Your Medicare Works in Puerto Rico, But With Real Limits

Yes, you can use Medicare in Puerto Rico, but not the same way you use it in the 50 states. Original Medicare (Part A and Part B) is accepted in Puerto Rico, and you keep your coverage if you move there. However, the network of doctors and hospitals that accept Medicare is much smaller, many specialists are not available, and some services are not covered at all in Puerto Rico the way they are on the mainland.

If you have a Medicare Advantage plan (Part C), your coverage may not work in Puerto Rico at all, depending on your plan. Most Medicare Advantage plans are not available in Puerto Rico, and if you move there, you will lose your current plan and have to switch. This is the single biggest complication for people relocating to the island.

The rules are different if you are just visiting Puerto Rico for a vacation or short trip versus moving there permanently. Both situations require different steps, and both have traps that catch people off guard.

Key Takeaways

  • Original Medicare (Part A and Part B) works in Puerto Rico, but the number of participating doctors and hospitals is far smaller than on the mainland.
  • Medicare Advantage plans (Part C) usually do not work in Puerto Rico, and you will need to switch to Original Medicare or a Puerto Rico-specific plan if you move there.
  • If you are moving to Puerto Rico permanently, you must notify Social Security and Medicare within 30 days of establishing residency.
  • Prescription drug coverage (Part D) may not cover medications filled in Puerto Rico pharmacies, even if the pharmacy is in your plan's network.
  • For short visits, Original Medicare covers emergency and urgent care, but you should carry proof of coverage and know which hospitals accept Medicare before you go.

How Original Medicare Works in Puerto Rico

If you have Original Medicare (Part A hospital insurance and Part B medical insurance), you can use it in Puerto Rico. Part A covers inpatient hospital stays, skilled nursing facility care, and some home health services. Part B covers doctor visits, outpatient care, and some preventive services. Both parts are accepted at hospitals and clinics in Puerto Rico that are enrolled in Medicare.

The problem is that far fewer providers in Puerto Rico accept Medicare compared to the mainland. Some hospitals and clinics do not participate in Medicare at all. Before you move or plan an extended stay, you need to call ahead and confirm that your doctor or the hospital you might use actually accepts Medicare. The Centers for Medicare & Medicaid Services (CMS) maintains a searchable directory of Medicare providers in Puerto Rico, but it is not always current, so a phone call is safer than relying on the online list alone.

You will pay the same cost-sharing amounts in Puerto Rico as you do on the mainland — the same deductibles, copayments, and coinsurance. However, if you need care from a provider who does not accept Medicare, you will pay the full bill out of pocket, and Medicare will not reimburse you.

Medicare Advantage Plans and Puerto Rico

Medicare Advantage plans (Part C) almost never work in Puerto Rico. These are private insurance plans that replace Original Medicare, and they are sold by insurance companies like UnitedHealthcare, Humana, and Aetna. The vast majority of Medicare Advantage plans are only available in the 50 states and Washington, D.C. — not in Puerto Rico.

If you have a Medicare Advantage plan and you move to Puerto Rico, your plan will end on the date you establish residency there. You will then need to choose a new plan. Your options are to switch to Original Medicare (Part A and Part B) or to a Medicare plan that is actually available in Puerto Rico. A small number of insurance companies do offer Medicare plans in Puerto Rico, but the selection is much narrower than on the mainland, and not all of them include prescription drug coverage (Part D).

This change is not optional — you cannot keep your mainland Medicare Advantage plan if you move to Puerto Rico. You must make a new choice within 60 days of losing your current plan, or you will be locked out of enrollment until the next annual open enrollment period (October 15 to December 7).

What Happens to Your Prescription Drug Coverage

If you have a Part D prescription drug plan, you need to check whether it covers medications filled in Puerto Rico. Some Part D plans do cover Puerto Rico pharmacies, but many do not. Even if a pharmacy is in your plan's network on the mainland, that does not mean it is covered in Puerto Rico.

Before you move or take a long trip, contact your Part D plan directly and ask: "Does my plan cover prescriptions filled in Puerto Rico?" Get the answer in writing if possible. If your current plan does not cover Puerto Rico, you will need to switch to a plan that does, or you will pay the full cost of medications out of pocket.

If you are moving to Puerto Rico permanently and your current Part D plan does not cover the island, you can switch plans during the Special Enrollment Period that opens when you lose coverage. You have 60 days to choose a new plan.

Steps to Take If You Are Moving to Puerto Rico

If you are relocating to Puerto Rico permanently, you must notify both Social Security and Medicare. Contact Social Security within 30 days of establishing residency in Puerto Rico. You can do this by calling 1-800-772-1213 or by visiting your local Social Security office. Tell them your new address in Puerto Rico.

At the same time, contact Medicare to update your address. You can call 1-800-MEDICARE (1-800-633-4227) or visit Medicare.gov. Medicare will send you new cards and information about your coverage in Puerto Rico. If you have a Medicare Advantage plan, this is when you will learn that your plan is ending and that you need to choose a new plan.

If you have a Part D prescription drug plan, contact your plan directly to ask whether it covers Puerto Rico. If it does not, you can switch to a plan that does during the Special Enrollment Period. If you have a Medigap supplemental insurance policy, contact your insurance company — some Medigap plans do not work in Puerto Rico, and you may need to switch.

Using Medicare for a Short Visit to Puerto Rico

If you are visiting Puerto Rico for a vacation or short trip and you have Original Medicare, your coverage travels with you. You can see a doctor or go to a hospital that accepts Medicare, and you will pay the same cost-sharing amounts as you would on the mainland.

Before you leave, write down the names and phone numbers of hospitals in the area where you will be staying. Call ahead to confirm they accept Medicare. If you need emergency care, go to the nearest hospital emergency room — Medicare covers emergency services regardless of whether the hospital is in your plan's network.

Bring your Medicare card with you. Some providers in Puerto Rico may not be familiar with Medicare, so having the card in hand can speed up the process. If you take prescription medications, bring enough to last your entire trip, because your Part D plan may not cover prescriptions filled in Puerto Rico.

Supplemental Insurance and Medicare in Puerto Rico

If you have a Medigap policy (supplemental insurance that works alongside Original Medicare), check with your insurance company before you move to or spend time in Puerto Rico. Some Medigap policies cover Puerto Rico, and some do not. The rules vary by insurance company and by policy type.

Call your Medigap insurance company and ask directly: "Does my policy cover care in Puerto Rico?" If it does not, you may be able to switch to a different Medigap policy that does, though you may face higher premiums or waiting periods depending on your health and the insurance company's rules.

If you have a Medicare Advantage plan with supplemental coverage built in, this is another reason to contact your plan as soon as you know you are moving — the entire plan will end, and you will need to choose new coverage.

Common Mistakes and How to Avoid Them

The biggest mistake is assuming your Medicare Advantage plan will work in Puerto Rico. It will not. If you are planning a move and you have a Medicare Advantage plan, contact your plan when ready — do not wait until after you move. You need time to research and choose a new plan before your current one ends.

Another common mistake is not checking whether your Part D plan covers Puerto Rico. Many people discover this problem only when they try to fill a prescription after they arrive. Call your plan before you move or travel.

A third mistake is not updating your address with Social Security and Medicare. If you move to Puerto Rico without notifying them, your mail will go to your old address, and you may miss important notices about changes to your coverage.

Finally, do not assume that a provider who accepts Medicare on the mainland will accept it in Puerto Rico. The networks are different. Always call ahead to confirm.

Frequently Asked Questions

Will my Medicare Advantage plan work if I move to Puerto Rico?

No. Almost all Medicare Advantage plans end when you establish residency in Puerto Rico. You will need to switch to Original Medicare or a Medicare plan available in Puerto Rico within 60 days of losing your current plan, or you will be locked out until the next annual open enrollment period.

Can I use my Part D prescription drug plan in Puerto Rico?

Some Part D plans cover Puerto Rico pharmacies, but many do not. You must contact your plan directly to ask. If your plan does not cover Puerto Rico and you are moving there, you can switch to a plan that does during the Special Enrollment Period.

What do I do if I need emergency care while visiting Puerto Rico?

Go to the nearest hospital emergency room. Medicare covers emergency services in Puerto Rico regardless of whether the hospital is in your plan's network. Bring your Medicare card. For non-emergency care, call ahead to confirm the provider accepts Medicare.

Do I have to notify Medicare if I move to Puerto Rico?

Yes. Contact Social Security within 30 days of establishing residency and update your address with Medicare by calling 1-800-MEDICARE. This ensures your mail reaches you and Medicare can notify you of any changes to your coverage.

Will my Medigap supplemental insurance work in Puerto Rico?

Some Medigap policies cover Puerto Rico, and some do not. Contact your insurance company before you move to confirm. If your policy does not cover Puerto Rico, you may be able to switch to one that does, though terms vary by company.