San Juan Islands healthcare access and Medicare

The geography of health care in San Juan County

San Juan County is reached only by ferry, small plane or private boat. Washington State Ferries serves four of its islands from Anacortes: San Juan, Orcas, Lopez and Shaw. Several smaller islands are reachable only by private vessel or plane.

For Medicare beneficiaries, this means:

• Limited specialty care on-island. Primary care is available on the larger islands, but much specialty and hospital care is on the mainland.
• Mainland trips for specialists. Anacortes (Skagit County), Bellingham (Whatcom County) and the Seattle area are common destinations for advanced care.
• Ferry schedules and weather affect appointment access. Storms can delay or cancel sailings, and summer crowds can fill vehicle space.
• Air ambulance considerations. Serious emergencies may require air transport to a mainland hospital.

Health care on the islands

What's available differs from island to island, and residents of the smaller islands often travel to a larger island or the mainland for care. Before you choose a plan, list:

• The island clinics, pharmacy and any on-island hospital or emergency services you use
• The mainland specialists, imaging centers and hospitals you've been referred to
• How you travel to them (ferry, plane) and how often

Then check every name on that list against any plan you're considering.

Choosing a Medicare plan in San Juan County

CMS data for 2027 show 4 Medicare Advantage plans open to everyone in San Juan County, from 5 companies, compared with 71 statewide. The right choice depends heavily on where you'll get specialty care. You can see plans in your ZIP code, or a licensed insurance agent with Benefits Life can walk through plans from the companies they work with: (206) SENIORS (206-736-4677), TTY 711.

Original Medicare with Medigap

Some San Juan Islanders find Original Medicare with a Medigap policy simpler because:

• It works with any provider in the U.S. that accepts Medicare, with no network
• You can see specialists in Anacortes, Bellingham or Seattle without checking a network
• Original Medicare doesn't require referrals to see a specialist
• A Medigap policy pays some or all of the deductibles and coinsurance, which makes costs easier to plan around ferry travel and overnight stays

Medigap has its own premium, and you would add a separate Part D drug plan. The best time to buy Medigap is your 6-month Medigap open enrollment period, which starts when you are 65 or older and enrolled in Part B.

Medicare Advantage, if it has the right network

If you choose Medicare Advantage, confirm the plan's network includes:

• Your on-island providers and any island hospital you use
• Specialists you regularly see in Anacortes or Bellingham
• Seattle-area specialists and hospitals, if you go there

PPO plans cover out-of-network care, usually at a higher cost; HMO plans generally cover only network providers except for emergencies and urgently needed care. Ask about referral and prior authorization rules too, since a denied referral can mean an extra ferry trip.

Medication access

For Part D or a Medicare Advantage plan with drug coverage:

• Confirm your island pharmacy is in the plan's network, and whether it is a preferred pharmacy
• Mail-order can reduce trips for maintenance medicines
• Before winter storm season, ask your doctor and pharmacy how to get an emergency supply if ferries stop running

Emergency care and ambulance coverage

For serious emergencies such as major trauma, heart attack or stroke, air ambulance transport to a mainland hospital is often needed.

Medicare Part B covers ground ambulance transport when traveling in any other vehicle could endanger your health. It may cover emergency transport by airplane or helicopter when you need immediate, rapid transport that ground transportation can't provide. Medicare pays for transport to the nearest appropriate facility that can give you the care you need. After the Part B deductible ($283 in 2026), you generally pay 20% of the Medicare-approved amount. Medicare Advantage plans must also cover emergency ambulance services, and a Medigap policy may pay some or all of your share.

Washington State Ferries medical preferential loading

Washington State Ferries runs a medical preferential loading program for customers whose health would be put at risk by an extended wait at the terminal. Key rules from WSDOT:

• A licensed health care provider (such as an MD, RN, PA or midwife) or their clinic administrator must submit the application. Physical therapists and chiropractors can't certify.
• It is not for getting to appointments on time when waiting wouldn't harm your health.
• On the Anacortes / San Juan Islands route, you must arrive 30 minutes before sailing; after the gate closes you can't board.
• You sail on the next available scheduled sailing. Bring the printed confirmation email and an ID that matches it.
• Only one standard vehicle under 22 feet qualifies; RVs and vehicles with tows don't.

Apply and check the current rules on the WSDOT medical preferential loading page.

Telehealth as a partial answer

Through December 31, 2027, Medicare covers telehealth services you can get from anywhere in the U.S., including your home. Follow-ups, some specialty consultations and mental health visits by video or phone can save a ferry trip. Ask your providers which services they offer by telehealth. More on telehealth in rural Washington.

Cross-border to BC?

San Juan Islanders sometimes think about Canadian health care because it's close. Important: Original Medicare generally doesn't cover care outside the U.S. The exceptions are narrow, such as an emergency while traveling by the most direct route between Alaska and another state, or a Canadian hospital that is closer than the nearest U.S. hospital that can treat you. Medicare drug plans don't cover drugs bought outside the U.S. Some Medigap plans pay for emergency care abroad during the first 60 days of a trip.

Other ferry-dependent communities

Similar questions come up in other Washington communities that rely on ferries, including:

• Vashon Island (King County)
• Anderson Island and Ketron Island (Pierce County)
• South Whidbey Island (Island County), which also has a bridge at its north end
• Bainbridge Island (Kitsap County), which also has a bridge to the Kitsap Peninsula

These have shorter crossings than the San Juans and are closer to mainland providers, but the same plan-network checks apply.

Sources

• WSDOT, Washington State Ferries — Medical preferential loading
• Medicare.gov — Ambulance services coverage
• eCFR — 42 CFR 422.113, Medicare Advantage ambulance, emergency and urgently needed services
• Medicare.gov — Telehealth
• Medicare.gov — Travel outside the U.S.
• Medicare.gov — Learn what Medigap covers
• CMS — Medicare Advantage and Part D Landscape files, CY2027 (plan and company counts)

Frequently asked questions

Is Original Medicare or Medicare Advantage a better fit for San Juan Islanders?

It depends on where you get care. Original Medicare, often with a Medigap policy, works with any provider in the country that accepts Medicare, so mainland specialists don't have to be in a network. A Medicare Advantage plan can work if its network includes your island providers and the mainland specialists and hospitals you use; check each one before you enroll.

Does Medicare cover air ambulance from the islands?

Medicare Part B may cover emergency ambulance transport by airplane or helicopter when you need immediate, rapid transport that ground transportation can't provide, to the nearest appropriate facility. After the Part B deductible you generally pay 20% of the Medicare-approved amount. A Medigap policy or Medicare Advantage plan may pay some of that share.

Can I use Canadian health care?

In almost all cases, no. Original Medicare covers care in Canada only in narrow situations, such as a medical emergency while traveling by the most direct route between Alaska and another state, or when a Canadian hospital is closer than the nearest U.S. hospital that can treat you. Don't plan routine care across the border.

How does telehealth help island residents?

Through December 31, 2027, Medicare covers telehealth services you can get from anywhere in the U.S., including your home. Video or phone visits for follow-ups, some specialty care and mental health care can save a ferry trip. Ask your providers which visits they offer by telehealth.

Can I get priority boarding on the ferry for medical reasons?

Washington State Ferries has a medical preferential loading program for people whose health would be put at risk by a long wait at the terminal. A licensed health care provider must apply for you, and it is not meant for getting to appointments on time. On the Anacortes and San Juan Islands route you must arrive 30 minutes before sailing.

Medicare in your Washington county

Plans, local agents and help, county by county: Adams · Asotin · Benton · Chelan · Clallam · Clark · Columbia · Cowlitz · Douglas · Ferry · Franklin · Garfield · Grant · Grays Harbor · Island · Jefferson · King · Kitsap · Kittitas · Klickitat · Lewis · Lincoln · Mason · Okanogan · Pacific · Pend Oreille · Pierce · San Juan · Skagit · Skamania · Snohomish · Spokane · Stevens · Thurston · Wahkiakum · Walla Walla · Whatcom · Whitman · Yakima