Medicare itself is a federal program, so the core rules come from the Centers for Medicare & Medicaid Services (CMS). However, states can add consumer protections, administer related Medicaid programs, regulate insurers, and run assistance programs. Washington has several notable state-specific Medicare rules and policies that differ from many other states.
Below are the most important Washington-specific Medicare regulations and features.
1. Washington’s “Continuous Medigap Open Enrollment” Rule
Washington has one of the strongest Medigap consumer protections in the U.S.
Washington rule:
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If you already have a Medigap plan B–N, you can switch to another Medigap plan anytime during the year.
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Insurers cannot require medical underwriting (no health questions).
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The new policy must be issued regardless of pre-existing conditions.
This is governed by Washington law (RCW 48.66.045).
How this differs from most states:
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Most states allow switching only during the initial 6-month Medigap enrollment window or with underwriting afterward.
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Washington allows switching year-round.
Important limitation:
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If you have Plan A, you generally can only switch to another Plan A.
This rule is widely considered one of the most consumer-friendly Medigap protections in the country.
2. Washington Runs Medicare Savings Programs Through Apple Health
Washington administers federal Medicare Savings Programs (MSPs) through its Medicaid program called Apple Health.
Programs include:
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Qualified Medicare Beneficiary (QMB)
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Specified Low-Income Medicare Beneficiary (SLMB)
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Qualified Individual (QI)
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Qualified Disabled and Working Individuals (QDWI) (Washington State Health Care Authority)
These programs can pay for:
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Medicare Part B premiums
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Deductibles
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Coinsurance
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Copayments (Washington DSHS)
Washington has also expanded eligibility thresholds slightly:
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QMB eligibility raised to 110% of the federal poverty level (recent update). (Washington State Health Care Authority)
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3. Washington Eliminated Asset Verification for MSP Applications
Washington simplified access to Medicare cost-assistance programs.
For Medicare Savings Programs:
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Resource (asset) verification was removed during application.
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This reduces paperwork and makes it easier for seniors to qualify. (GovDelivery)
Many states still require strict asset documentation.
4. Washington Opted Out of Federal Physician Supervision Requirement for CRNAs
Washington opted out of the federal rule requiring physician supervision of nurse anesthetists for Medicare reimbursement.
This means:
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Certified Registered Nurse Anesthetists (CRNAs) can practice without physician supervision in Medicare settings.
States must formally opt out to allow this.
5. State Administration of Dual-Eligible Programs
Washington coordinates Medicare with Medicaid via Apple Health long-term care programs.
Categories include:
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Full-Benefit Dual Eligible (FBDE) – Medicare + full Medicaid
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Partial-Benefit Dual Eligible – Medicare + MSP assistance (Washington State Health Care Authority)
These programs can cover:
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Long-term services and supports
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Nursing facility coinsurance
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Home and community-based services.
6. Washington Participates in the 2026 Traditional Medicare Prior Authorization Pilot
Starting January 1, 2026, Washington became one of six states in a federal test program requiring prior authorization for certain services under traditional Medicare. (Kiplinger)
Key points:
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Applies to 17 services prone to fraud or misuse.
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Emergency and inpatient-only procedures are excluded.
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Designed to reduce improper billing.
This program is called the WISeR model.
7. Washington’s State Medicare Counseling Program
Washington provides free Medicare counseling through SHIBA.
Program:
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Statewide Health Insurance Benefits Advisors
Services:
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Plan comparison
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Appeals help
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Fraud reporting
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Enrollment assistance. (Office of the Insurance Commissioner)
While many states have SHIP programs, Washington’s SHIBA is one of the larger volunteer networks.
Key Takeaways
The most unique Medicare rules in Washington are:
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Year-round Medigap switching with no underwriting
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Expanded Medicare Savings Program access via Apple Health
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Simplified eligibility (no asset verification)
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CRNA supervision opt-out
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Integrated Medicare-Medicaid programs
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Participation in a federal prior-authorization pilot (2026)
✅ The biggest practical difference for residents:
Washington’s Medigap switching rule gives beneficiaries far more flexibility than most states.