Health Insurance in Puerto Rico
Healthcare and health insurance related questions will be high on the agenda for anyone going to Puerto Rico - whether that’s simply passing through, a short holiday, or even a permanent move. Fortunately, this guide provides you with everything you need to know about health insurance in Puerto Rico. Expect to also learn about the country’s healthcare system and some useful travel tips. If you just want a free quote, click on the button to receive it!
About Puerto Rico
Puerto Rico is an unincorporated territory of the United States, located in the northeast Caribbean Sea. It is an archipelago between the Domincan Republic and the US Virgin Islands, almost 2,000 km away from the coast of Miami in Florida. It is important to note that the territory is not an official US state, although Puerto Ricans have been US citizens by default since 1917. Puerto Rico is home to 3.2 million people, mainly dominated in the capital city San Juan. Its official languages are Spanish and English, while major religions are Roman Catholicism and Protestantism. The majority of people in the territory are white (80.5%), followed by blacks (8%), amerindians (0.4%), asians (0.2%), mixed (4.2%), and others (6.7%). The territory’s healthcare system is based on that of the US, characterized by a range of health insurance options.
Healthcare system in Puerto Rico
The US Department of Health and Human Services states in an issue brief that the majority of Puerto Ricans do not have access to a healthcare system that is on par with the rest of the US. In comparison with the different states in the US, Puerto Rico is poorer than the poorest US state. There have been reports of hospitals laying off employees, closing down wings, and limiting healthcare services. Hospitals operating are largely overcrowded, with emergency department patients waiting nearly 13 hours from arrival to admission. The territory’s healthcare system has also been strained by the effects of Hurricanes Irma and Maria in September 2017.
There are both public and private hospitals in Puerto Rico. Public hospitals are plagued with systemic issues, while private ones offer more convenience and better service to those who can afford it. In fact, the Puerto Rican government is trying to push for the territory to become a medical tourism destination providing affordable, but high quality care. Therefore, most expats prefer to use the private healthcare sector.
Public health insurance
For low income Puerto Ricans, there are a couple of public health insurance options. Here are the few main ones.
The Puerto Rican Medicaid program is a unique healthcare program that provides free or low-cost services exclusively through public facilities. Approximately half of the territory’s population are eligible for the Medicaid program, with the eligibility criteria being income based.
For those only edible for Medicaid and not Medicare (explained below), they can enroll in the Mi Salud program. This includes inpatient and outpatient hospital care, primary care, prescriptions, dental, as well as transportation.
Children’s Health Insurance Program (CHIP):
The CHIP insures children in families with incomes too high to be eligible for Medicaid, but those who cannot afford to pay for a private health insurance plan. In Puerto Rico, this is done through a Medicaid Expansion program.
Children must meet all of the following requirements:
- Aged 19 or below
- Have a total household income of up to 266% of the local poverty levels
For those eligible for the Puerto Rican Medicaid program, they might also be eligible for Medicare. Eligibility for both gives access to the Medicare Platino program. This covers everything the Mi Salud program does, plus inpatient and outpatient behavioral health services.
Users need to meet any of the following requirements:
- Aged 65 or older
- Receiving Social Security Disability Income (SSDI) for at least 25 months
- Diagnosed with Amyotrophic Lateral Sclerosis (ALS) or End-Stage Renal Disease (ESRD)
Private health insurance
There are a number of private health insurers in Puerto Rico and costs are much lower than in the US. Many insurers also tend to be more open to covering things like pre-existing conditions. In most policies, small co-payments are common. One thing to note is that healthcare providers aren’t always able to take card payments, so you should always bring some cash with you.
In case of an emergency, you should dial 911. Operators will tend to speak Spanish when answering, but it is possible to transfer the call to an English speaker. If you require an ambulance, these are run by private companies and require you to pay upfront. This may be covered by your health insurer, but it’s best to check this beforehand.
Puerto Rico Travel Advice
If you’re visiting Puerto Rico, you should take into account some of the following tips regarding health and safety. Travel insurance is also highly recommended for all visitors in case of health emergencies.
General tips: Public transport is not good, just like in the US. Therefore, taxis are highly recommended. If you have an international driver’s license, you will also be able to rent a car and drive. However, remember to stay on main roads and use well-lit car parks. Furthermore, avoid wearing expensive jewelry or carry valuable items on you.
Hurricane: The hurricane season normally runs from June to November, so you should monitor the progress of any approaching storms on the US National Hurricane Center website and follow instructions issued by local authorities. Note that Puerto Rico’s infrastructure was affected by Hurricanes Irma and Maria in September 2017.
Earthquakes: Watch out for any earthquakes as the region is prone to them. For more information about what to do before, during and after an earthquake, check out the US Emergency Management website. In January 2020, a magnitude 6.4 earthquake struck around 10 km off Puerto Rico’s coast. The aftershock continued up until May, causing damage in the south west of the island.
Dengue fever: A common tropical disease in Puerto Rico is dengue fever, a viral disease transmitted by mosquitoes. They breed primarily in artificial water containers such as discarded tires, cans, jars, barrels, plastic containers, cisterns, and metal drums. Therefore, the disease is especially common in densely populated and run-down environments.
Please note that the information on this page is not fully comprehensive and is subject to change without prior warning. It is advisable to consult with a local Puerto Rican representative or US embassy should you have any doubts before you depart on your journey.
Private health insurance for expats in Puerto Rico
Expats are strongly urged to secure a private health insurance plan in Puerto Rico, given the territory’s low standards of public healthcare and infrastructure volatility arising from natural disasters. While a local health insurance plan is an option, an international one gives you more flexibility to seek treatment overseas and medical evacuation should you need it.
Looking for a health insurance plan? Pacific Prime provides expat health insurance plans to foreign nationals in Puerto Rico. We can help you secure plans with no deductibles or excesses, along with a range of benefits. Whether it’s coverage for outpatient treatment, dental, vision, maternity, and beyond, browse our plan page to see what's on offer.
If you foresee moving away from Puerto Rico in the near future or worry about developing a pre-existing condition, we can also help you select plans that are globally portable and renewable for life. No matter where you are or what happens, you’ll always have the coverage you need. Contact us today for a free quote and insurance consultation!