Annual Notice of Change letters land in late September, and the enrollment window opens October 15. For a Puget Sound family already thinking about care, this is the one month a year when the plan choice is actually reversible.
By Diane Whitfield, CSA · September 17, 2026
Every September, Medicare plans mail out an Annual Notice of Change — the document that tells your parent what their premium, deductible, drug list, and provider network will look like next year. Most families set it on the counter unopened. Then Medicare's Annual Enrollment Period runs October 15 through December 7, 2026, with anything you change taking effect January 1, 2027.
For a family that is already watching a parent slow down, that window is worth a real evening of attention. The plan choice made in October is the plan that will be sitting underneath the next hospital stay, the next rehab admission, and the next set of specialist referrals — and outside this window, the options narrow sharply.
Start by clearing up the single most expensive misunderstanding in this field: neither Original Medicare nor a Medicare Advantage plan pays the monthly rent at an assisted living community or a licensed adult family home. In the Puget Sound market that is roughly $6,000 to $8,000 a month for assisted living and $4,500 to $7,000 for an adult family home, and it comes from private funds, long-term-care insurance, veterans benefits, or Washington's Apple Health with the COPES waiver.
What Medicare does cover is short-term skilled nursing and rehabilitation. Under Original Medicare, that means up to 100 days in a skilled nursing facility per benefit period following a qualifying inpatient hospital stay — the first 20 days with no coinsurance, and a daily coinsurance after that which Medicare resets each year. Medicare Advantage plans must cover the same benefit, but they get to run it differently, and that difference is where Puget Sound families get surprised.
Advantage plans in King, Snohomish, and Pierce counties compete hard, and many offer real extras — transportation to appointments, an over-the-counter allowance, meals after a hospital discharge, even a limited number of in-home support hours. Those benefits are genuinely useful to an older adult still living at home, and they are listed in the Annual Notice of Change.
The trade-off is network and authorization. An Advantage plan may waive the three-day inpatient requirement before rehab, which helps, but it also decides which skilled nursing facilities are in network and reviews the stay as it goes — which can mean coverage ends before the family expected it to. Before renewing, look up the rehab facilities closest to your parent's home and confirm they are in the plan's network for 2027, not just for this year. Networks change every January, and a plan that covered the facility down the road from the house in Kent or Marysville may not next year.
Moving from Original Medicare into an Advantage plan is easy. Moving the other direction can be complicated, because a Medigap supplement policy — the thing that makes Original Medicare workable for someone with real medical needs — is not guaranteed to be available on the same terms once you have left. Washington's Medigap rules are more generous than the federal floor, but they are specific, and this is exactly the question to get answered by someone with no commission at stake.
There is also a second, narrower window: from January 1 to March 31, someone enrolled in a Medicare Advantage plan may make one change — to a different Advantage plan or back to Original Medicare with a drug plan. It is a useful safety valve, not a substitute for choosing carefully in the fall.
Washington runs a free, unbiased Medicare counseling program called SHIBA — Statewide Health Insurance Benefits Advisors — through the Office of the Insurance Commissioner, at 1-800-562-6900. SHIBA volunteers compare plans side by side and take no commission, which is not true of every voice that will call your parent this fall. Expect a heavy volume of marketing calls and mailers between now and December 7; nothing legitimate requires a same-day decision.
Your Area Agency on Aging can also help sort out what sits next to Medicare: Aging and Disability Services for King County, Homage for Snohomish County, and Aging & Disability Resources of Pierce County, all reachable through Community Living Connections. And if the enrollment conversation is happening because care needs are changing, that is the moment to look at the whole picture — Medicare handles the medical side, but the housing and personal-care side runs on a different set of programs entirely.
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