Building a Stronger Healthcare Future for Puerto Rico
More than two-thirds of Puerto Rico's residents depend on Medicaid or Medicare Advantage for their health coverage, making these programs the foundation of the Island's healthcare system. Ensuring that they remain strong, sustainable, and adequately funded is essential to protecting access to quality care, supporting healthcare providers, and strengthening Puerto Rico's future.
Latest News
Congressional Support Grows for Puerto Rico’s Call to Address Medicare Advantage Funding Disparities.
U.S. Senator Roger F. Wicker (R-Mississippi) has urged HHS and CMS to consider administrative action for 2028 to establish more appropriate Medicare Advantage payment benchmarks for Puerto Rico, using cost data from comparable geographic areas, such as the U.S. Virgin Islands.
His letter adds to growing support from congressional leaders, the Government of Puerto Rico, and healthcare stakeholders to address a longstanding structural funding disparity.
With more than 670,000 beneficiaries and an enrollment rate exceeding 96%, Puerto Rico has the highest Medicare Advantage participation rate in the nation. Yet its payment benchmarks remain approximately 40% below the national average.
A concrete solution is on the table, and CMS has an existing statutory pathway to consider it for 2028.
Read MMAPA’s press release and Senator Wicker’s letter below.
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Our Federal Priorities
Accountability and Results
Puerto Rico has strengthened program integrity, enhanced accountability, and demonstrated responsible stewardship of federal healthcare resources through compliance with federal oversight requirements while continuing to improve access to quality care.
Puerto Rico at a Glance
3.2 million
Residents
Puerto Rico ranks first among U.S. states and territories for both oldest median age and the proportion of residents aged 65 and older.
41.7%
of residents live below the federal poverty levels, compared with 11.5% in the United States
25%
of residents are age 65 or older, compared with 18% in the United States
$27,000
Median household income
60.4%
Utility costs in Puerto Rico are 60.4% higher than the U.S. national average.
68.7
Healthcare Cost Index: 68.7 (the lowest among nearly 300 U.S. cities), despite operating
with some of the highest utility costs in the nation
Medicaid Snapshot
1.3 Million
Residents Rely on Medicaid
Nearly half of Puerto Rico's population depends on Medicaid for access to healthcare.
307,000+
are on Medicare Advantage
Over 307,000 beneficiaries are enrolled in D-SNP plans that integrate Medicare and Medicaid benefits.
Sept 30, 2027
Current Medicaid Funding Expires
Congressional action is needed to avoid a future Medicaid funding cliff and ensure continued access to care.
One of the Nation's Strongest
Program Integrity Frameworks
Puerto Rico has strengthened accountability, oversight, and program integrity while improving access to healthcare.
Medicare Advantage Snapshot
683,000+
Medicare Advantage Beneficiaries
More than 680,000 beneficiaries rely on the Medicare Advantage program in Puerto Rico.
96%
Medicare Advantage Enrollment
96% of eligible Medicare beneficiaries in Puerto Rico are enrolled in Medicare Advantage plans.
99%
4.5- or 5-Star Plans
99% of Medicare Advantage beneficiaries in Puerto Rico are enrolled in plans rated 4.5 or 5 stars.
20+ Years
Integrated D-SNP Model
Puerto Rico has more than 20 years of experience operating an integrated Medicare-Medicaid D-SNP model.