2025 Guide to Medicare Advantage Plans in Puerto Rico
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Uncovering the Top Medicare Advantage Plans in Puerto Rico
Are you considering enrolling in a Medicare Advantage plan in Puerto Rico? You're in good company. This year, more than 31 million people enrolled in a private Medicare health plan. Some want lower costs. Some are looking for more benefits. Others need access to more healthcare providers and doctors.
This page is dedicated to assisting you in exploring the highest-rated Medicare Advantage (MA) plans available in Puerto Rico, highlighting the insurance providers that offer these plans, and providing guidance on locating suitable plans within your specific geographic region. This information is crucial as the availability of these plans varies by location, and it's essential to identify the options accessible in your area.
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Unveiling the Standout Medicare Advantage Plans in Puerto Rico
Each year, the Centers for Medicare & Medicaid Services (CMS), reviews and rates Puerto Rico's Medicare Advantage plans based on a 5-star scale. The information used to create a plan's star rating comes from member input and data reported by the plan.
Puerto Rico has 5-star Medicare Advantage plans available in 2025. Not all states and locations do. This year, the highest rated Medicare plans available in Puerto Rico come from:
MedicareWire recommends that you evaluate the plans offered by these Puerto Rico health insurance companies, before all others, for this single reason. More stars awarded by CMS typically means members get better results. So, for instance, five-star plan members might receive better service, phone support, and care than those who have a four-star plan.
TIP: Everyone's personal situation is different. And so are Puerto Rico's Medicare Advantage plans. That's why it is so important to understand Medigap vs Medicare Advantage plans.
Complete List of Puerto Rico's Plan Providers
Puerto Rico has 6 providers that offer Medicare Advantage plans. They include:
- Humana
- MCS Classicare
- Medicare y Mucho Mas
- PMC Medicare Choice
- Triple S Advantage
- Triple-S Advantage
Top Puerto Rico Plans by CMS 5-Star Score
Here's a list of the best Medicare Advantage plans available in Puerto Rico, according to the Centers for Medicare & Medicaid Services:
Top Medicare Advantage Plans in Puerto Rico
| Provider | Plan ID | Plan Name | Premium | Limit | Stars |
|---|---|---|---|---|---|
Interested in joining a plan from one of the top-rated providers? That has a lot to do with your Puerto Rico Municipio. Medicare Advantage plans are regional, and you can't join a plan that isn't in your area.
Top-Rated Medicare Advantage Plans in Puerto Rico by Municipio
Choose your Puerto Rico Municipio below to see the best (and the worst) plans.
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Strategies for Choosing the Optimal Medicare Advantage Plan in Puerto Rico
If you’re approaching the age of 65, navigating a special enrollment event, or looking to review your plan options ahead of the Annual Enrollment Period, there are a number of details you need to consider when comparing your options.
1. Examine Your Projected Utilization Needs
Do you believe that you will get the most out of your plan's benefits, including hospital inpatient care? If you do, evaluate plans with higher monthly premiums, low copayments, and low maximum out-of-pocket limits. Conversely, if your health is good and you rarely use services, look for plans with low premiums or a zero-dollar premium. These plans may have high out-of-pocket maximums and high deductibles, so weigh your risk carefully.
2. Review Your Drug Costs
Prescription drugs, not doctors, are what many seniors blame for driving up their healthcare costs. Part D prescription benefits are included with most Puerto Rico Medicare Advantage plans. It would be best if you made sure that the plan you choose covers your drugs at a price you can afford.
3. Assess Your Need for Supplemental Coverage
Original Medicare does not all health care costs. It covers your major medical and some preventive care services, but it does not cover dental, vision, hearing, or prescriptions. A growing number of Medicare Advantage plans cover many of the essential services that your Part A and Part B benefits do not.
4. Consider Your Healthcare Providers
Medicare Advantage plans use healthcare provider networks, and not all primary care doctors and specialists accept all plans. For many Puerto Rico shoppers, finding a plan that their doctors accept is exhausting. We can help!
Find Plans in your area with your ZIP Code
Next Steps
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Frequently Asked Questions
Still have questions? These common questions and answers might help.
What is the biggest disadvantage of Medicare Advantage?
Medicare Advantage plans can have some potential drawbacks. Many plans require members to use their provider network. Costs are also heavily influenced by how you use healthcare services. This makes it difficult to budget for healthcare expenses. Most plans require members to get referrals for specialists or authorization before they can receive healthcare services. Learn more about the pros and cons of Medicare Advantage plans.
Do Medicare Advantage plans pay 100% of all costs?
The average cost of a Medicare Advantage plan in Puerto Rico is $nan. But that's just the monthly premium. If you have one or more chronic health conditions, a plan's out-of-pocket costs (e.g. deductibles and copays) are also a factor to consider. Plus, most Medicare Advantage plans include prescription drug benefits, which have their own out-of-pocket costs.
What do Medicare Advantage plans include?
All Medicare Advantage plans offered in Puerto Rico must cover all of the Original Medicare benefits. But, private Medicare plans are not required to provide healthcare services similarly. For instance, Medicare Part A covers 80% of hospital stays, skilled nursing, home care, hospice care, and home health care. And Part B covers 80% of doctor visits, lab tests, and other outpatient services. However, Medicare Advantage plans are allowed to set their own copays and routinely charge more than 20%. That said, they do have an annual limit, whereas Original Medicare doesn't.
Citations & References
- CMS.gov, 2023 Medicare Part C Landscape Source Files, Last Accessed January 13, 2023
- CMS.gov, "5-STAR PLAN RATINGS", Last Accessed October 22, 2022
- Medicare.gov, "Understanding Medicare Advantage Plans", Last Accessed October 16, 2022
- KFF.org, "Medicare Advantage 2023 Spotlight: First Look", Last Accessed September 5, 2023
- Medicare.gov, "How to join a Medicare Advantage Plan", Last Accessed October 11, 2022
- CMS.gov, Part C and D Performance Data, Last Accessed October 13, 2024
- CMS.gov, Monthly MA Enrollment by State/County/Contract, Last Accessed October 10, 2024
For details on how we research, analyze, and construct plan information for Puerto Rico using CMS data, see our Medicare Plan Research Methodology.
Plans Offered
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Baylor Scott & White Health Plan, Capital Blue Cross, Cigna Healthcare, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, GlobalHealth, Health Care Service Corporation, Healthy Blue, HealthSun, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.