0 premiums, $0 primary care copays, and zero drug costs. Some plans also include grocery allowances of $25-$75/month, utility assistance, and transportation to medical appointments. CHPW's Dual Complete plan is among the most comprehensive D-SNP options, with grocery benefits, dental, vision, hearing, and fitness access.
If you think you may qualify for both Medicare and Apple Health, contact DSHS at 1-800-562-3022 or visit dshs.wa.gov to determine eligibility. Dual-eligible beneficiaries also have expanded enrollment rights: they can change MA plans once per quarter in Q1, Q2, and Q3, in addition to changes during AEP.
Frequently Asked Questions
How many Medicare Advantage plans are available in Washington in 2026?
Washington has 126 Medicare Advantage plans available statewide for 2026, per the CMS 2026 Medicare and Prescription Drug Landscape. The exact number in your county varies: King County has 37 plans, Spokane County has 38, and rural Klickitat County has 12. Use the ZIP-code search at medicare.gov to see every plan available at your address.
What is the average Medicare Advantage premium in Washington for 2026?
The statewide average monthly premium for Medicare Advantage plans in Washington is approximately $18 for 2026, slightly above the national MA average of $14 per month. Many HMO plans, especially from Kaiser Permanente and UnitedHealthcare, charge $0 monthly premium. PPO plans and Regence BlueShield plans tend to be pricier, with some Regence plans averaging around $85-$100/month.
What is Apple Health Medicare Connect?
Apple Health Medicare Connect is Washington state's brand name for Dual Special Needs Plans (D-SNPs), which are Medicare Advantage plans for people enrolled in both Medicare and Apple Health (Washington's Medicaid program). These plans are funded by Medicare, not Apple Health, and typically offer $0 premiums, $0 copays for primary care, zero drug costs, and extra benefits like grocery allowances and transportation. Carriers offering Apple Health Medicare Connect in 2026 include UnitedHealthcare, Kaiser Permanente, CHPW, Molina, and WellCare.
When can I sign up for Medicare Advantage in Washington?
The main window is the Annual Election Period (AEP) from October 15 to December 7, 2026, for coverage starting January 1, 2027. New Medicare enrollees can sign up during their 7-month Initial Enrollment Period around their 65th birthday. Existing MA enrollees can switch plans or return to Original Medicare once during the MA Open Enrollment Period (January 1 - March 31, 2026). Dual-eligible residents with Apple Health can switch MA plans once per quarter in Q1, Q2, and Q3 as well.
Which carriers offer Medicare Advantage in Washington in 2026?
The leading carriers in Washington for 2026 are UnitedHealthcare (largest national carrier, AARP-branded plans), Kaiser Permanente Washington (4.0-star HMO, western and eastern WA), Humana (HMO and PPO statewide), Aetna (4.5-star plans in Spokane), Molina Healthcare of Washington, WellCare (Centene, strong SNP focus), Regence BlueShield (regional, below-average Star Ratings), Community Health Plan of Washington (CHPW, D-SNP focused), and HealthSpring (HCSC). Note: Premera Blue Cross exited the Medicare Advantage market effective January 1, 2025 and does not offer MA plans in 2026.
Can I switch from Medicare Advantage back to Original Medicare in Washington?
Yes. You can switch back during AEP (October 15 - December 7) or the MA OEP (January 1 - March 31). Washington has stronger Medigap protections than most states: after 90 days of continuous Medigap coverage, you can switch Medigap plans year-round without medical underwriting. However, that right to switch between Medigap plans without underwriting is not the same as a guaranteed right to buy Medigap when first leaving MA. If you are leaving MA and want Medigap for the first time, you may need a guaranteed-issue right (such as your plan leaving the market or losing MA eligibility). Consult SHIBA at 1-800-562-6900 before making this move.
Does Medicare Advantage cover prescription drugs in Washington?
Most Washington Medicare Advantage plans include Part D prescription drug coverage (called MA-PD plans). The 2026 Part D annual out-of-pocket maximum is $2,100, set by the Inflation Reduction Act signed in 2022. All MA-PD plans also cap insulin at $35/month. Always verify your specific medications are on the plan's formulary and at a cost tier you can afford before enrolling.
What free help is available for Medicare shopping in Washington?
Washington's SHIBA program (Statewide Health Insurance Benefits Advisors) provides free, unbiased Medicare counseling from trained volunteers at no cost. SHIBA can help you compare plans, understand Apple Health Medicare Connect eligibility, review your rights, and navigate enrollment. Call 1-800-562-6900 or visit insurance.wa.gov to find a local SHIBA counselor. You can also use medicare.gov to compare plans online by ZIP code.
