Understanding Medicare Advantage Plans in Puerto Rico

For residents of Puerto Rico, Medicare Advantage plans — also known as Medicare Part C — have become the preferred way to receive Medicare benefits. These plans are offered by private insurance companies 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 convenient package.

How Medicare Advantage Works in Puerto Rico

Under the Medicare Advantage program, Medicare pays a fixed monthly amount to a private insurer for each enrollee. In return, the insurer administers the plan’s benefits, manages the provider network, and offers additional coverage not included in Original Medicare. In Puerto Rico, most Medicare Advantage plans are Health Maintenance Organizations (HMO) or Preferred Provider Organizations (PPO), meaning members generally need to use in-network doctors and hospitals to receive the lowest out-of-pocket costs.

Why Medicare Advantage Is Popular in Puerto Rico

One of the main reasons Medicare Advantage in Puerto Rico is so popular is the added value it offers. Many plans come with $0 monthly premiums and include extra benefits like comprehensive dental care, vision exams and glasses, hearing aids, transportation to medical appointments, fitness programs, and prepaid cards for over-the-counter medications and groceries. These benefits can significantly improve the quality of life for seniors and those with chronic conditions.

Medicare Advantage vs. Original Medicare

With Original Medicare, beneficiaries get separate Part A and Part B coverage, and if they want drug coverage, they need to add a standalone Part D plan. They might also consider a supplemental Medigap policy, which is not widely available in Puerto Rico. Medicare Advantage, on the other hand, bundles hospital, medical, and often drug coverage into one plan, simplifying enrollment and potentially reducing costs.

Types of Medicare Advantage Plans Available in Puerto Rico

In Puerto Rico, Medicare Advantage plans generally fall into these categories:

• HMO (Health Maintenance Organization) – Requires members to use in-network providers except in emergencies.

• PPO (Preferred Provider Organization) – Offers more flexibility to see providers outside the network but at a higher cost.

• SNP (Special Needs Plans) – Tailored for people with specific health conditions or those eligible for both Medicare and Medicaid (dual-eligible).

The right choice depends on your health needs, budget, and whether your preferred doctors and hospitals are in-network.

Costs of Medicare Advantage in Puerto Rico

Many Medicare Advantage plans in Puerto Rico have $0 monthly premiums, but enrollees still pay the Medicare Part B premium unless it’s covered by the plan. Costs also include co-pays for doctor visits, deductibles, and an annual out-of-pocket maximum, which protects you from excessive medical bills. This maximum resets each year and can vary widely between plans.

The Importance of Provider Networks

Because most Medicare Advantage plans in Puerto Rico are HMOs or PPOs, the provider network plays a crucial role in determining access to care. If you see an out-of-network doctor, you might pay more or the service might not be covered at all. For this reason, it’s essential to check each year whether your preferred doctors and hospitals remain in the plan’s network.

Top Medicare Advantage Providers in Puerto Rico for 2026

Based on CMS data and market presence, the following are the most significant Medicare Advantage companies in Puerto Rico for 2026:

1. MCS Classicare – Achieved a 5-star CMS rating, the highest possible score for quality.

2. Triple-S Advantage – Backed by Blue Cross Blue Shield, offering a broad provider network.

3. MMM Healthcare – Known for strong dual-eligible plans and comprehensive benefits.

4. First Medical Health Plan – Wide coverage across the island with competitive benefits.

5. Plan de Salud Menonita – Strategically located in rural areas with owned hospitals providing essential services.

Why Plan de Salud Menonita Is Strategic in Rural Areas

Plan de Salud Menonita is unique because it owns and operates hospitals in municipalities like Aibonito, Cayey, and Guayama, where access to medical care can be limited. This means Medicare Advantage members in these areas get local access to inpatient services, emergency care, and specialist visits without traveling long distances. For residents in Puerto Rico’s mountainous or rural regions, this is a major advantage.

Enrollment Periods for Puerto Rico

Medicare Advantage enrollment periods in Puerto Rico match those in the mainland U.S.:

• Annual Enrollment Period (AEP): October 15 – December 7.

• Medicare Advantage Open Enrollment Period: January 1 – March 31, allowing plan changes or a switch back to Original Medicare.

• Special Enrollment Periods: Triggered by events like moving, losing coverage, or qualifying for Medicaid.

How to Choose the Best Medicare Advantage Plan in Puerto Rico

When selecting a Medicare Advantage plan, consider:

1. Provider network – Is your doctor or hospital included?

2. Drug coverage – Are your prescriptions covered affordably?

3. Extra benefits – Dental, vision, hearing, transportation, OTC allowances.

4. Costs – Premiums, co-pays, deductibles, and out-of-pocket maximums.

5. Star ratings – Higher CMS ratings indicate better performance.

The Bottom Line

For 2026, Puerto Rico’s Medicare Advantage market will be shaped by strong local players like MCS Classicare, Triple-S Advantage, MMM Healthcare, First Medical, and Plan de Salud Menonita — especially after Humana’s exit. Choosing the right plan means balancing cost, benefits, and access to care. Using tools like Medicare’s Plan Compare and reviewing the CMS Star Ratings can help you make an informed choice.