Medicare

The Medicare “advantage” in Puerto Rico

Nowhere is Medicare Advantage more popular than in Puerto Rico, where 70 percent of eligible Medicare beneficiaries – nearly 600,000 people – are enrolled. This amounts to approximately 20 percent of our population, making it a vital source of healthcare coverage for the island’s seniors and people with disabilities.

The Medicare “advantage” in Puerto Rico

Carlos Rodriguez, Esq.
Chief Legal Counsel
Triple-S Management Corp.

There are a host of reasons that contribute to its popularity. Medicare Advantage plans focus on coordinated, patient-centered care, meaning a primary care physician ensures coordination of care for each individual. This is critical for people who might otherwise only visit a doctor or a healthcare facility when their health is seriously compromised or deteriorated. Emphasis is placed on preventive care including vaccinations, checkups for diabetes, colon cancer and other critical screening tests.

With 41 percent of the population in Puerto Rico living below the poverty line, many residents struggle to afford basics like adequate housing, let alone medicines and other healthcare needs. Medicare Advantage offers benefits that are not available in traditional Medicare, for example, coverage for prescriptions and integration of additional services aimed at addressing the needs of a low-income population. Many plans have transportation options for non-emergency medical needs to ensure beneficiaries have access to their doctors’ appointments. This is vital for those with very limited financial resources.

In addition, approximately half of people enrolled in Medicare Advantage plans in Puerto Rico have low incomes that also qualify them for Medicaid, a group known as dual-eligible. Coordination of care for those enrolled in both Medicare Advantage and Medicaid has been critical for the most vulnerable, especially since this group includes a high percentage of people who are chronically ill and who suffer from multiple chronic diseases, including diabetes, cardiovascular and lung disease, among others.

Unfortunately the Medicare Advantage program is significantly underfunded in Puerto Rico, creating a downstream affect that has negatively impacted patients, doctors and hospitals. During the last several years, a mass migration of physicians to the mainland has left Puerto Rico with a shortage of specialists. The doctors that have remained are faced with unmanageable patient loads. Investments in healthcare facilities have lagged due to a scarcity of funds. These chronic problems became even more evident in the aftermath of hurricane Maria in 2017.

Yet despite the challenges, the Medicare Advantage program in Puerto Rico is providing quality coverage and benefits our seniors need at an affordable cost. That is clearly demonstrated in quality ratings: More than 90 percent of Medicare Advantage plans on the island have achieved 4.5 stars and our own satisfaction surveys on beneficiaries show that 90 percent of those surveyed perceive that the healthcare quality they receive is five stars.

As policymakers wrestle to balance quality healthcare and budget constraints, Puerto Rico’s experience with the Medicare Advantage program should be looked at carefully as an example of a resourceful way to do more with less.

For more information on the health\care system in Puerto Rico, visit https://mmapapr.org/.

Triple-S Management Corporation is an independent licensee of the Blue Cross Blue Shield Association.

Categories: Medicare
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