Puerto Rico’s resident commissioner in Washington, Pablo José Hernández, and three Democratic members of Congress on Friday, November 13, urged the administration of Donald Trump to improve payments to Puerto Rico’s Medicare Advantage plans, in which about 682,000 people are enrolled. Hernández, Puerto Rican congressmen Darren Soto (Florida) and Ritchie Torres (New York), and their colleague Raúl Ruiz (California) asked the U.S. Department of Health and Human Services and the Centers for Medicare and Medicaid Services (CMS) to "address the serious funding disparities that threaten access to quality health care for Medicare beneficiaries in Puerto Rico."
In a letter to U.S. Health Secretary Robert Kennedy Jr., the federal lawmakers said the executive branch should correct "the Medicare Advantage benchmark for Puerto Rico for calendar year 2028." Of the 682,000 people enrolled in Medicare Advantage in Puerto Rico, 308,000 are in dual-eligible plans with Medicaid. Although CMS granted a 4.01% increase this year, the Medicaid and Medicare Advantage Products Association (MMAPA) has said payment rates to Puerto Rico’s Medicare Advantage plans remain 41% below the U.S. average and about 20% below the U.S. Virgin Islands.
Like MMAPA, Hernández and the congressmen urged that Puerto Rico’s Medicare Advantage rates be no less than 70% of the U.S. average. "In Puerto Rico, we pay the same Medicare contributions, but our health system receives fewer resources than the states," Hernández said, adding that the inequality affects hospitals, doctors and patients, especially older adults.
In October, Ruiz, a physician, introduced legislation to raise Medicare Advantage payments to the same level as the U.S. Virgin Islands, which are 21% higher than Puerto Rico’s; the measure is co-sponsored by Hernández, Soto and Republican Gus Bilirakis (Florida).