Puerto Rico has a population of about 3 million as of 2018. Roughly, 1.3 million of the population are seniors over the age of 60. People that reside in Puerto Rico are United States citizens; however, Medicare healthcare coverage options can vary.
Puerto Rico is a U.S. territory; other U.S. territories such as, the Northern Mariana Islands, Guam, the Virgin Islands, and American Samoa offer Medicare coverage for those who meet the requirements for eligibility.
Medicare Coverage in Puerto Rico
If you live in Puerto Rico and are looking for health care coverage, you may qualify for Medicare health insurance. Additionally, you might have some questions about eligibility, enrollment and your options for coverage.
The first step is to understand what Medicare options are available to you or your loved ones. Eligibility for Medicare begins at the age of 65.
Of course, Medicare has exceptions for certain situations. The basic requirements for Original Medicare coverage in Puerto Rico are like the requirements for the rest of the continental U.S.
Residents of Puerto Rico (PR) must be at least 65 or older; those under 65 must be eligible or currently collecting Social Security disability benefits. Those who are Medicare-eligible because of disability must be receiving SS benefits for a minimum of 24 consecutive months before enrolling in Part A or Part B plans.
Individuals getting SS benefits because of ALS or Lou Gehrig’s disease become Medicare eligible in the first month Social Security Association (SSA) benefits. Anyone diagnosed with End-Stage Renal Disease (ESRD) or needs a kidney transplant will qualify for Medicare coverage.
People born in Puerto Rico are U.S. citizens as reported in 2017 by the New York Times. Legal residency is anyone who has lived in PR for at least 5 years. You must have permanent residency for 5 consecutive years, one month before applying for Medicare coverage in PR.
Types of Medicare Coverage in Puerto Rico
Although the coverage options in PR are different, there are still options to choose from. The service area you live in will determine what Medicare plan options are available. Medicare coverage comes in many forms.
For instance, Original Medicare consists of Part A and Part B. Part A provides you with hospital/in-patient coverage; Medicare Part B is your medical insurance. Part B is for doctor services, testing, and other out-patient related services.
Original or Traditional Medicare is the United States’ federally funded health care insurance program for individuals age 65 and above; or for those qualifying by disability or condition.
Medicare Supplement Insurance is an insurance option working with your Medicare Parts A and B. Supplement insurance often referred to as Medigap, helps cover costs of some out-of-pocket expenses like co-payments, coinsurance, and deductibles.
Stand-alone Medicare Part D Prescription Drug Plans offer coverage for prescription expenses in addition to your Original Medicare.
Medicare Advantage plans offer coverage equivalent to your Medicare Parts A and B. Advantage plans are provided by private insurance companies and may offer coverage for services Original Medicare doesn’t cover.
It’s important to remember that not all Medicare options are available in your service area in Puerto Rico. You should contact a Medicare agent to help determine what coverage options are best for you.
Medicare Part B
Enrolling in Medicare Part B for residents of Puerto Rico is not automatic. Residents who want this coverage must enroll themselves. Many U.S. seniors are automatically enrolled in Original Medicare when they turn 65. Automatic enrollment includes Medicare Part A and for some, Medicare Part B.
If you’re 65+ living in the continental U.S., and currently receive retirement benefits from the SSA or the Railroad Retirement Board (RRB) enrollment in Original Medicare is automatic.
For those collecting benefits from the SSA or RRB because of disability will be enrolled after the 24th-month benefits have been received.
When you’re Medicare eligible in Puerto Rico, you may be enrolled in Medicare Part A (hospital insurance) automatically. On the other hand, enrollment in Medicare Part B (medical insurance) is not; joining a Part B plan isn’t required, but it’s recommended to enroll when you first become eligible.
What if I Don’t Sign Up for Part B When Eligible in Puerto Rico
Medicare likes when people enroll in plans when they first become eligible. If you don’t join a Medicare Part B plan in PR at the time of eligibility, you may face an additional penalty charge once you decide to enroll.
Late enrollment penalty charges will begin once your Part B coverage begins the following enrollment. Part B late enrollment penalty charges can increase your premium amount by 10% for every year you’re not enrolled after you’re first eligible for Medicare.
For instance, let’s look at Becky’s situation. Becky waited to enroll in Part B because she has health coverage through her employer. Since Becky is currently still employed, her health coverage will last until she stops working or retires.
Once she decides to retire, Becky will have an 8-month Special Enrollment Period to join Medicare. The 8-month window will begin when Becky stops working or if her health coverage ends before she stops working – whichever comes first. During this time, Becky can enroll in Original Medicare without worrying about any Late Enrollment penalties.
How to Sign Up for Medicare in Puerto Rico
Signing up for Medicare Part B in Puerto Rico is as simple as filling out a form. The Application for Enrollment in Part B Form (CMS-40B) is available for eligible PR residents.
Free of charge, you can find the CMS-40B form online through the Social Security website (SSA.gov). The Centers for Medicare & Medicaid Services offers this form too, you can download it by visiting their website (cms.gov). You may visit your local Social Security office if you’re not comfortable with the online options.
Use a Medicare Agent
Finding healthcare coverage when you need it the most can be stressful. Medicare agents are happy to help clear up any concerns or questions you may have. Medicare plan options can seem a bit overwhelming. Don’t worry! We’re here to help you!
While we aren’t licensed in Puerto Rico, we can assist you if you’ve recently moved to another Medicare-eligible location. Our agents can provide quotes and help you make the right decision for your healthcare coverage.
Why wait? Give us a call today at the number provided above. Or fill out the online rate form and discover the best policy for you!