Medicare in Puerto Rico

Summary: Medicare in Puerto Rico works the same as it does in the States. But Puerto Ricans must contact Social Security to enroll in Medicare Part B as it’s not automatic. You should enroll in Part B as soon as you are eligible to avoid the penalty. Having both parts of Original Medicare also allows you to enroll in Medicare Supplement plans, Medicare Part D prescription drug plans, or Medicare Advantage plans. Estimated Read Time: 6 mins

Table of Contents:

1. Does Medicare Cover You in Puerto Rico?
2. Types of Medicare Coverage in Puerto Rico
3. How to Request Medicare in Puerto Rico
4. What if I Don’t Sign Up for Part B When Eligible in Puerto Rico?
5. Does a Medicare Supplement Cover Puerto Rico?
6. Can I Use My Medicare in Puerto Rico?
7. How to Sign Up for Medicare 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.

Does Medicare Cover You in Puerto Rico?

Because Puerto Rico is a U.S. territory, Medicare covers your healthcare needs. Puerto Rico and Medicare operate together similar to the federal government’s program in other U.S. territories, such as Guam.

In Puerto Rico, Medicare doesn’t automatically enroll you in Part B. Therefore, if you wish to have this coverage and are eligible, you need to call Social Security to sign up. Beneficiaries should do this during their Initial Enrollment Period. By doing so, you avoid paying penalties and can also enroll in Medicare Supplement plans (Medigap), Medicare Part D prescription plans, or Medicare Advantage plans. You cannot have both a Medicare Advantage plan and Medigap at the same time.

Types of Medicare Coverage in Puerto Rico

Medicare plans in Puerto Rico are the same as they are 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 healthcare insurance program for individuals aged 65 and above; or those qualifying by disability or condition.

Original Medicare consists of Part A and Part B. You can also enroll in a Medicare Supplement plan, also known as Medigap, for supplemental coverage. A Medicare Supplement (Medigap) plan helps cover the co-payments, coinsurance, and deductibles. Medicare Part D prescription drug plans are also available and cover the costs of your prescriptions.

Alternatively, Medicare Advantage plans are also available. Medicare Advantage plans in Puerto Rico must offer coverage equivalent to Parts A and B. However, their availability can vary. Puerto Rico Medicare Advantage plans also have networks. You’ll want to be sure that your doctors are within your plan’s network before enrolling.

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 available to you.

How to Request Medicare in Puerto Rico

Because enrolling in Medicare Part B is not automatic for residents of Puerto Rico, those 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.

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

Enrolling in Medicare Part B isn’t required, but it’s recommended to enroll when you first become eligible. Remember, you also must have Part A & Part B to enroll in either a Medicare Advantage or Medigap plan. However, there are additional repercussions that can occur if you wait to sign up.

If you don’t sign up for Part B at the time of eligibility, you may face additional penalties that Medicare adds to your monthly premium once you decide to enroll. Delaying this portion of Medicare in Puerto Rico means incurring Part B late enrollment penalty charges. These penalties can increase your premium amount by 10% for every year you’re not enrolled after you’re first eligible for Medicare.

Lastly, there is an exception. 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.

Does a Medicare Supplement Cover Puerto Rico?

Medicare Supplement plans in Puerto Rico are available and cover your healthcare needs the same as they would stateside. There are no networks with Medigap plans. Your coverage kicks in when there are out-of-pocket costs after Original Medicare pays its portion.

The one thing that is important to highlight for Puerto Ricans is the emphasis on enrolling in Medicare Part B as soon as you are eligible. This allows you to avoid the Part B penalty. Enrollment in both Parts A and B is also a requirement for enrolling in a Medicare Supplement plan. You cannot have Medigap if you only have Part A coverage.

Can I Use My Medicare in Puerto Rico?

While you can use Medicare in PR, be aware that if you are traveling, there are some issues that can arise if you have Medicare Advantage. Here are a few reasons why:

• Medicare Advantage plans have strict, local networks. Receiving care outside of these networks is often more complicated and expensive. However, there are exceptions for emergencies.
• If you are traveling, be aware that if you are outside of your Medicare Advantage plan’s area for over six months without interruption, your carrier can disenroll you. At this point, you receive a Special Enrollment Period to join a new plan. Should you fail to choose another plan you are automatically enrolled in Original Medicare.
• Some plans may allow you to travel as much as a year outside of their network, but these vary by location.

You may be able to find a Medicare Advantage plan that allows you to travel outside its service area for up to a year, but availability varies. Beneficiaries that travel often may want to consider Medicare Supplement plans for the following reasons:

• There are no networks for Medigap plans. You can travel anywhere in the U.S., including its territories to use your coverage.
• Some Medicare Supplement plans may offer foreign emergency coverage.
• It doesn’t matter if you live outside of the United States for a certain period with Medigap coverage. But remember, you can only use your coverage outside of the United States during an emergency if your plan allows. Even then, there is a lifetime limit which applies.

One important note is how Medicare works with cruise ships. Considering the Port of San Juan is one of the busiest ports for cruises. If you are within six hours of an American port, your Medicare coverage is applicable. This means even when you are at sea, your coverage may cover healthcare services.

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.