What are my Medicare options in Puerto Rico?
Medicare coverage in Puerto Rico. Another option is a Medicare Advantage plan, available through the Medicare Part C program. These plans offer an alternative way to get your Original Medicare benefits; they include at least the same amount of coverage as Original Medicare (except for hospice, which is still covered through Original Medicare).
How many Medicare Advantage Dual-eligible Special Needs Plans are there in Puerto Rico?
Approximately 277,000 beneficiaries – approximately 49 percent of all Medicare Advantage enrollees in Puerto Rico – are enrolled in Medicare Advantage Dual-Eligible Special Needs Plans. CMS will implement a number of changes in the 2017 Rate Announcement that will significantly benefit Medicare Advantage enrollees in Puerto Rico.
Why is Medicare Advantage so popular 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 health care coverage for the island’s seniors and people with disabilities.
How is the Department supporting health care delivery in Puerto Rico?
Over the past year, the Department has worked with stakeholders and the government of Puerto Rico to solicit input on opportunities to support health care delivery in Puerto Rico. Currently, the Medicare Advantage program covers 567,000 beneficiaries in Puerto Rico.
Is Medicare Part D available in Puerto Rico?
Every one of the more than 612,000 Medicare beneficiaries in Puerto Rico can choose to enroll in the voluntary Medicare prescription drug coverage beginning on November 15.
How many different Medicare Part D plans are there?
The average Medicare beneficiary has a choice of 54 Medicare plans with Part D drug coverage in 2022, including 23 Medicare stand-alone drug plans and 31 Medicare advantage drug plans.
Does Puerto Rico have Medicare Advantage plans?
Now it's starving the island's healthcare system. Nowhere in the United States is Medicare Advantage (MA) enrollment as popular as it is in Puerto Rico where more than seven out of every 10 Medicare-eligible adults are enrolled in the program.
Is Medicare the same 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.
What is the most popular Medicare Part D plan?
Best-rated Medicare Part D providersRankMedicare Part D providerMedicare star rating for Part D plans1Kaiser Permanente4.92UnitedHealthcare (AARP)3.93BlueCross BlueShield (Anthem)3.94Humana3.83 more rows•Mar 16, 2022
Are all Part D drug plans the same?
All Medicare drug coverage must give at least a standard level of coverage set by Medicare. However, plans offer different combinations of coverage and cost sharing. Plans offering Medicare drug coverage may differ in the drugs they cover, how much you have to pay, and which pharmacies you can use.
How many people are on Medicare in Puerto Rico?
Medicare Advantage in Puerto Rico Currently, the Medicare Advantage program covers 567,000 beneficiaries in Puerto Rico.
Is extra help available in Puerto Rico?
Note: People who live in Puerto Rico, the U.S. Virgin Islands, Guam, or American Samoa can't get SSI. If you have limited income and resources, you may qualify for Extra Help to pay for your Medicare prescription drug costs. The amount of Extra Help you get is based on your income and resources.
Does anthem cover Puerto Rico?
Anthem completes acquisition of Puerto Rico-based Medicare Advantage, Medicaid plans. Anthem has completed its acquisition of MMM Holdings and its affiliates, which offer Medicare Advantage and Medicaid plans based in Puerto Rico.
What is Puerto Rico health insurance like?
The public healthcare sector in Puerto Rico is generally well managed and is handled via a government-run program. No, healthcare is not free. However, the government provides insurance for those who qualify for the “la Reforma”, a government-funded program.
Does Puerto Rico have Medicare Medicaid?
All 50 states and all U.S. territories (Puerto Rico, American Samoa, Guam, Northern Mariana Islands, U.S. Virgin Islands) have access to the United States Medicare and Medicaid programs, though it may be a little different in each place.
What happens to my Medicare if I move to another country?
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.
Medicare Coverage in Puerto Rico
Here’s a rundown on your Medicare options. 1. You can choose to stay with the federally administered Medicare program, which is Original Medicare,...
Medicare Eligibility in Puerto Rico
You’re typically eligible for Medicare if you’re either a United States citizen or permanent legal resident of at least five continuous years. In P...
Medicare Enrollment in Puerto Rico
Medicare enrollment in Puerto Rico works differently than it does in the United States. Puerto Rico residents who are already receiving Social Secu...
Medicare Plans in Puerto Rico
Once you’re enrolled in Original Medicare, Part A and Part B, you may have other options as well, including Medicare Advantage plans, Medicare Pres...
Is Puerto Rico a full benefit state?
Based on our modeling, Puerto Rico would benefit more from these changes than any state. All of the dually eligible beneficiaries determined eligible by Puerto Rico are full benefit, due to the lack of a Medicare Savings Program. As such, plans enrolling dually eligible beneficiaries – including Dual Special Needs Plans – will likely see a significant increase in risk scores.
Is Puerto Rico a Medicare Advantage?
At the end of 2015, Congress passed a law increasing the payments made to Puerto Rico hospitals for inpatient services under Medicare fee-for-service. As fee-for-service payments are part of the basis for Medicare Advantage payments, CMS is proposing to adjust the fee-for-service basis for 2017 Medicare Advantage payments to reflect the higher payments that will be made to Puerto Rico hospitals in 2016; ordinarily, this change would not be reflected until 2018.
Does Medicare Advantage have a quality bonus?
Medicare Advantage plans that achieve high star ratings are eligible for Quality Bonus Payments. Stakeholders in Puerto Rico have raised concerns that it is more difficult for plans serving in Puerto Rico to achieve high star ratings, making these payments more difficult to attain. CMS is proposing a number of changes to address these concerns, and to create a more level playing field for these plans.
Is Puerto Rico eligible for low income subsidy?
By statute, residents of Puerto Rico are ineligible for the Low Income Subsidy , which provides cost sharing and premium assistance to low income Part D enrollees. CMS is proposing to estimate a low income subsidy indicator for Puerto Rico that simulates which enrollees would qualify for the low income subsidy if residing in the 50 states to include in the interim adjustment. Stakeholders have argued that the lack of the low income subsidy makes compliance with some measures – like medication adherence – more difficult. To address this difference in benefits, CMS is proposing a differentiated weighting for the adherence measures in the calculation of the Overall and Summary Star Ratings.
Is the Part C and D Star Rating system sensitive to low income subsidy?
Plans and other stakeholders have raised concerns that the current Part C and D Star Rating system is sensitive to the low income subsidy/dually eligible and disability status of a contract’s enrollees. In response, CMS conducted extensive research on this issue last year, released findings in 2015, and requested comment on the proposed methodological changes.
Does Medicare Advantage have a quality bonus?
Medicare Advantage plans that achieve high Star Ratings are eligible for Quality Bonus Payments. Stakeholders in Puerto Rico have raised concerns that it is more difficult for plans serving in Puerto Rico to achieve high Star Ratings, making these payments more difficult to attain. Beginning in 2017, CMS will make a number ...
Is Puerto Rico a Medicare beneficiary?
Based on our modeling, Puerto Rico would benefit more from these changes than any other state or territory. All of the dually eligible beneficiaries in Puerto Rico are in the full benefit category, due to the lack of a Medicare Savings Program. As such, plans enrolling dually eligible beneficiaries – including Dual Special Needs Plans – will likely see a significant increase in risk scores.
Is Puerto Rico eligible for low income subsidy?
By statute, residents of Puerto Rico are ineligible for the low income subsidy, which provides cost-sharing and premium assistance to low income Part D enrollees. CMS is finalizing its proposal to estimate a low income subsidy indicator for Puerto Rico to be used in conjunction with the interim analytical adjustment. The low income subsidy indicator will identify beneficiaries in contracts operating solely in Puerto Rico whose incomes would result in a low income subsidy designation in the 50 states and DC. Stakeholders have suggested that the lack of the low income subsidy makes compliance with some measures – like medication adherence – more difficult. To address this difference in benefits, CMS will implement a differentiated weighting for the three medication adherence measures in the calculation of the overall and summary Star Ratings for contracts operating solely in Puerto Rico.
How to get extra help for Part D?
For plans with Part D Coverage: You may be able to get Extra Help to pay for your prescription drug premiums and costs. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778 or consult www.socialsecurity.gov; or your Medicaid Office.
How long does Medicare open enrollment last?
Contact may be made by an insurance agent/producer or insurance company. For Medicare Supplement Insurance Only: Open enrollment lasts 6 months and begins the first day of the month in which you are 65 or older and enrolled in Medicare Part B. Some states have an open enrollment period for eligible individuals under the age of 65, and a second enrollment period when they turn 65. If you are under 65, check with your state insurance department for guidelines.
How often does Medicare evaluate plans?
Every year, Medicare evaluates plans based on a 5-star rating system.
How to contact Medicare by phone?
For a complete list of available plans please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048) , 24 hours a day/7 days a week or consult www.medicare.gov.
Does Medicare Part D cover medical insurance?
Medicare Part D plans, also known as Medicare Part D Prescription Drug Plans, help cover the cost of prescription medications, but do not include medical coverage.
Who may contract with other plan sponsors?
Pharmacies, Physicians, and Providers may also contract with other Plan Sponsors.
Do you have to have Medicare Part A or Part B?
You must have Medicare Part A or Part B (or both) to join a Medicare Prescription Drug plan. Members may enroll in the plan only during specific times of the year. Contact the plan for more information.
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.
How many seniors are in Puerto Rico?
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.
What is Medicare Supplement Plan?
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.
How to sign up for Part B 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.
When do seniors enroll in Medicare?
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 ...
Does Part B have late enrollment penalties?
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.
Is Medicare the same as Medicare 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.
How many people are on Medicare 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 health care coverage for the island’s seniors and people with disabilities.
What percentage of Puerto Rico's population is below poverty line?
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 health care needs.
What is the importance of coordination of care for those enrolled in Medicare Advantage and Medicaid?
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.
Why is Medicare Advantage so popular?
Medicare Advantage plans focus on coordinated, patient-centered care, meaning a primary care physician ensures coordination of care for each individual.
Is Puerto Rico a dual eligible state for medicaid?
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.
Is Medicare underfunded in Puerto Rico?
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. ...
How many standardized Medigap plans are there?
There are 10 standardized Medigap plans with letter names A through N. Plans with the same letter must offer the same basic benefit regardless of the insurance company providing the plan. For example, all Medigap Plan A policies provide the same benefit, but health insurance company premiums vary based on the way they choose to set rates—community-rated, entry age-rated or attained-age-rated.
What are the requirements to be eligible for a Medigap plan?
To be eligible for a Medigap plan, you must be enrolled in Original Medicare Parts A and B, but not a Medicare Advantage plan. You must also be in one of the following categories:
What Is Medigap?
Medigap, or Medicare Supplement, is a private insurance policy purchased to help pay for what isn’t covered by Original Medicare (which includes Part A and Part B ). These secondary coverage plans only apply with Original Medicare—not other private insurance policies, standalone Medicare plans or Medicare Advantage plans.
How long does it take to get a Medigap policy?
To buy a Medigap policy, it’s best to enroll during your Medigap Open Enrollment period, which lasts six months. This period begins the first month you have Medicare Part B and are 65 or older. You can buy any Medigap policy sold in your state during this time, even if you have health problems.
How long can you delay Medicare coverage?
Companies could delay coverage up to six months for a pre-existing condition if you didn’t have creditable coverage (other health insurance) before enrolling in Medicare.
Is Medigap the same as Medicare Advantage?
Medigap plans aren’t the same as Medicare Part C, also known as Medicare Advantage. While a Medicare Advantage plan can serve as an alternative way to get Medicare Part A and Part B coverage, Medigap plans only cover what Part A and Part B do not.
Does Medigap cover prescriptions?
Medigap plans generally don’t cover prescriptions, so you may want to consider enrolling in Medicare Part D, which specifically covers prescription drugs, or a Medicare Advantage plan that includes drug coverage.
