Do Puerto Ricans Get Medicare?
Yes! Puerto Ricans who meet the U.S. Medicare program’s eligibility requirements can enroll in Medicare. Puerto Rico Medicare follows the same rules and regulations as every other U.S. state.
Here’s a guide for Puerto Rican Medicare eligibility, coverage, costs, and more.
Click below to learn more about Puerto Rico Medicare:
- Who is Eligible for Medicare in Puerto Rico?
- What Medicare Plans Are Available in Puerto Rico?
- How to Apply for Medicare in Puerto Rico
- When Can You Apply for Medicare in Puerto Rico?
- Find Medicare Doctors in Puerto Rico
Who is Eligible for Medicare in Puerto Rico?
There are a few ways to qualify for Medicare in Puerto Rico. That’s right, you don’t necessarily have to be 65! You can qualify for Medicare by:
- Turning 65
- Getting diagnosed with ALS
- Getting diagnosed with ESRD
- Entering your 25th month of SSDI
What Medicare Plans Are Available in Puerto Rico?
Original Medicare coverage is limited, but you may be able to get more coverage through a Medicare Advantage, Part D, or Medicare Supplement plan.
Original Medicare
All Medicare beneficiaries need to start with Original Medicare, which includes parts A and B. Part A includes inpatient hospital, hospice, skilled nursing facility, and home health coverage. Premiums, deductibles, coinsurance, and copayments may apply.
If you were employed and paid Medicare taxes for at least 40 quarters (about ten years), or if you get retirement benefits from Social Security or the Railroad Retirement Board, you may have premium-free Part A (premium-free does not necessarily excuse you from other costs). If you only worked for between 30 and 39 quarters, your Part A premium will be $240/month in 2019. If you worked for less than 30 quarters, your Part A premium will be $437/month in 2019.
Part B includes outpatient care, preventative services (like your annual wellness visit), outpatient mental health, lab tests/X-rays, emergency transportation, and durable medical equipment. Premiums, deductibles, coinsurance, and copayments may apply.
The standard Part B premium in 2019 is $135.50. Qualifying for premium-free Part A in Puerto Rico does not mean that you will qualify for premium-free Part B. If you have a high income, your Part B costs may be higher than $135.50.
Puerto Rico Medicare Advantage Plans
Medicare Advantage plans are able to cover the benefits that Original Medicare does not. That can include fitness benefits, dental, vision, prescription drugs, and even meal delivery. Believe it or not, some people can get MA plans for a $0 premium! However, MA plans can be different not only in every state but also in every county and zip code.
Medicare Supplements in Puerto Rico
Medicare Supplements, or Medigap plans, are different from Medicare Advantage plans. Instead of adding health benefits, Medigap plans can add financial benefits. There are several different types of Medigap plans, all of which have different costs and benefits. Benefits include coverage for costs like copayments, deductibles, etc. Use our Medicare Plan Finder tool to find out which type of Medigap plan is right for you.
Part D Prescription Drug Plans in Puerto Rico
You can get Medicare prescription drug coverage in Puerto Rico in two different ways. You can either enroll in a Medicare Advantage plan that comes with a prescription drug benefit, or enroll in a stand-alone prescription drug plan. Keep in mind that you cannot have both a Medicare Advantage plan and a prescription drug plan at the same time, so you’ll have to choose one or the other.
How to Apply for Medicare in Puerto Rico
To enroll in a Medicare Advantage, Part D, or Medicare Supplement plan, you have to have Original Medicare first.
You can enroll in Original Medicare by visiting SocialSecurity.gov, calling Social Security at 1-800-772-1213, or visiting your local Social Security office.
If you are retiring or have retired from a railroad, you can enroll by contacting the Railroad Retirement Board at 1-877-772-5722.
Puerto Rico Social Security Offices
Borinquen Town Plaza
Aquadilla, PR 00603
880 Isaac Cruzstgo St.
Arecibo, PR 00612
Road 167 Forest Hills Plz 2fl
Bayamon, PR 00959
30 Padial St.
Caguas, PR 00725
5829 65 Infanteria Ave
Carolina, PR 00987
102 Garrido Morales
Fajardo, PR 00738
54 Rd 3 Albizu Campos
Guayama, PR 00784
75 J Aguiar Aramburu
Humacao, PR 00791
Esq Expreso To Ciales
Manati, PR 00674
357 Hostos Ave
Mayaguez, PR 00680
2190 Ponce By-pass
Ponce, PR 00716
1579 Ave Ponce De Leon
San Juan, PR 00926
When Can You Apply for Medicare in Puerto Rico?
The best time to sign up for Medicare is when you’re first eligible. If you are aging into the program, you’ll have an Initial Enrollment Period beginning three months before you turn 65 and ending three months after. If you are eligible for Medicare and not yet 65, your Initial Enrollment Period will typically begin on the day you become eligible.
If you age into the Medicare program but miss your Initial Enrollment Period, you can enroll during the General Enrollment Period, which runs from January 1 through March 31.
Once you’re enrolled in Original Medicare, you can apply for Medicare Supplement plans at any time. However, you can only apply for Medicare Advantage or Part D plans during exclusive enrollment periods. Anyone with Medicare can use the Annual Enrollment Period for Medicare Advantage and Part D. This runs from October 15 through December 7 of each year. Some people will also qualify for a Special Enrollment Period and will be able to enroll during other parts of the year.
If these enrollment periods aren’t confusing enough, there is technically one more. The Open Enrollment Period runs from January 1 through March 31 of each year. The OEP is ONLY for people who ALREADY have Medicare Advantage. Basically, it allows people who enrolled in Medicare Advantage during AEP to “change their mind” and not have to wait a full year to make another change.
Find Medicare Doctors in Puerto Rico
Finding doctors in Puerto Rico who accept Medicare is easy! Just go to Medicare.gov’s Physician Finder tool and enter your zip code or city as well as the type of doctor you’re looking for. It’s that easy! We used San Juan as an example.
