Medicare Challenges

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Medicare has long been underfunded in Puerto Rico. Americans on the Island pay the same Medicare payroll tax as mainland citizens but receive the lowest level of federal Medicare spending in the country. Federal underfunding of Medicare Advantage (MA) in Puerto Rico has contributed to a health care crisis in the wake of the COVID-19 pandemic.

While 80% of Puerto Rico's Medicare enrollees elect benefits through MA plans, only 30% of mainland enrollees do. And yet, MA in Puerto Rico is:

  • 41% below the U.S. average in federal benchmark funding
  • 37% below the lowest state's federal benchmark funding
  • 23% below the U.S. Virgin Islands' federal benchmark funding

This lack of funding has strained an already broken system. As a result of this chronic underfunding, thousands of physicians have fled the island and essential investments in diagnostic and treatment equipment have had to be deferred.

PRIMA

The Puerto Rico Integrity in Medicare Advantage Act (PRIMA) would stabilize Medicare Advantage payments and incentivize doctors to return to Puerto Rico. H.R. 1969, sponsored by Rep. González-Colón (R-PR-At Large), makes important adjustments to the MA payment formula for a period of three years, helping health care recovery efforts in the aftermath of Irma and Maria. PRIMA would also incentivize doctors to stay in Puerto Rico and encourage those who have left to return by restoring funding to the MA program and directing 50 percent of new funds directly to providers and bolstering MA’s ability to deliver a high-quality, coordinated care model to more than 80% of Puerto Ricans on Medicare.

Learn more here.