Puerto Rico

Written By Jerdon Johnston

Citizen Guide for Puerto Rico

Understanding Your Healthcare Options in Puerto Rico

Navigating healthcare coverage in Puerto Rico can be complex, but there are several programs available to help residents access quality care. Whether you are uninsured, underinsured, or seeking assistance with medical costs, this guide will introduce you to the key healthcare options available.

Who Needs This Guide?

  • You are uninsured or struggling to afford health insurance.

  • You want to explore your healthcare coverage options in Puerto Rico.

  • You need financial assistance for medical costs.

  • You want to maximize the benefits of your current healthcare plan.

Key Healthcare Programs in Puerto Rico

1. Medicaid & CHIP (Puerto Rico’s Medicaid Program – Mi Salud)

  • Who Qualifies? Low-income individuals, families, pregnant women, children, and people with disabilities.

  • What It Covers? Doctor visits, hospital care, prescriptions, preventive services, and more.

  • How to Apply? Visit Puerto Rico’s Medicaid office or apply through the local health insurance exchange.

2. Affordable Care Act (ACA) Plans

  • Who Qualifies? Individuals who do not receive insurance through an employer, Medicare, or Medicaid.

  • What It Covers? Comprehensive health coverage, including preventive care, emergency services, and mental health care.

  • How to Apply? Visit healthcare.gov for federal marketplace options, though Puerto Rico has specific exemptions from some ACA requirements.

3. Medicare

  • Who Qualifies? Individuals 65+ or those with certain disabilities.

  • What It Covers? Hospital stays (Part A), doctor visits (Part B), and optional prescription drug coverage (Part D).

  • How to Apply? Visit Medicare.gov or the Social Security Administration.

4. Employer-Sponsored Health Insurance

Many employers in Puerto Rico offer group health insurance plans, often covering a portion of the premium. If you have a job, check with your employer about available health benefits. COBRA-like continuation coverage may also be available for those who recently lost employer-based insurance.

5. Short-Term & Supplemental Health Plans

For those in transition or needing extra coverage, options include:

  • Short-term health plans to bridge gaps in coverage.

  • Accident or critical illness insurance to cover unexpected medical expenses.

Financial Assistance Programs

  • Premium Tax Credits – Reduce the cost of ACA marketplace plans (applicable in limited cases due to Puerto Rico’s unique status).

  • State-Specific Assistance Programs – Puerto Rico offers additional subsidies and programs under Mi Salud.

Where to Get Help

  • Puerto Rico Health Insurance Marketplace – Explore available ACA-compliant and private insurance options.

  • Medicaid Office – Apply for Mi Salud based on eligibility.

  • Local Community Health Centers – Access low-cost or free healthcare services.

  • Tsunami Advisors – Personalized guidance to find the best plan for your needs.

➡ Need Help? Schedule a free consultation with a Tsunami Advisor today!

 
Jerdon Johnston