The Puerto Rico Chamber of Commerce took part in efforts that led U.S. Senator Roger Wicker to ask the federal Department of Health and Human Services (HHS) for measures to correct Medicare Advantage payment disparities in Puerto Rico starting in 2028, Chamber president José "Che" Aparicio said on Monday. Aparicio said more than 680,000 beneficiaries in Puerto Rico depend on the program, and that a fairer payment mechanism is fundamental to strengthening the health system, supporting providers and protecting older adults’ access to care.
On October 16, Wicker asked HHS and the Centers for Medicare and Medicaid Services (CMS) to use their administrative powers to address flaws in how payments are calculated in regions where few beneficiaries are enrolled in Original Medicare. The proposal would use traditional Medicare claims data from a comparable region, such as the U.S. Virgin Islands, to set a payment benchmark that would raise Puerto Rico’s Medicare Advantage rates to 70% of the national average starting in 2028.
According to the letter, Puerto Rico’s benchmark payments are about 40% below the national average and 20% below those of the U.S. Virgin Islands. Wicker attributed part of the gap to the current calculation relying on data from a relatively small population still in Original Medicare. Chamber Health Committee chair Luis Pizarro said payment gaps affect providers’ ability to treat patients and the stability of medical services.
On October 29, the Chamber will hold the forum "Actualización 2026 del Diagnóstico a la Acción" at the Bahía Beach Resort Hotel in Río Grande, where health insurance benefits for businesses will be discussed.