Compare 2023 Puerto Rico Medicare Advantage Plans
Puerto Rico Medicare Advantage Plans (also known as Part-C) are offered by Medicare approved private insurance companies. There are several types of Medicare Advantage Plans available in PR, depending on your location. Some Puerto Rico MA plans may include additional benefits such as routine vision, hearing care and prescription drug coverage. Some plans may offer coverage for services like transportation to doctor visits, over-the-counter drugs that Part D doesn’t cover, and many services that promote your health and wellness. If you enroll in a Medicare Advantage Prescription Drug plan, you can get all your benefits in one plan. With any MA plan, you still must pay your monthly Part B premium along with any plan premium. To compare different plans available in Puerto Rico, click on your county below to see a list of available plans, what benefits it offers, its cost and if there are any limitations.
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2023 Giveback Plans in Puerto Rico
The Medicare Giveback Benefit is a Part B premium reduction rebate provided by some Medicare Advantage plans in some areas of Puerto Rico. If you enroll in a Medicare Advantage plan with this benefit, some or all your monthly Part B premium will be covered by the plan carrier. The standard Part B monthly premium in 2023 is $164.90. The plan carrier will reduce this cost by “giving back” towards your Part B premium amount. The Part B Giveback is generally credited monthly to your Social Security checks.
| Plan Name | Plan ID | Provider Name | Premium | Give Back Amount |
|---|---|---|---|---|
| Basic (HMO) |
H5774-003 | Triple S Advantage | $0 | $50.00 |
| Humana Gold Plus H4007-021 (HMO) |
H4007-021 | Humana | $0 | $30.00 |
| Magno (HMO-POS) |
H5774-027 | Triple S Advantage | $0 | $30.00 |
| MCS Classicare Efectivo (HMO) |
H5577-005 | MCS Classicare | $0 | $60.00 |
| MCS Classicare Freedom (HMO) |
H5577-014 | MCS Classicare | $0 | $55.00 |
| MCS Classicare Hero (HMO) |
H5577-044 | MCS Classicare | $0 | $100.00 |
| MMM Balance (HMO-POS) |
H4004-063 | PMC Medicare Choice | $0 | $70.00 |
| MMM Plenitud (HMO-POS) |
H4004-065 | PMC Medicare Choice | $0 | $40.00 |
| Optimo (PPO) |
H4005-001 | Triple-S Advantage | $0 | $50.00 |
Most Popular Plans by Enrollment in Puerto Rico
*Based off 2022 CMS enrollment data
| Plan Name | Plan ID | Marketing Name | Premium | Enrollment |
|---|---|---|---|---|
| MMM Elite (HMO-POS) | H4003-034 |
Medicare y Mucho Mas | $0 | 58319 |
| MMM Plenitud (HMO-POS) | H4004-065 |
PMC Medicare Choice | $0 | 22587 |
| MCS Classicare Efectivo (HMO) | H5577-005 |
MCS Classicare | $0 | 22262 |
| MCS Classicare Essential (HMO-POS) | H5577-008 |
MCS Classicare | $0 | 20449 |
| MCS Classicare Activo (HMO) | H5577-031 |
MCS Classicare | $0 | 14098 |
2023 Plans by Provider
Humana
MCS Classicare
Medicare y Mucho Mas
PMC Medicare Choice
Triple-S Advantage
Medicare Advantage changes in Puerto Rico, 2023
• In Puerto Rico, 758,037 individuals are enrolled in Medicare.
• The average monthly Advantage plan premium changed from $0.61 in 2022 to $0.12 in 2023. This represents an -81.1% change in average premium.
• 69 Advantage plans are available in 2023, compared to 53 plans in 2022. This represents a 30.2% change in plan options.
• 100% of people with Original Medicare have access to a Part-C plan.
• 100% of people with Original Medicare will have access to a Part-C plan with a $0 monthly premium.
• $0 is the lowest monthly premium for an Advantage plan.
• Through the CMS Value-Based Insurance Design (VBID) Model, 43 plans will offer Medicare Advantage individuals extra options, including reductions in cost sharing (in some cases to zero) for some benefits, such as eliminated Medicare Part D cost sharing; rewards and incentives programs related to healthy behaviors; and customized, innovative benefits that address social determinants of health, such as food insecurity and social isolation, for individuals who receive low income subsidies (Extra Help) and/or chronically ill individuals.
•In addition, through the VBID Model’s Hospice Benefit Component, 31 plans will offer the Medicare hospice benefit through their plan.
With the passing of the Inflation Reduction Act, people with Medicare prescription drug coverage will have a $35 cost-sharing limit on a month’s supply of each covered insulin products. As well as adult vaccines that are recommended by the Advisory Committee on Immunization Practices (ACIP) at no additional cost.
Source: CMS Fact SheetHow do I qualify for Medicare Advantage in Puerto Rico?
You can join a Medicare Advantage Plan in Puerto Rico if all these apply:
•You're a U.S. citizen or lawfully present in the U.S.
•You have Medicare Part A and Part B.
•You live in the service area of the plan you want to join.
When can I enroll in a Medicare Advantage Plan in Puerto Rico?
Open enrollment starts October 15 and runs to December 7, 2022. During this time, those eligible for Medicare can compare 2023 coverage options on Medicare.gov. The Medicare Plan Finder provides clear easy-to-use information to allow people to compare options for Medicare Advantage Plans in Puerto Rico, which may change from year to year.
Late September 2022 • The 2023 Medicare & You handbooks are mailed to beneficiaries. Keep the handbook as a reference guide.
• Plan providers begin notifying enrollees about changes to their plans.
• Beneficiaries can begin comparing plans starting October 1.
• Beneficiaries should watch their mail for notices from Medicare with information about changes in 2023.
• Star ratings will be available starting October 11.
• The Annual Enrollment Period begins October 15.
• The Annual Enrollment Period ends December 7.
January 2023• Medicare plan coverage begins January 1.
January 1 - March 31The open enrollment period gives you an opportunity to try out an insurance plan. During this period, you can make one switch to a different Advantage Plan, or you can disenroll and return to Original Medicare. If so, you will be able to join a Medicare Prescription Drug Plan. Any changes you make during this period will be effective on the first of the month after the request is received by the provider.
During this period (Jan 1 - March 31) you can't:• Switch from Original Medicare to a MA Plan.
• Join a Prescription Drug Plan if you're on Original Medicare.
• Switch from one Medicare Prescription Drug Plan to another if you're
on Original Medicare.
Can I switch to a Puerto Rico Part-C Plan anytime?
Medicare provides special enrollment periods. You can make changes to your MA plans and Medicare Part-D coverage when certain events happen, like if you move and need Medicare in Rhode Island or lose your insurance coverage. These chances to make changes are called Special Enrollment Periods (SEPs). Regulations about the type of changes and when you can make changes are different for each SEP.
Are some Medicare Advantage Plans free in Puerto Rico?
You may be surprised to find some Medicare Advantage Plans are offering a $0 premium. Of course, no Medicare Part-C plan is really $0 cost for you. There may be copays, deductibles, and coinsurance.
Why consider a Medicare Advantage Plan?
Many Medicare Advantage Plans offer preventive care and disease management programs to help people better manage their health, and healthy patients generally have better health outcome. With a Medicare Advantage Plan, you may have coverage for things like fitness programs and some vision, hearing, and dental services (like routine check-ups) that Original Medicare doesn't cover.
Also, MA plans may offer lower out-of-pocket expenses for you than Original Medicare. There is a limit from Part-C Plans on what you must pay out-of-pocket each year.
Plus plans may offer coverage for services like transportation to doctor visits, over-the-counter drugs, and services that promote your health and wellness.
Which pre-existing conditions are not covered by MA Plans?
You can join any Medicare Advantage Plan in PR even if you have a pre-existing condition.
How Much Does Medicare Advantage Cost in Puerto Rico?
The average premium for a Medicare Advantage Plan in 2022 was $19 per month, some premiums cost $0, and others cost over $100. In addition to any premiums your plan may charge, you may have to pay a yearly deductible. Cost-sharing in the form of copays, coinsurance, and deductibles varies depending on your provider. What you pay in a Medicare Advantage Plan in Puerto Rico depends on several factors. In most cases, you will need to use health care providers who participate in the plan’s network. Some plans will not cover all services from providers outside the plan’s network and service area.
What does Medicare Advantage cover?
Medicare Advantage Plans offer both medical (Part-B) and hospital (Part-A) insurance coverage and additional benefits. Depending on the type of plan you choose.
•Prescription drug coverage. While this isn’t typically covered under original Medicare, most Medicare Advantage Plans offer additional prescription drug coverage and all MAPD plans offer drug coverage. To find out if your medications are covered, check the plan’s formulary or list of covered prescription drugs.
•Dental, hearing, and vision. This includes some non-medically necessary coverage, which Original Medicare doesn't always cover. MA plans differ in benefits offered and vary from plan to plan.
How to join a Medicare Advantage Plan
Go to the Medicare Plan Finder and enter your zip code to find and compare plans in your area. You can speak to a licensed Medicare agent at 1-855-778-4180 (TTY 711) to help you determine which Medicare Advantage Plan would help with your health care needs.
How to Choose a Medicare Advantage Plan in Puerto Rico
Exploring your options could save you a lot of money. When choosing an Advantage Plan, consider the out-of-pocket costs and coverage for your medical needs and prescription drugs, coverage for any current medical issues, and which providers and facilities are included in the plan’s network. You can find out more about the costs and coverage for all the MAPD plans available in Puerto Rico by selecting your county above.
•Which plan fits your budget. How much is the monthly premium? How much is the annual deductible? How much are the copays and coinsurance? What are the plans' maximum out-of-pocket costs?
•Check CMS star ratings. CMS created the five-star quality rating system to help compare plans being offered. The star rating is on a scale of 1 to 5, with 5 being best.
•Look for your doctors. If you have caregivers and medical facilities you use and prefer, look for plans that include them.
•Prescription Drugs. To find a Medicare Advantage plan that includes your prescription drug coverage. Look at the plans Drug List (formulary) for coverage of your current medications. Check if your preferred local pharmacy is included in the plan’s pharmacy network or consider using a mail order pharmacy to lower costs.
•Other coverage. Part-C Plans offer some additional benefits for dental, hearing, vision, gym memberships and transportation to medical appointments.
•Travel coverage. Original Medicare generally doesn’t cover care outside the U.S. You may be able to buy supplemental insurance that offers emergency care when you travel outside of the U.S.
Puerto Rico Health Insurance Assistance Program (SHIP)
The State Health Insurance Assistance Program (SHIP) is a national program that offers one-on-one counseling and education to individuals. SHIP team members are highly trained and certified to assist people on their Medicare, Medicare Advantage and Medigap and Medicaid benefits. SHIP also assists individuals with low income to apply for benefits, such as Medicaid, Extra Help, (Low Income Subsidy) and Medicare Savings Program which help pay for or reduce healthcare costs.
Website: https://agencias.pr.gov/agencias/oppea/educacion/Pages/ship.aspx
Telephone: 1-878-919-7291
How Much Does Medicare Advantage Cost in Puerto Rico
The average premium for a Medicare Advantage Plan in 2022 was $19 per month, some premiums cost $0, and others cost over $100. In addition to any premiums your plan may charge, you may have to pay a yearly deductible.
Source:CMS Star Ratings
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