Original Medicare plus extra coverage
- Part A
- Part B
- Medigap (Plans A–N)
- Part D drug plan
Use any doctor or hospital in the US that accepts Medicare. A Medigap plan helps pay what Original Medicare does not. A separate Part D plan covers drugs.
Medicare, explained in plain language
Sound Benefits helps people in Washington understand their Medicare choices and compare plans side by side.
- Licensed in Washington
- Plans from several insurance companies
- Medicare Advantage, Medigap and drug plans
Get started
Start your plan review
Answer a few questions about your doctors, medicines and budget. We use your answers to compare plans with you.
Prefer to talk? Call (206) 604-7050.
We do not offer every plan available in your area. Currently we represent 3 organizations which offer 20 products in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.
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Medicare basics
Medicare comes in four parts
Medicare is the federal health insurance program for people 65 and older, and for some younger people with a disability, kidney failure or ALS.
Part A: Hospital insurance
Inpatient hospital care, skilled nursing care, home health care and hospice.
Part B: Medical insurance
Doctor visits, outpatient care, therapy and medical equipment.
Part C: Medicare Advantage
A private plan that bundles Parts A and B, and usually Part D.
Part D: Prescription drugs
Coverage for the medicines you take at home.
Your choices
Two ways to get your Medicare
Most people choose one of two paths. Each fits different needs, doctors and budgets.
A Medicare Advantage plan (Part C)
- Part A
- Part B
- Part D (usually)
- Extras such as dental, vision and hearing
A private company covers your Medicare benefits in one plan. Most plans use a network of doctors, and costs and extras vary from plan to plan.
Medicare Advantage plan types
- HMO
- Use doctors and hospitals in the plan's network, except in an emergency.
- PPO
- See doctors outside the network for covered care, usually at a higher cost.
- SNP
- Special Needs Plans for people with certain chronic conditions, people who also have Medicaid, or people living in some care facilities.
When to enroll
Know your enrollment windows
Medicare has set times to sign up or make changes. Missing a window can mean waiting, or a penalty that lasts.
- IEP
Initial Enrollment Period
7 months around your 65th birthday
Starts 3 months before your birthday month and ends 3 months after it.
- AEP
Annual Enrollment Period
October 15 – December 7
Join, switch or leave a Medicare Advantage plan. Add, switch or drop a drug plan. Changes start January 1.
- OEP
Medicare Advantage Open Enrollment
January 1 – March 31
If you have a Medicare Advantage plan, you can make one change: switch plans or go back to Original Medicare.
- GEP
General Enrollment Period
January 1 – March 31
Sign up for Part A or Part B if you missed your first chance.
- SEP
Special Enrollment Period
After certain life changes
Moving, retiring, a disability, moving into a care facility, or getting Extra Help or Medicaid can open a window to change plans.
- 65+
Still working at 65?
- You can wait to sign up for Part B while you have health coverage from your own or your spouse's current job.
- Sign up within 8 months after that job or coverage ends to avoid a penalty.
- COBRA and retiree coverage do not count as coverage from a current job.
- If the employer has fewer than 20 employees, ask how its plan works with Medicare before you wait.
- A late-enrollment penalty adds 10% to the Part B premium for each full year you could have had it.
Costs
Medicare costs for 2026 and 2027
The Centers for Medicare & Medicaid Services (CMS) sets these amounts each year. Medicare Advantage and drug plans set their own premiums and copays within these limits.
Plans you choose during this enrollment period start in 2027. We add 2027 amounts as CMS publishes them.
| Cost | 2026 | 2027 |
|---|---|---|
| Part B monthly premium (standard) | $202.90 | Not yet published |
| Part B yearly deductible | $283 | Not yet published |
| Part B coinsurance after the deductible | 20% of the approved amount | 20% of the approved amount |
| Part A hospital deductible (each benefit period) | $1,736 | Not yet published |
| Part A hospital days 61–90 | $434 a day | Not yet published |
| Part A lifetime reserve days 91–150 | $868 a day | Not yet published |
| Skilled nursing facility days 21–100 | $217 a day | Not yet published |
| Part A premium if you or your spouse worked under 10 years | Up to $565 a month | Not yet published |
| Part D deductible (most a plan can charge) | $615 | $700 |
| Part D yearly out-of-pocket limit for covered drugs | $2,100 | $2,400 |
Sources:
Questions to ask
Choosing a plan that fits your life
A low premium does not mean low costs for the year. Use these questions to compare plans.
Does the plan fit your budget and your health?
- Look past the premium. Add up deductibles, copays and the out-of-pocket limit.
- If you travel, check how the plan covers care away from home.
Are your doctors and drugs covered?
- Is each of your medicines on the plan's drug list, and at what cost?
- Is your pharmacy in the network?
- Do your primary care doctor, specialists and hospital accept the plan? Confirm with each office.
Is your agent working for you?
- Does the agent compare plans from more than one insurance company?
- Does the agent work with Medicare every day?
- Will the agent check that your doctors and hospitals accept the plan you choose?
Resources
Numbers to keep handy
People with limited income may get help paying for Medicare and prescriptions through Medicaid or Extra Help (the Low Income Subsidy).
Medicare
1-800-MEDICARE (1-800-633-4227)
24 hours a day, 7 days a week. TTY 1-877-486-2048.
medicare.govSocial Security
1-800-772-1213
7am – 7pm, Monday – Friday. TTY 1-800-325-0778. Apply for Extra Help online.
ssa.govWashington Apple Health (Medicaid)
1-800-562-3022
TTY 711 through Washington Relay.
hca.wa.gov