How Is Puerto Rico’s Health Care Typically Paid For?

The Puerto Rico Medicaid program is financed through

local and Federal funds

. It has operated with a fixed Federal Financial Participation (FFP), since 1968. Congress fixed the amount at $20 million in 1968, and increased this amount to $30 million in 1972.

Do Puerto Ricans pay into Medicaid?

Over 35 percent of adults in Puerto Rico reported they were in fair or poor health in 2014 compared to just under 18 percent in the states. Despite these challenges, over 90 percent of people in Puerto Rico are insured, in large part because

Medicaid covers about 45 percent of Puerto Rico's residents

.

Is healthcare affordable in Puerto Rico?

Private healthcare in Puerto Rico

Medical insurance is affordable, especially if an expat has their insurance through their employer

. Also, insurers in Puerto Rico are generally more open to covering things that may not have been covered in an expat's home country, like pre-existing conditions.

How much does healthcare cost in Puerto Rico?

Compared to U.S. insurance prices, Puerto Rico health insurance can sometimes cost half as much and covers much more.

An individual PPO plan for a family of 5 is about $700 per month

including medical, RX, dental and vision. A single medical plan including medical, RX, dental and vision is less than $200 per month.

Does Puerto Rico get Medicare?

Medicare eligibility in Puerto Rico

In Puerto Rico, as in the United States, residents are generally first eligible for Medicare when they turn 65 or through disability if they're younger than 65 and have been receiving Social Security or Railroad Retirement Board disability benefits for at least two years.

Does Puerto Rico have national healthcare?

Public health care services are available to all persons in Puerto Rico too poor to afford adequate medical care

.

What is Puerto Rico Medicaid called?

The island's present-day Medicaid program,

the Government Health Plan, also called Vital

, was established in 1993 by the Puerto Rico Health Insurance Administration Act (Law 72) which also shifted much of the publicly financed health care system to the private sector.

Where is the best healthcare in Puerto Rico?

Are hospitals in Puerto Rico good?

In general,

Puerto Rico hospitals score lower than the national average in quality metrics

, based on reports from the Centers for Medicare and Medicaid Services (CMS) Hospital Compare database

₁

. The difference is significant in metrics related to readmission, mortality, and Emergency Department (ED) care.

Is health insurance required in Puerto Rico?

There is no individual mandate

, the rule that says everyone must get health insurance. Puerto Rico's health insurance commissioner Angela Weyne says that creates a problem.

Does the Affordable Care Act cover Puerto Rico?

The Department of Health & Human Services (“HHS”), however, has recently clarified that the following requirements imposed under the ACA,

will not apply to individual or group health insurance in the U.S. territories, including Puerto Rico

: (i) guaranteed availability; (ii) community rating; (iii) single risk pool; (iv …

Does Blue Cross Blue Shield coverage in Puerto Rico?

The 34 independent and locally operated Blue Cross Blue Shield companies

deliver health insurance coverage to one in three Americans across all 50 states, the District of Columbia and Puerto Rico

. In addition, the BCBS Federal Employee Program® insures over five million federal employees, retirees and their families.

Do Puerto Rico pay federal taxes?

Puerto Rico is an unincorporated territory of the United States and Puerto Ricans are U.S. citizens; however, Puerto Rico is not a U.S. state, but a U.S. insular area. Consequently, while

all Puerto Rico residents pay federal taxes

, many residents are not required to pay federal income taxes.

How many people are on Medicare in Puerto Rico?

This will provide needed health security for 3.5 million Americans in Puerto Rico, including

over 740,000

Medicare beneficiaries and over 300,000 dual eligible. Puerto Rico ranks 26th among states in total Medicare beneficiary population.

Do I have to pay for Medicare if I live abroad?

Remember,

you can have Medicare while you live abroad, but it will usually not cover the care you receive

. Most people qualify for premium-free Part A, meaning you will pay nothing for coverage. If you must pay a premium for Part A, be aware of the high monthly cost for maintaining Part A coverage.

How many hospitals does Puerto Rico have?

There are

14

hospitals and primary care medical facilities in Puerto Rico.

Who pays for Medicaid in Puerto Rico?

As a U.S. territory, Puerto Rico has unequal access to Medicaid funding. Even though the poverty rate in Puerto Rico is over two times higher than in Mississippi, the nation's poorest state,

the federal government

covers 55 cents of every dollar spent by Puerto Rico on Medicaid compared to 76 cents in Mississippi.

How does Medicaid work in Puerto Rico?

Puerto Rico has elected to operate a title XXI funded Medicaid Expansion program, and

covers children up to age 19 with family income up to 266 percent of the local poverty level

.

Does Medicaid pay for nursing home in Puerto Rico?

Puerto Rico's Medicaid program

does not cover home health services

, hospice care, medical equipment and supplies, or nursing facility services, and as such, these services are not available through managed care.