WA Cares Fund in 2026: The 0.58% Premium, the $36,500 Benefit and How It Fits With Medicare

0.58% of every paycheck, a lifetime benefit of $36,500, and since July 1, 2026, real money going out the door. That's WA Cares Fund in three numbers. Washington is the first state to run a public long-term care insurance program, and after three years of payroll deductions before any benefits, the benefit side is now open.

Why cover it on a Medicare page? A common assumption at 65 is that Medicare covers the nursing home. Medicare.gov answers it bluntly: Medicare doesn't pay for long-term care. It goes on to say that Medicare and most health insurance, including Medicare Supplement Insurance (Medigap), don't pay for long-term care services, including care in a nursing home or in the community. WA Cares is aimed at exactly that gap. It does not replace Medicare and it isn't part of Medicare; it's a separate state program with its own rules, run by the Department of Social and Health Services (DSHS) with the Health Care Authority and the Employment Security Department (ESD).

Every figure below comes from WA Cares, ESD, DSHS, the Pension Funding Council, the Office of the Insurance Commissioner, the statute (chapter 50B.04 RCW) or Medicare.gov.

Source: WA Cares, Covered benefits; WA Cares employer page; WA Cares, July 1, 2026 announcement; WA Cares, Qualifying for benefits.

What Medicare pays for, and what it doesn't

Medicare pays for medical care. Long-term care is mostly not medical. Medicare.gov defines it as help with the basic personal tasks of everyday life (dressing, bathing, using the bathroom), plus things like home-delivered meals, adult day health care and transportation. That's the care most people end up needing as they age, and it's the care Medicare leaves to you.

Where people get confused is skilled nursing. Medicare Part A does cover a stay in a skilled nursing facility, but only for a limited time and only after a qualifying inpatient hospital stay of at least three days in a row. Observation time doesn't count toward those three days. In 2026 you pay nothing for days 1 through 20 after the $1,736 Part A deductible, $217 a day for days 21 through 100, and all costs from day 101. That's rehab after a hospital stay, not a place to live.

Home health has the same shape. Medicare's home health benefit requires that you be homebound and need part-time or intermittent skilled care. Medicare.gov lists what it doesn't pay for: 24-hour-a-day care at home, home meal delivery, homemaker services unrelated to your care plan, and custodial or personal care when that's the only care you need.

Source: Medicare.gov, Long-term care; Medicare.gov, Skilled nursing facility care; Medicare.gov, Home health services; RCW 50B.04.010(2); WA Cares, Covered benefits.

One more thing on coordination. The law tells the Health Care Authority to write rules for coordinating benefits when a WA Cares beneficiary is also covered by Medicaid, Medicare, Labor & Industries or private long-term care coverage (RCW 50B.04.020). If Medicare is paying for a skilled stay, expect WA Cares to look at what Medicare already covers. Ask before you assume both pay for the same day.

The premium: 0.58% with no wage cap

People search for the "WA Cares tax rate." Legally it's a premium, collected by ESD through payroll the same way Paid Family and Medical Leave is. RCW 50B.04.080 set the starting rate at 0.58% of wages from July 1, 2023. Starting January 1, 2026, the Pension Funding Council sets the rate every two years, at no more than 0.58%, and at the lowest level needed to keep the trust solvent.

For 2026 nothing changed. On October 8, 2025, the Pension Funding Council voted 6-0 to keep the rate at 0.58%, as the State Actuary recommended.

Two details that surprise people:

• No wage cap. Unlike Paid Leave, WA Cares premiums are not capped at the Social Security taxable maximum. Every dollar of wages is assessed.
• The employer doesn't pay a share. The whole premium comes out of the employee's pay, though an employer may choose to pay some or all of it (WA Cares employer page).

The math is the one ESD gives employers: gross wages times 0.0058. Hypothetical examples at four salary levels:

$40,000 in wages$232$60,000 in wages$348$85,000 in wages$493$150,000 in wages$870

Source: Rate from WA Cares employer page and Pension Funding Council, Oct 8, 2025; amounts computed for illustration.

Show the numbers

Item	Premium per year
$40,000 in wages	$232
$60,000 in wages	$348
$85,000 in wages	$493
$150,000 in wages	$870

At $60,000 a year, that's $348, about $29 a month. Ten years at that wage with no raises comes to $3,480 in premiums, for a benefit worth $36,500 in 2026 dollars and indexed upward from there. Whether that's a good trade depends on whether you ever need care; there's no cash-out if you don't. WA Cares says plainly it works like insurance, not a savings account.

Is the premium deductible on your federal return? WA Cares says it can't advise on that and points people to a tax professional or the IRS. I'd do the same.

Who qualifies: three contribution paths

You need two things: enough contribution years, and a care need. A year counts if you worked at least 500 hours in Washington that calendar year (WA Cares puts that at about 10 hours a week). Part-time work counts the same as full-time.

Source: RCW 50B.04.050; WA Cares, Qualifying for benefits.

If you've read older articles that say "ten years without a five-year break," that was the old law. The 2023 version of RCW 50B.04.050 required a total of ten years without interruption of five or more consecutive years. The 2025 amendments, effective January 1, 2026, cut it to a total of ten years.

The temporary pathway is why benefits were available on day one. Contributions started in July 2023, so nobody has 10 years yet. WA Cares' summary for 2026 applications: if you've contributed for at least three years, you've earned access to the full $36,500.

The transition pathway matters most to readers of a Medicare page. If you were born before 1968 and you're still working, each qualifying year earns you a tenth of the full benefit. Example: say you were born in 1960, worked 500+ hours in Washington in two qualifying years, then retired. Under the transition rule that's 2 x $3,650 = $7,300. The statute also says someone born before 1968 who meets the 3-of-6 rule gets the full amount, so a third qualifying year changes the answer from $7,300 to $36,500 (as long as those years stay inside the six-year window). If you need care, have WA Cares check both paths.

And if you're fully retired and not working at all? WA Cares says you won't be able to earn benefits. A retiree who still works at least 500 hours a year as an employee does contribute and earn.

The care-need test

Contribution years get you in the door. To actually use the money, DSHS has to find that you need help with at least three activities of daily living, and that the need is expected to last at least 90 days (RCW 50B.04.060). WA Cares lists seven:

Source: activity list from WA Cares, Qualifying for benefits and WA Cares FAQ; plain-language descriptions are ours.

Supervision counts. If you can bathe yourself but someone has to set things up, cue you or watch you, WA Cares counts that activity. That matters for people with early dementia who are physically capable but not safe alone. The assessment is a conversation with a WA Cares team member, in person or by phone, and the statute requires DSHS to have enough assessors that a decision can be made within 45 days of a request.

It's not age-based. An eligible beneficiary has to be 18 or older, and WA Cares points out that long-term care isn't only for older people: accidents and illnesses happen at any age.

What the benefit pays for

WA Cares says it covers more than 40 care services. The statute's list (RCW 50B.04.010(2)) runs from in-home personal care to nursing homes. Grouped the way WA Cares groups them:

Source: WA Cares, Covered benefits; RCW 50B.04.010(2). WA Cares notes some services may not be available statewide.

How it pays: you don't file claims. You choose a registered WA Cares provider, approve the authorization, and WA Cares pays the provider directly. Each service has a maximum rate, and providers can't charge more than the maximum or ask you to pay extra out of pocket. An earlier version of the law capped use at $100 a day; WA Cares says that cap is gone, so you can spend the balance as fast or as slowly as your care requires.

A family member can be the paid caregiver, including a spouse or registered domestic partner, through a home care agency or as an individual provider.

How far does $36,500 go? WA Cares' own estimate is around 20 hours a week of home care for about a year. It also published three sample care plans (built in 2025, prices are estimates and not guaranteed):

Paid family caregiver 10 hrs/wk for 2 years + supplies$35KRamp and doorways + alert system 3 yrs + meals 3 yrs$36KPart-time aide 20 hrs/wk for 6 months + ramp + equipment$29K

Source: WA Cares, Covered benefits: how far does the benefit go?

Show the numbers

Item	Estimated total
Paid family caregiver 10 hrs/wk for 2 years + supplies	$35K
Ramp and doorways + alert system 3 yrs + meals 3 yrs	$36K
Part-time aide 20 hrs/wk for 6 months + ramp + equipment	$29K

Those plans all keep the person at home, and that's the design. WA Cares says most people will choose benefits that let them stay home. Treat $36,500 as a meaningful layer, not a complete long-term care plan.

Two protections worth knowing. WA Cares benefits are not subject to estate recovery, and under RCW 50B.04.150 benefits used are not income or resources for eligibility for any other state program, Medicaid, a state-federal program or any other means-tested program. If you're also applying for a Medicare Savings Program or Apple Health, a WA Cares benefit doesn't count against you there. The benefit can't be transferred to a spouse or family member, and there's no cash-out.

Exemptions, opting back in and moving away

This is where the most out-of-date information lives online, so here's the current state of things.

The private-insurance exemption is closed. Workers who had private long-term care insurance bought before November 1, 2021 could apply for a permanent exemption from October 1, 2021 through December 31, 2022 (RCW 50B.04.085). That window is over and new applications aren't accepted.

But those people can now opt back in. The 2025 law lets anyone with that exemption cancel it and join. WA Cares gives the window as January 1, 2026 through June 30, 2028. You don't owe back premiums for the exempt years, but those years also don't count toward your contribution requirement. If you're in your 50s and have one of these exemptions, the rejoin decision deserves a real look before mid-2028.

Source: WA Cares, How the fund works; WA Cares, Exemptions; RCW 50B.04.055; RCW 50B.04.090; RCW 50B.04.085.

The 90-day rules have teeth. If a conditional exemption ends and you don't restart premiums within 90 days, RCW 50B.04.055 lets ESD collect the unpaid premiums with interest of 1% per month. An approved exemption starts the first day of the quarter after approval, and you have to give your approval letter to every current and future employer. ESD's WA Cares line is 833-717-2273.

Self-employed. Self-employed people only earn benefits if they elect coverage. Under RCW 50B.04.090 the election had to be made before July 1, 2026, or within three years of first becoming self-employed. Once you elect, you can't withdraw; the premium is 0.58% of net earnings plus any wages your business pays you.

Moving out of state. Since July 1, 2026, workers who move away can keep their WA Cares coverage if they paid premiums for at least three years (500+ hours each in Washington) and notify ESD within one year of moving (RCW 50B.04.180). You keep reporting wages and paying premiums from the new state. Benefits for out-of-state participants start July 1, 2030, and they face a different care-need test: under RCW 50B.04.060(2)(a)(ii), being unable to do at least two of six activities (eating, toileting, transferring, bathing, dressing, continence) without substantial help for at least 90 days, or needing substantial supervision because of severe cognitive impairment. For anyone planning to retire to Arizona or Florida, this is the one deadline to put on the calendar before the moving truck arrives.

How to apply

Applications go through WA Cares, not Medicare and not Social Security. The steps:

1. Create a benefits account through SecureAccess Washington and add the service "WA Cares Benefits Account." A Paid Leave account used for an exemption or self-employed reporting is separate; you still need a benefits account.
2. Submit your application online, or by phone at 844-CARE4WA. A family member or legal representative can apply for you with documents showing they represent you.
3. Get your contributions confirmed. WA Cares checks your history and sends a contribution determination letter with the benefit amount you've earned.
4. Discuss your care needs with a WA Cares team member, in person or by phone.
5. Get the approval letter, then pick registered providers. If you're denied, you can appeal.

For in-person help, your local Area Agency on Aging can assist (855-567-0252), and WA Cares notes an appointment may be needed. Before you need care at all, log in and look at your annual statement; the 2026 statement covers contributions from July 1, 2023 through December 31, 2025, and you can request an updated one each April. If a year is missing, fix it now rather than during a care crisis.

How I'd fit it into Medicare planning

Medicare decisions and WA Cares don't interact much on paper, but they belong in the same conversation. My read, for someone in their early to mid 60s in Washington:

• Know your WA Cares status before you retire. Pull your annual statement. Count your 500-hour years. If you were born before 1968, each qualifying year adds $3,650 under the transition rule, and a third recent year can open the full benefit through the 3-of-6 path.
• Don't count on Medicare or Medigap for custodial care. Medicare.gov is explicit that neither pays for long-term care. Your Medicare choices during Open Enrollment (see our Washington guide to the 2027 Open Enrollment Period) are about medical costs.
• If money is tight, check the state help that does exist. A Medicare Savings Program can pay Part B premiums, and WA Cares benefits aren't counted against you for Medicaid or other means-tested programs.
• Think of $36,500 as a first layer. WA Cares itself says that for people with private long-term care insurance, the benefit can help cover the private policy's waiting period. Rules for the supplemental private long-term care market took effect May 1, 2026, and WA Cares says such policies may become available in 2027.

For unbiased Medicare counseling at no charge in Washington, call SHIBA at 800-562-6900. For WA Cares questions, go to WA Cares directly at 844-CARE4WA. Our Washington Medicare page and Washington insurance FAQ cover the Medicare side.

FAQ

What is the WA Cares tax rate for 2026?

The WA Cares premium is 0.58% of wages in 2026. The Pension Funding Council voted on October 8, 2025 to keep the rate at 0.58%, and by law it can't be set higher than that. There is no wage cap.

How much is the WA Cares benefit?

The full lifetime benefit is $36,500 in 2026, and it is adjusted for inflation each January 1. People born before 1968 who qualify only through the transition pathway get $3,650 for each year they contributed.

When can you use WA Cares benefits?

Benefits became available July 1, 2026. You must meet a contribution requirement and need help with at least three activities of daily living for at least 90 days.

Can I still get a WA Cares exemption?

The private long-term care insurance exemption closed December 31, 2022. Exemptions are still available for people with a permanent address outside Washington, military spouses or partners, veterans with a 70% or higher service-connected disability, and active-duty members with civilian jobs.

Does Medicare cover long-term care in Washington?

No. Medicare.gov says Medicare doesn't pay for long-term care, and Medicare and most health insurance, including Medigap, don't pay for long-term care services in a nursing home or in the community. WA Cares is a separate state program.

WA Cares rules are set by chapter 50B.04 RCW and agency rules, and Medicare coverage depends on your own situation. Confirm the details with WA Cares, SHIBA, 1-800-MEDICARE or a licensed agent, and talk to an attorney or tax professional about legal or tax questions.

Sources

1. WA Cares Fund: How the fund works
2. WA Cares Fund: Covered benefits
3. WA Cares Fund: Qualifying for benefits
4. WA Cares Fund: Applying for benefits
5. WA Cares Fund: Exemptions
6. WA Cares Fund: Self-employed elective coverage
7. WA Cares Fund: Employer information
8. WA Cares Fund: Frequently asked questions
9. WA Cares Fund: Benefits now available (July 1, 2026)
10. WA Cares Fund home page
11. Chapter 50B.04 RCW: Long-term services and supports trust program
12. RCW 50B.04.050 (2023 archived version)
13. RCW 50B.04.150: Benefits not income or resource
14. Pension Funding Council: Adoption of Long-Term Services and Supports Rate, Oct 8, 2025
15. Medicare.gov: Long-term care
16. Medicare.gov: Skilled nursing facility care
17. Medicare.gov: Home health services
18. Medicare.gov: Medicare Savings Programs
19. Washington Office of the Insurance Commissioner: SHIBA