Congressional Support Grows for Puerto Rico’s Call to Address Medicare Advantage Funding Disparities
MMAPA Highlights Senator Roger Wicker’s Letter Urging CMS to Address Medicare Advantage Payment Gap for 2028
San Juan, Puerto Rico – Puerto Rico’s call to address Medicare Advantage (MA) funding gap continues to gain support in the U.S. Congress. The Puerto Rico Medicaid and Medicare Advantage Products Association (MMAPA) welcomed a letter from U.S. Senator Roger F. Wicker (R-Mississippi) to the Department of Health and Human Services (HHS) Secretary Robert F. Kennedy Jr. and the Centers for Medicare & Medicaid Services (CMS,) sent on October 16, urging administrative action to address Puerto Rico’s low Medicare Advantage payment rates beginning in 2028.
The letter adds to ongoing efforts by congressional leaders, the Government of Puerto Rico, and the business and healthcare sectors urging CMS to review the methodology used to establish Medicare Advantage payment rates on the Island, considering its unique population characteristics and exceptionally high program enrollment.
“Every new voice joining this effort strengthens Puerto Rico’s message in Washington. We appreciate Senator Wicker’s recognition that the current funding methodology does not adequately reflect our reality and his support for a concrete alternative that CMS has the authority to consider. This effort is about more than numbers or payment formulas. It is about ensuring the stability of a program that hundreds of thousands of older adults depend on, supporting our physicians and hospitals, and protecting long-term access to quality healthcare services,” said Solange De Lahongrais, President of MMAPA.
In his letter, Senator Wicker urges CMS to exercise its existing administrative authority under Section 1876(a)(4) of the Social Security Act to establish a minimum benchmark in markets with extremely low Original Medicare enrollment. Among the proposed alternatives is using cost data from a comparable region, such as the U.S. Virgin Islands, which would allow Puerto Rico’s benchmark to be set at approximately 70% of the national average. This approach could improve Medicare Advantage’s funding base in Puerto Rico without bringing the Island’s payment rates in line with those in the states. It would also provide greater stability for health plans and the physician and hospital networks serving beneficiaries.
Currently, more than 670,000 beneficiaries in Puerto Rico receive healthcare services through Medicare Advantage, representing over 96% of eligible beneficiaries. Yet the benchmarks used to calculate payments to health plans on the Island are approximately 40% below the national average and nearly 20% lower than those in the U.S. Virgin Islands.
Senator Wicker’s letter reinforces MMAPA’s longstanding concern that the current Medicare Advantage funding methodology relies on Original Medicare costs, even though only about 29,000 beneficiaries in Puerto Rico are enrolled in both Parts A and B of that program. This increasingly small population does not accurately reflect the healthcare needs or costs of serving the vast majority of the Island’s older adults.
“Puerto Rico has the highest Medicare Advantage enrollment rate in the nation, consistently delivers outstanding quality performance, yet receives the lowest payment benchmarks. Our seniors and healthcare system should not be penalized for the program’s success. We now have a concrete alternative and a statutory provision that allows CMS to consider a methodology based on comparable geographic areas. What we need is for this opportunity to translate into action for 2028. A more stable funding base supports long-term planning, helps strengthen provider networks, and protects continuity of care for our beneficiaries,” said Roberto Pando, MMAPA Board Member and Chair of its Medicare Policy Committee.
Senator Wicker’s letter coincides with Medicare’s Annual Enrollment Period, which began on October 15 and runs through December 7. As this period continues, discussions in Washington remain focused on the administrative changes needed to strengthen the stability and sustainability of Medicare Advantage in Puerto Rico beginning in 2028.
Senator Wicker’s letter adds to several recent communications sent to the federal Administration supporting changes to Puerto Rico’s Medicare Advantage payment methodology:
October 16, 2026: Senator Roger F. Wicker (R-Mississippi) urges HHS and CMS to use existing administrative authority to establish more appropriate benchmarks in markets with low Original Medicare enrollment, using cost data from comparable regions.
August 3, 2026: A letter led by Representatives Greg Murphy and Brian Fitzpatrick, signed by 14 Republican members of Congress, urges CMS to establish a national minimum MA benchmark beginning in 2028.
June 23, 2026: Puerto Rico Republican Party Chairman Ángel M. Cintrón supports the proposal to use U.S. Virgin Islands payment rates as a benchmark reference.
May 19, 2026: Governor Jenniffer González-Colón urges CMS to prioritize a lasting solution to Puerto Rico’s Medicare Advantage payment gap as part of the 2028 rate-setting process.
February 18, 2025: A letter led by Resident Commissioner Pablo José Hernández and signed by 15 members of the U.S. House of Representatives calls for action to address Medicare Advantage payment gap in Puerto Rico.
MMAPA reiterated its commitment to working with the federal Administration, the Government of Puerto Rico, and congressional leaders to advance an administrative solution that strengthens Medicare Advantage’s long-term sustainability and protects healthcare access for the Island’s older adults.
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