Can You Get Medicare in Puerto Rico?

Pamela Cannaday by Pamela Cannaday | Licensed since 2011
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This article was updated on: 08/13/2018

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Do you live in Puerto Rico? You may be a United States citizen, but are you eligible for Medicare? Here’s a quick overview of Medicare in Puerto Rico and some possible coverage options.

Medicare in Puerto Rico: eligibility

You’re generally eligible for Medicare in Puerto Rico when you turn 65. Here are the typical requirements to qualify for Original Medicare (Part A and Part B) in Puerto Rico.

At least one of these must be true for you:

  • Age 65 or over
  • Receiving/eligible for Social Security disability benefits for at least 24 months in a row (even if under 65)
  • Receiving Social Security benefits because of amyotrophic lateral sclerosis (ALS, or Lou Gehrig’s disease). You qualify for Medicare the first month you receive SSA benefits (even if under 65).
  • Diagnosed with end-stage renal disease (ESRD), a kidney disease that requires dialysis or a kidney transplant. You can be any age.

And either:

  • A United States citizen. People born in Puerto Rico are U.S. citizens, the New York Times reported in 2017.
  • A legal resident of at least 5 years, specifically: “a lawfully admitted alien with permanent continuous residency of at least five years prior to the month you apply for Medicare.”

Medicare in Puerto Rico: Part B

As a resident of Puerto Rico, you might have to enroll in Medicare Part B manually if you want this coverage.

Many people in the continental United States are automatically enrolled in Original Medicare, Part A and Part B. That’s the usual story if either:

  • You’re receiving retirement benefits from the Social Security Administration (SSA) or from the Railroad Retirement Board (RRB) when you turn 65
  • You’ve been receiving disability benefits from the SSA or from the RRB for at least 24 months

When you become eligible for Medicare in Puerto Rico, you might be automatically enrolled in Part A (hospital insurance), but generally not in Part B (medical insurance).

Medicare in Puerto Rico: how do you sign up?

To sign up for Medicare Part B in Puerto Rico, you can fill out a form. It’s called the Application for Enrollment in Part B Form (CMS-40B). You can get this form at no cost by:

  • Downloading it from Social Security (ssa.gov)
  • Downloading it from the Centers for Medicare & Medicaid Services (cms.gov)
  • Visiting your local Social Security office

To contact Social Security, visit ssa.gov or call 1-800-772-1213. TTY users can call 1-800-325-0778. Representatives are available Monday through Friday, from 7AM to 7PM.

Medicare in Puerto Rico: what if you don’t sign up for Part B?

If you don’t sign up for Medicare Part B in Puerto Rico as soon as you’re eligible, you could face a late enrollment penalty when you do enroll. Your Part B premium may be 10% higher for every year (12-month period) that you were eligible for Part B but didn’t enroll.

You’ll generally have to pay this penalty for as long as you have Medicare Part B.

However, if you qualify for a Special Enrollment Period for enrolling in Part B, the penalty might not apply.

Medicare in Puerto Rico: what types of coverage are available?

You might have choices when it comes to your Medicare coverage in Puerto Rico. Here’s a quick summary.

Original Medicare, Part A and Part B – This is the federal program for people 65 or older, or who qualify by disability.

Medicare Supplement insurance – This insurance works alongside Medicare Part A and Part B. It might help cover out-of-pocket costs like Part A and Part B copayments, coinsurance, or deductibles.

Stand-alone Medicare Part D Prescription Drug Plans – Again, this coverage works alongside Medicare Part A and Part B. It’s available from private insurance companies that contract with Medicare.

Medicare Advantage plans – These plans provide your Medicare Part A and Part B benefits through a private, Medicare-approved insurance company. Most of them include prescription drug coverage. Learn more about Medicare Advantage plans.

Please note that not all types of Medicare coverage may be available in your part of Puerto Rico. To find out about plans in your area, contact Medicare – the information is at the bottom of this page.

The product and service descriptions, if any, provided on these Medicare.com Web pages are not intended to constitute offers to sell or solicitations in connection with any product or service. All products are not available in all areas and are subject to applicable laws, rules, and regulations.

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