Explore Medicare Advantage (Part C) Plans for 2026
- PlanesMedicos.com Editorial Staff
- Aug 15
- 4 min read
Exploring Medicare Advantage (Part C) Plans in Puerto Rico for 2026
For many residents of Puerto Rico, Medicare Advantage — also known as Medicare Part C — is the most convenient and comprehensive way to receive Medicare benefits. These plans are offered by private insurers approved by the Centers for Medicare & Medicaid Services (CMS) and combine hospital coverage (Part A), medical coverage (Part B), and, in most cases, prescription drug coverage (Part D) into one integrated package.
What Is Medicare Advantage?
A Medicare Advantage plan functions as an alternative to Original Medicare. Instead of Medicare paying providers directly, CMS pays a fixed amount each month to a private insurance company, which then manages your benefits. Most plans also offer extras such as dental, vision, and hearing benefits, transportation to appointments, and prepaid cards for over-the-counter (OTC) health items.
Medicare Advantage in Puerto Rico
The Medicare Advantage market in Puerto Rico is highly competitive, with several local and national carriers offering $0 premium plans. According to Medicare’s Plan Finder, these plans can include significant supplemental benefits that are especially valuable for seniors on fixed incomes. Puerto Rico’s high Medicare Advantage enrollment rate — among the highest in the U.S. — reflects both the affordability and appeal of these comprehensive packages.
Key Change for 2026: Humana’s Exit
A major development for 2026 is that Humana will no longer offer Medicare Advantage plans in Puerto Rico as of January 1. Beneficiaries currently enrolled in Humana MA plans will need to select new coverage during the Annual Enrollment Period from October 15 to December 7, 2025, or through a special enrollment period.
Main Medicare Advantage Providers in Puerto Rico for 2026
The top five companies expected to lead the market in 2026 include:
1.
MCS Classicare is the only Puerto Rico Medicare Advantage plan to have earned a 5-star CMS rating in 2025. This rating reflects outstanding performance in preventive services, chronic condition management, and member satisfaction. MCS offers a variety of HMO and Special Needs Plans (SNPs) with $0 premiums and benefits like full dental coverage, vision, hearing aids, OTC allowances, and wellness programs.
2.
As the exclusive licensee of Blue Cross Blue Shield in Puerto Rico, Triple-S Advantage combines strong brand recognition with one of the island’s largest provider networks. Its 2026 offerings include HMO, PPO, and SNP plans, many with no monthly premium, plus dental and vision coverage, transportation, and telehealth services.
3.
Known as Medicare y Mucho Más, MMM Healthcare has a strong footprint in Puerto Rico’s Medicare market, particularly in serving dual-eligible beneficiaries. Its Platino plans feature grocery and fuel cards, home delivery of prescriptions, and comprehensive dental and vision care. MMM emphasizes preventive services and care coordination for members with chronic illnesses.
4.
First Medical provides extensive island-wide coverage with HMO plans starting at $0 premium. Benefits for 2026 include hospital, primary care, specialist visits, prescription drugs, dental, vision, hearing, and transportation. First Medical is well-regarded for its customer service and long-standing partnerships with local healthcare providers.
5.
Plan de Salud Menonita is a non-profit healthcare organization with a strategic presence in Puerto Rico’s central and rural regions. The plan owns and operates hospitals in municipalities such as Aibonito, Cayey, and Guayama, ensuring that members in underserved areas have nearby access to inpatient and emergency services. For residents outside metropolitan San Juan, this local infrastructure can make Menonita one of the most valuable Medicare Advantage options.
Types of Medicare Advantage Plans Offered
In Puerto Rico, the most common plan types are:
HMO (Health Maintenance Organization) – Requires members to use network providers.
PPO (Preferred Provider Organization) – Allows more flexibility to use out-of-network providers at higher costs.
SNP (Special Needs Plans) – Designed for members with specific health needs or who qualify for both Medicare and Medicaid.
Costs and Coverage Details
While many Medicare Advantage plans in Puerto Rico advertise $0 premiums, beneficiaries should also consider co-pays, deductibles, and the plan’s out-of-pocket maximum. This limit provides financial protection in case of serious illness or injury. Coverage for prescription drugs varies by plan, so it’s essential to check the formulary each year to ensure your medications are covered affordably.
The Role of Provider Networks
In an HMO or PPO plan, the provider network determines which doctors and hospitals you can see without incurring higher costs. Plans with broader networks can offer greater convenience, but network size and composition vary significantly between carriers. Before enrolling, confirm your preferred healthcare providers are in-network.
How to Compare Plans for 2026
When choosing a Medicare Advantage plan for 2026, consider:
Network access – Are your doctors and hospitals included?
Drug coverage – Are your prescriptions on the plan’s formulary?
Extra benefits – Dental, vision, hearing, OTC allowances, and transportation.
Costs – Premium, co-pays, deductibles, and annual out-of-pocket maximum.
CMS Star Ratings – Higher ratings generally indicate better plan performance.
Tools like Medicare Plan Compare can help you compare costs and benefits side-by-side.
Enrollment Periods for 2026
Puerto Rico follows the same Medicare Advantage enrollment periods as the mainland U.S.:
Annual Enrollment Period (AEP): October 15 – December 7, 2025.
Open Enrollment Period: January 1 – March 31, 2026, allowing one plan change or a return to Original Medicare.
Special Enrollment Periods: Triggered by qualifying life events like moving or losing coverage.
The Bottom Line
For 2026, Medicare Advantage in Puerto Rico remains a robust and competitive market — even with Humana’s exit. Local leaders like MCS Classicare, Triple-S Advantage, MMM Healthcare, First Medical, and Plan de Salud Menonita continue to offer strong benefits, broad coverage, and competitive pricing. Using reliable resources such as Medicare.gov and consulting with licensed insurance agents can ensure you choose a plan that matches your healthcare needs and budget.
