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Medicare Coverage in Puerto Rico


If you live in Puerto Rico and are looking for healthcare coverage, you do have options for coverage under Medicare. Puerto Rico has a population of about 3 million. 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.

Types of Medicare Coverage in Puerto Rico

Medicare coverage in Puerto Rico is the same as it is everywhere else. The only difference is you will not be automatically enrolled in Part B, you have to request enrollment yourself. Medicare is the United States’ federally funded health care insurance program for individuals age 65 and above; or those qualifying by disability or condition.

Medicare consists of Part A and Part B. You can also enroll is a Medicare Supplement plan, also known as Medigap. Medigap plans help cover the co-payments, coinsurance, and deductibles. Then you have Part D which covers prescription costs.

Advantage plans offer coverage equivalent to Parts A and B; also, some include benefits Medicare doesn’t, such as Part D, dental, vision, and hearing.

It’s important to remember that not all Medicare options are available in your service area in Puerto Rico. You should contact an agent to help determine what coverage options are best for you.

How to Request Medicare in Puerto Rico

Enrolling in Part B for residents of Puerto Rico is not automatic. Residents who want this coverage must register themselves. Many U.S. seniors are automatically enrolled in Medicare when they turn 65. Automatic enrollment includes Part A and for some, Part B.

When you’re Medicare eligible in Puerto Rico, you may be enrolled in Part A automatically. However, enrollment in Part B is not; enrolling in Part B isn’t required, but it’s recommended to enroll when you first become eligible. You also have to have Part A & Part B to enroll in either a Medicare Advantage or Medigap plan.

What if I Don’t Sign Up for Part B When Eligible in Puerto Rico?

If you don’t sign up for Part B at the time of eligibility, you may face additional penalties that are added to your monthly premium once you decide to enroll. 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.

Lastly, those who qualify for a Special Enrollment Period for signing up for Part B, late enrollment penalties will not apply. This includes having creditable coverage through your employer if you’re still working.

How to Sign Up for Medicare in Puerto Rico

Signing up for Part B in Puerto Rico is as simple as filling out a form. You can find the CMS-40B form online through the Social Security website. The Centers for Medicare & Medicaid Services offers this form, too; you can download it by visiting their website. You may visit your local Social Security office if you’re not comfortable with the online options.

Lindsay Malzone

Lindsay Malzone is the Medicare expert for MedicareFAQ. She has been working in the Medicare industry since 2017. She is featured in many publications as well as writes regularly for other expert columns regarding Medicare. You can also find her over on our Medicare Channel on YouTube as well as contributing to our Medicare Community on Facebook.

2 thoughts on “Medicare Coverage in Puerto Rico

  1. I’m 81 y.o. and thinking of moving to Puerto Rico. I’m covered by Medicare A, B, D. Plus I have medicaid (in Massachusetts it’s called Mass Health). All premiums are paid for me, not from my SOC SEC. In other words, I pay only minimum for Rx co-pay. Everything else is paid. What would I need to do upon arriving in PR? And what kind of coverage will I get?

    1. Hi Lee! You can find these answers on SSA.gov regarding Medicare in Puerto Rico. It goes over the forms you need and the kind of coverage options available to you.

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