For Immediate Release
Contact: Melisa Diaz
202.285.0785 /melisa@melisadiaz.com
March 20, 2024, San Juan, Puerto Rico – The Puerto Rico Medicaid and Medicare Advantage Products Association (MMAPA) was pleased to receive a request for additional information from Health and Human Services Secretary Xavier Becerra on March 14, 2024, regarding the Medicare Advantage program in Puerto Rico.
The request, which seeks information on cost sharing by benefit category offered by Medicare Advantage plans in Puerto Rico, is another key opportunity to submit additional information about the disparity in funding of the MA program and the unique situation of beneficiaries residing in Puerto Rico, which we hope will potentially elicit positive administrative action to mitigate the funding gap as part of the final payment rule for 2025, that is expected to be published the first week of April. Keep in mind that in Puerto Rico, Medicare Advantage is Medicare, due to the low participation of beneficiaries in the traditional Medicare program without supplemental benefits.
"We appreciate the U.S. Department of Health and Human Services' focus on this critical issue, and the Biden-Harris Administration's commitment to address the inequities that affect citizens residing in Puerto Rico. Medicare Advantage base payments for beneficiaries residing in Puerto Rico are 39% below the national average and 21% below the applicable payment to the neighboring territory of the U.S. Virgin Islands,” said MMAPA president Roberto Pando-Cintrón. “Medicare beneficiaries in Puerto Rico pay the same payroll tax, the same Part B premium ($174.70 per month,) and the same prices for drugs as any citizen residing in the states.”
“In an unprecedented move over the past few months, over 60 local and national government officials as well as community organizations have joined forces to submit comments to the U.S. Department of Health and Human Services and the Centers for Medicare & Medicaid (CMS) proposing that MA payments in Puerto Rico be at least equal to those in the U.S. Virgin Islands. Among the signatories are the Governor of Puerto Rico, the Resident Commissioner, America's Health Insurance Plans (AHIP), 19 members of Congress from both parties, and 11 national organizations such as Hispanic Federation, National Kidney Foundation, LULAC, SEIU, and the National Hispanic Medical Association. At the local level, they include the IPAS Association (Primary Medical Groups), the Hospitals’ Association, and the Community Pharmacies Association, out of a total of 20 provider and community associations in Puerto Rico,” Pando explained.
The Medicare Advantage program has filled gaps in basic needs and benefits that are not covered in Puerto Rico by Medicare, Medicaid, Social Security, and the local Nutrition Assistance Program (PAN, by its acronym in Spanish) as part of MA’s supplemental benefits. At the same time, data from the U.S. Census Bureau shows that 38.8% of Puerto Rico's population 65 years of age and older live below the federal poverty level, which is higher than the national average of 9.6%. Compared to the U.S. average, the poverty rate among older persons is four times higher. For these reasons, Medicare Advantage has been selected over regular Medicare by 95% of eligible enrollees. Of individuals who are dual eligible (eligible for both Medicaid and Medicare,) 99% have opted for Medicare Advantage under the Platinum Medicare program. This type of benefit is uniquely needed in Puerto Rico, because in other states, these gaps are filled by other federal programs that do not apply to individuals living on the island.
Basic benefits that are excluded for beneficiaries when living in Puerto Rico include:
1. “Medicare Savings Program” - Dual beneficiaries enrolled in Platinum Medicare are not eligible for the Medicare Savings Program (MSP), which covers the $174.70 Part B payment. Platinum Medicare beneficiaries are required to pay an additional $2,000 per year that they would not be required to pay in the states.
2. Part D Low Income Subsidy (LIS) - This program averages $442 per month in the states to cover pharmacy benefit gaps for low-income people up to 150% of the federal poverty level. It is estimated that over 400,000 people in Puerto Rico would be eligible.
3. "Supplemental Security Income (SSI)" - It is estimated that adding SSI eligibility would increase monthly Social Security checks by more than $600 for over 300,000 low-income Medicare beneficiaries in Puerto Rico.
4. "Long Term Services and Supports (LTSS)" - In the states, this provides Medicaid coverage and pays, on average, $700 per month to Medicare and Medicaid beneficiaries (Platinum Medicare in Puerto Rico) for in-home and institutional assistance.
5. State Nutritional Assistance Program (SNAP) – In comparison to the states, Puerto Rico’s Nutrition Assistance Program (PAN, by its acronym in Spanish) provides eligible beneficiaries about $120 less per month for food per person.
“We thank the Biden Administration for the process and concern in addressing the disparity in Medicare Advantage for U.S. citizens living in Puerto Rico. The opportunity to offer additional data and information is of great help to educate and support decisions that aim to achieve greater health equity and give a fair opportunity to beneficiaries, providers, and the health system in Puerto Rico,” Pando said.
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The Puerto Rico Medicaid and Medicare Advantage Products Association (MMAPA) is a non-profit organization comprised of the main Medicaid and Medicare Advantage organizations on the island. Our mission is to develop public policy proposals that sustain and improve funding for Medicaid and Medicare Advantage beneficiaries, and Puerto Rico's health system as a whole.
