2026 Medicare Changes Simplified for Washington State

Feeling Lost in Medicare Alphabet Soup?

WISeR, VBID, SSBCI, MOOP, ANOC… sound familiar? If those acronyms make your head spin, you’re not alone. Every fall, millions of people try to make sense of their Medicare coverage, and this year is shaping up to be one of the most complicated yet.

The 2026 Annual Enrollment Period runs October 15 through December 7, 2025, and several federal changes take effect January 1, 2026. Below, I’ve simplified what’s new — the good, the bad, and the “wait, what does that even mean?” We’re also including a resource that can help you get personalized, unbiased guidance about your specific Medicare options here in Washington.

Medicare 2026 at a Glance

The Tough News First

Original Medicare (Parts A & B)

Hospital (Part A) and medical (Part B) premiums and deductibles will rise slightly in 2026, according to the Centers for Medicare & Medicaid Services (CMS).
Source: CMS 2026 Medicare & You Handbook

Preventive and telehealth services are still covered, but some of the emergency pandemic-era flexibility is winding down.

The New WISeR Model

Starting January 1, 2026, Washington will participate in the new WISeR (Wasteful and Inappropriate Service Reduction) Model, a 6-year CMS pilot.

It focuses on about 17 specific medical procedures (like spinal fusions, knee arthroscopies, and certain injections) that have shown high variation in use. Doctors may need to submit prior authorizations or undergo extra review before Medicare pays.

Source: CMS Innovation Center, WISeR Model Overview

If you’re on Original Medicare, this could mean longer processing times for elective procedures — but it doesn’t change what’s covered or your appeal rights.

Medigap (Medicare Supplement) Premiums

Most Medigap insurers are expected to raise rates in 2026 due to rising healthcare costs and claims.
The exact increase will vary depending on your plan (G, N, etc.), your insurer, your age, and state / local pricing rules.
This could be a good time to re-shop or compare plans if your premium jumps.

Source: KFF's "What to Expect for Medicare and Social Security in 2026" projects an 8–12% increase in Medigap premiums. Odyssey Advisors, Inc

Medicare Advantage (Part C)

CMS has finalized a 5.06% increase in payments to Medicare Advantage (MA) plans for 2026, but that doesn’t necessarily mean your costs go down.
Many insurers are tightening networks, adding referral requirements, or dropping PPO options in favor of HMOs.

Source: CMS 2026 Medicare Advantage & Part D Rate Announcement

At the same time, the VBID (Value-Based Insurance Design) pilot — which allowed flexible benefits for lower-income or high-need members — ends after 2025. In its place, plans can only offer extra benefits to people who meet strict “chronically ill” criteria under SSBCI (Special Supplemental Benefits for the Chronically Ill).

Translation: fewer “bonus” benefits like meal delivery, transportation, or home modifications unless you meet medical eligibility rules.

Source: CMS Final Rule Summary: Contract Year 2026

Prescription Drug Coverage (Part D)

2026 is a big transition year for drug coverage.

• The good news: the annual out-of-pocket cap drops to $2,100, protecting more seniors from runaway drug bills.

• The catch: many plans are raising premiums or moving drugs to higher tiers.

Average Part D premiums are projected to fall from $38.31 in 2025 to $34.50 in 2026, but your personal plan costs could still rise.

Sources:

• CMS Part D Bid and Premium Demonstration Parameters, 2026

• FierceHealthcare: CMS Says 2026 Part D Premiums Will Decline

Now for the Positives

• Lower average drug plan premiums and a firm out-of-pocket cap for prescriptions are real wins.

• No major benefit cuts to preventive or wellness visits.

• Vaccines and insulin remain capped ($35/month for insulin).

• Medicare Advantage funding is increasing, which may help preserve benefits in stronger local plans.

What You Should Do Before Enrollment

1. Review your ANOC (Annual Notice of Change) letter in early October.

2. Check that your doctors and preferred pharmacies are still in-network.

3. Compare 2026 plans in your ZIP code — many counties are seeing plan exits or merges.

4. Get free, unbiased help from SHIBA (Statewide Health Insurance Benefits Advisors).

Getting Help: You Don’t Have to Figure This Out Alone

Medicare can feel overwhelming — especially with all the changes coming in 2026. But you don’t have to make sense of it by yourself. Washington State’s SHIBA program (Statewide Health Insurance Benefits Advisors) offers free, confidential, and unbiased help from trained counselors who understand the local plans and the new rules.

Whether you’re comparing Medicare Advantage options, checking how your prescriptions are covered, or wondering if Original Medicare is still the best fit, SHIBA can walk you through your choices step by step.

You can connect with SHIBA through the Washington State Office of the Insurance Commissioner at https://www.insurance.wa.gov/shiba or call 1-800-562-6900.

Bottom Line

2026 brings real changes — some helpful, others more complicated. Staying informed now can save a lot of stress later. And if you ever feel buried in acronyms, just remember: even Medicare experts have to look them up sometimes.