Medicare Advantage in Puerto Rico

Medicare Advantage (MA) is a type of insurance used to supplement Medicare, the federal healthcare assistance program available to older adults and people with certain health issues. MA plans are offered by private companies, for profit. They provide coverage for additional services, such as prescription medications, home health care, dental and vision, and more.  Since people in Puerto Rico are not eligible for Medicare Part D, the prescription drug subsidy for low-income individuals, the MA plans may be the most practical way to cover those costs. 70% of Puerto Ricans receiving Medicare have MA plans, and these plans pay for about half of the medical care used on the Island.

There are disadvantages, though. Someone choosing an MA plan may lose their employer’s or union’s insurance plan. MA plans may also change — the companies providing them can change their offerings at will, or may decide only to cover people with both Medicare and Medicaid. They may limit the providers patients can choose, and costs may be higher than for Original Medicare. They can also offer different features and benefits in different places. In Puerto Rico, counties have on average 25.49  different plans available, compared with an average of 8.11 for counties in the states. The result can be confusion.

Medicaid Advantage payments in Puerto Rico are about 39% lower than in the states. This disparity adds to the difficulty of keeping doctors on the Island. The result is limited health care access for people in Puerto Rico. Recently, Medicare Advantage providers sued the territory over some specific regulations.

Quality of care

Costs and confusion are not the only problems with Medicare Advantage in Puerto Rico. A 2016 study found poor quality care as well.

“Enrollees in Puerto Rico receive substantially worse quality of care than their counterparts in the U.S. states,” said Dr. Amal Trivedi, associate professor at the Brown University School of Public Health. “What surprised us is not the fact that there was a difference, but just how enormous the gap was.” The researchers measured 17 different indicators of quality of care, including the use of the most current treatments and the outcomes of the treatment, and found that care inn Puerto Rico was poor compared with treatment in the states on 15 of the 17 metrics. In many cases, medications were not provided or patients could not afford to fill prescriptions.

“The combination of strained economic circumstances and reduced health care funding may have deleterious effects on the quality of care in Puerto Rico and undermine the federal goal of promoting equity in health care delivery in the Medicare program,” the report concluded.

While the study took place several years ago, the lower payments persist, the level of poverty persists, and the systemic problems go the health care system in Puerto Rico have not been solved since the study was conducted. Last year, a coalition of healthcare providers wrote to the federal government asking for an end to the funding gap in Medicare Advantage on the Island.

“The discrepancy in funding rates for Puerto Rico has contributed to underservicing of seniors and other Medicare beneficiaries on the island, but also to emigration from the island both of patients seeking better care and of medical professionals seeking better working conditions,” wrote Rafael Bernal in The Hill.

Medicare Advantage plans are becoming more popular across the nation, but Puerto Rico continues to have the largest amount of participation in spite off having the lowest funding level. Are Puerto Rico’s seniors being taken advantage of by Medicare Advantage?