On the islands, a Medicare Advantage plan ending is a smaller story than on the mainland, but a harder one for the people it hits. CMS counted 6,784 San Juan County residents on Medicare in July 2026. Just 1,220 of them, 18%, were in Medicare Advantage and other health plans; the other 5,564 used Original Medicare. If you're one of the 1,220 and your plan is leaving after December 31, 2026, the question you need to answer is simple to state: which doctors and hospitals off the island will your 2027 coverage let you use?
How many islanders are in this spot?
| Measure | San Juan County | Washington |
|---|---|---|
| People on Medicare (CMS, July 2026) | 6,784 | 1,586,306 |
| Using Original Medicare | 5,564 (82.0%) | 50.3% |
| In Medicare Advantage and other health plans | 1,220 (18.0%) | 49.7% |
| Separate Part D plan alongside Original Medicare | 4,403 | 503,353 |
| Dual-eligible (Medicare plus Apple Health) | 479 (7.1%) | 15.1% |
| Residents 65 and older (OFM, April 2025) | 7,104 (38.3%) | n/a |
| Land area / water area (Census) | 174 sq mi / 447 sq mi | n/a |
Sources: CMS Medicare Monthly Enrollment, July 2026 (people, not plans; the Medicare Advantage line includes cost plans and PACE); WA OFM 2025 age estimates; U.S. Census Bureau 2025 Gazetteer.
Two things follow. More than four in five islanders on Medicare already use Original Medicare, and 4,403 pair it with a separate drug plan, so that setup is the local norm. And because so few people here are in those plans, you shouldn't assume a mainland-style network will treat island life kindly. Check it.
There's one hospital in the county. What does that mean for my choice?
DOH and CMS list one hospital in San Juan County: PeaceHealth Peace Island Medical Center on Spring Street in Friday Harbor (CMS type: critical access). The lists show nothing on Lopez or Orcas. Anything Peace Island doesn't handle means a ferry or a flight to a mainland hospital, and those mainland providers are where the two Medicare roads split hardest.
| Question for an islander | Another Medicare Advantage plan | Original Medicare (plus Part D, optional Medigap) |
|---|---|---|
| Mainland hospitals and specialists | Non-emergency care may need to stay in the plan's network and service area | Any provider in the U.S. that accepts Medicare |
| Seeing a specialist | A referral may be required | Usually no referral needed |
| Yearly cap on what you pay | Plans have an annual out-of-pocket limit for covered services | No cap on its own; a Medigap policy can cover most of the gaps |
| Prescriptions | Most plans include drug coverage | Separate Part D plan |
Source: Medicare & You 2027, "At a glance" comparison (pp. 11-12).
My read for islanders: write down every mainland provider you've used in the past two years, including the ones in Anacortes, Mount Vernon, Bellingham or Seattle, and ask each whether they'll be in network for any plan you're considering for 2027. If the answers are shaky, that tells you something.
Example (hypothetical): a Lopez Island resident sees a primary care provider on the island, a cardiologist in Mount Vernon twice a year, and had a hip replaced in Seattle three years ago. If her plan ends and she looks at another Medicare Advantage plan, she needs a yes from all three offices for 2027, and she should ask how the plan treats a follow-up in Seattle if that surgeon isn't in network. If she moves to Original Medicare instead, any of those providers that accept Medicare can bill it, and her real decisions become which drug plan matches her prescriptions and whether to use her guaranteed right to a Medigap policy before the window closes. Neither path is automatically right; the provider list decides it.
What are my dates?
- Your plan keeps paying through December 31, 2026.
- Choose by December 31 and your new coverage starts January 1, 2027.
- Because your plan is leaving, you have a special enrollment period from December 8, 2026 to February 28, 2027. January sign-ups take effect February 1; February sign-ups, March 1.
- Choose nothing and Medicare puts you in Original Medicare on January 1, with no drug plan unless you get Extra Help (CMS assigns a plan to Extra Help members). Going 63 days or longer without drug coverage risks a Part D penalty that is added for as long as you have Medicare drug coverage.
The statewide guide for Washington explains each of these in full.
Can I switch to Original Medicare and get a supplement without health questions?
Yes, within a window. Washington's RCW 48.66.055 gives anyone whose Medicare Advantage plan stops serving their area a guaranteed issue right to certain Medigap plans: A through F (including high-deductible F), K or L if you were first eligible for Medicare before 2020; A, B, D, G (including high-deductible G), K or L if you were first eligible on or after January 1, 2020. The OIC says apply no earlier than November 1. The policy can begin when your old plan ends, and the right lasts until March 4, 2027. Keep the plan's notice and its postmarked envelope; insurers can ask for them.
Who can I talk to without taking the ferry?
SHIBA, Washington's free and unbiased Medicare counseling program, lists the Orcas Senior Center in Eastsound as the county's sponsor (360-376-2677). On October 26, 2026, OIC's local listings showed it not accepting appointments and pointed people to 1-800-MEDICARE. The phone lines still work from any island:
- SHIBA statewide line: 800-562-6900, weekdays 8:30 a.m. to 4:30 p.m.
- Medicare: 1-800-633-4227 (TTY 1-877-486-2048), 24 hours a day, 7 days a week except some federal holidays.
- San Juan County's Senior Services program, run by Health & Community Services under contract with the Northwest Regional Council (the area agency on aging), has specialists embedded in each island's senior center: San Juan Island 360-370-7526, Orcas 360-370-7525, Lopez 360-468-2421. They handle information and referral, transportation referrals and help with state program eligibility.
If income is limited, ask them about Medicare Savings Programs, which help pay Medicare premiums with no asset test. Only 479 people in the county are dual-eligible, so if you think you might qualify, it's worth the call.
What about ferry costs for mainland care?
Washington State Ferries gives riders with disabilities a 50% discount on passenger fares on any route. You show an ID that verifies a disability when you buy the ticket, and WSF's list of accepted IDs includes a Medicare card, along with the Regional Reduced Fare Permit. That's worth knowing for the 167 San Juan County residents on Medicare because of a disability.
Federal Medicare rules and Washington law decide how all of this works, and your plan's notices set your exact dates; before you commit, check your situation with 1-800-MEDICARE, SHIBA or a licensed agent.
Island questions
I live on Orcas or Lopez. Is there a hospital on my island?
Will a new Medicare Advantage plan cover my doctors in Anacortes or Bellingham?
Is the Orcas Senior Center doing SHIBA appointments?
Can my Medicare card get me a ferry discount?
Sources
- CMS Medicare Monthly Enrollment, July 2026
- WA OFM population estimates by age, 2025
- U.S. Census Bureau 2025 Gazetteer (land and water area)
- WA DOH hospital financial data (licensed hospitals)
- CMS Hospital General Information (hospital type)
- Medicare & You 2027
- CMS: CY 2027 MA and Part D Enrollment and Disenrollment Guidance
- Medicare.gov: Part D costs and late enrollment penalty
- Washington OIC: Is your Medicare Advantage plan changing or leaving?
- RCW 48.66.055: Medigap guaranteed issue
- Washington OIC: Find a local SHIBA office (checked Oct 26, 2026)
- San Juan County: Senior Services
- Washington State Ferries: Accessibility and reduced fares
- Washington HCA: Medicare Savings Program
