Types of Medicare Insurance Plans Available in Puerto Rico
Types of Medicare Coverage Available in Puerto Rico
If you live in Puerto Rico, you may be eligible for Medicare Part A and Part B coverage. Puerto Rico is a territory of the United States, and residents of Puerto Rico (as well as other territories, such as the Northern Mariana Islands, Guam, the Virgin Islands, and American Samoa) can qualify for Medicare if they meet eligibility requirements.
Here’s an overview of how Medicare works if you live in Puerto Rico, including eligibility, enrollment, and your coverage options.
Medicare coverage in Puerto Rico
Here’s a rundown on your Medicare options.
- You can choose to stay with the federally administered Medicare program, which is Original Medicare, Part A (hospital insurance) and Part B (medical insurance).
- Original Medicare offers limited prescription drug coverage, so you can enroll in an optional stand-alone Medicare Part D Prescription Drug Plan that works alongside your Medicare Part A and Part B coverage.
- You can also enroll in a Medicare Supplement (Medigap) plan to help pay for out-of-pocket costs in Original Medicare. Different Medigap plans pay for different amounts of those costs, including copayments, coinsurance, and deductibles.
- 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). One major benefit is that many Medicare Advantage plans provide additional coverage beyond Original Medicare, such as routine dental services, prescription drugs, or wellness programs. A Medicare Advantage Prescription Drug plan combines health benefits and prescription drug coverage into one policy.
Out-of-pocket costs, coverage details, and plan benefits vary among Medicare-approved private health insurance companies. Medicare beneficiaries in Puerto Rico should compare all available plan options in their location with their health and prescription drug needs in mind.
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 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. You may also qualify for Medicare at any age if you have end-stage renal disease or amyotrophic lateral sclerosis (also known as Lou Gehrig’s disease).
When you’re newly eligible and signing up for Medicare for the first time, you’re enrolling in Original Medicare, Part A and Part B, the government health-care program for those over 65 and certain disabled individuals.
If you’ve worked for at least 10 years while paying Medicare taxes, you typically get Part A without a premium, but most people pay a monthly premium for Part B.
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 Security or Railroad Retirement Board benefits when they turn 65 are automatically enrolled in Part A, but they must always sign up manually to get Part B. You can apply for Part B separately through Social Security or the Railroad Retirement Board (if you worked for a railroad); the contact information is below.
The best time to sign up for Medicare is generally during your Initial Enrollment Period, the seven-month period when you’re first eligible for Medicare. If you qualify because of age, this period starts three months before the month that you’re Medicare eligible, includes the month you turn 65, and continues for another three months afterwards. If you qualify because of disability, your Initial Enrollment Period starts three months before the 25th month of disability benefits and lasts seven months. You can also sign up for Part A at this time if you’re not automatically enrolled; for example, you’ll need to manually enroll in both Part A and Part B if you’re not yet receiving retirement benefits when you turn 65.
You can also sign up for Part A and/or Part B during the General Enrollment Period, which runs annually from January 1 to March 31. If you sign up during the General Enrollment Period after you’re first eligible, you might have to pay a late-enrollment penalty for Part A and/or Part B. For example, if you delay Part B enrollment until the General Enrollment Period, you may be charged a permanent premium increase of 10% for each full 12-months that you were eligible for Part B, but did not enroll. If you’re not eligible for premium-free Part A because you haven’t worked enough quarters, you may owe a late-enrollment penalty for Part A as well.
In certain situations, you may be able to delay Medicare enrollment and sign up through a Special Enrollment Period. For example, some people wait to enroll in Part B if they have employer-sponsored health coverage, since Part B comes with a monthly premium. The employer coverage must be based on current employment (either through your own work or your spouse’s work). In this situation, you’ll have an eight-month Special Enrollment Period to sign up for Medicare when you stop working or the health coverage ends (whichever happens first).To sign up for Part A and/or Part B, you can do any of the following:
You can enroll in Medicare Part A and/or Medicare Part B in the following ways:
- Online at SocialSecurity.gov.
- By calling Social Security at 1-800-772-1213 (TTY users 1-800-0778), Monday through Friday, from 7AM to 7PM.
- In person at your local Social Security office.
If you worked at a railroad, enroll in Medicare by contacting the Railroad Retirement Board (RRB) at 1-877-772-5772 (TTY users 1-312-751-4701). Railroad Retirement Board representatives are available Monday through Friday, from 9AM to 3:30PM.
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 Prescription Drug Plans, and Medicare Supplement plans. An eHealth licensed insurance agent can help you explore Medicare plans in your area; just give us a call today to get started.
To learn about Medicare plans you may be eligible for, you can:
- Contact the Medicare plan directly.
- Call 1-800-MEDICARE (1-800-633-4227), TTY users 1-877-486-2048; 24 hours a day, 7 days a week.
- Contact a licensed insurance agency such as Medicare Consumer Guide’s parent company, eHealth.
- Call eHealth's licensed insurance agents at 888-391-2659, TTY users 711. We are available Mon - Fri, 8am - 8pm ET. You may receive a messaging service on weekends and holidays from February 15 through September 30. Please leave a message and your call will be returned the next business day.
- Or enter your zip code where requested on this page to see quote.