Your Medicare works in Puerto Rico, but with important limits you need to know before you go

Yes, you can use your Medicare in Puerto Rico — but not the same way you use it in the 50 states. Medicare Part A (hospital insurance) and Part B (medical insurance) are accepted by hospitals and doctors in Puerto Rico, but the network is smaller, costs work differently, and some services may not be available. If you live in Puerto Rico full-time, you will need to understand how your coverage changes. If you are visiting, you should know what to expect at the point of care.

The key difference is that Puerto Rico is a U.S. territory, not a state. Medicare rules there follow federal law, but the healthcare system itself — the hospitals, doctors, and pharmacies — operates under Puerto Rico's regulations. That means your out-of-pocket costs, your choice of providers, and your access to certain medications can all differ from what you are used to on the mainland.

Key Takeaways

  • Medicare Part A and Part B work in Puerto Rico, but you will pay more out-of-pocket because most providers there do not participate in Medicare's network.
  • If you move to Puerto Rico permanently, you must notify Social Security, and your coverage rules may change depending on your residency status.
  • Prescription drug coverage (Part D) works in Puerto Rico, but the pharmacy network is limited and some medications may not be available.
  • Medicare Advantage plans (Part C) do not operate in Puerto Rico, so you cannot enroll in one there or keep one if you move.
  • Supplemental insurance (Medigap) does not work in Puerto Rico, so you will have higher deductibles and coinsurance on your own.

How Medicare Part A and Part B work in Puerto Rico

Medicare Part A and Part B are both accepted in Puerto Rico, but the way you pay for care is different. Most hospitals and doctors in Puerto Rico do not have contracts with Medicare. That means they are not bound by Medicare's fee schedules, and they can charge you more. You will still get credit toward your deductible and out-of-pocket maximum, but you may pay a larger share of the bill upfront.

When you receive care at a non-participating provider in Puerto Rico, you typically pay the full bill at the time of service and then submit a claim to Medicare yourself. Medicare will reimburse you based on what it considers a reasonable charge for that service — which is often less than what the provider charged you. This is called "balance billing," and it can leave you responsible for the difference.

Some hospitals and doctors in Puerto Rico do participate in Medicare. These are usually larger facilities in San Juan and other major cities. If you can find a participating provider, your costs will be closer to what you pay on the mainland. You can search for participating providers on the Medicare provider search tool at Medicare.gov, though the list for Puerto Rico is much shorter than for any state.

What happens to your coverage if you move to Puerto Rico

If you move to Puerto Rico permanently, you must tell Social Security within 30 days. Your Medicare coverage itself does not end, but your may be able to access for certain programs may change. If you are receiving Supplemental Security Income (SSI) in addition to Social Security, your SSI payments will stop when you move to Puerto Rico, even though your Medicare continues.

You should also contact your Medicare Advantage plan (if you have one) or your Medigap insurer (if you have supplemental coverage) before you move. Medicare Advantage plans do not operate in Puerto Rico, so you cannot keep your plan if you move there. You will need to switch to Original Medicare (Part A and Part B) and decide whether to buy a Medigap policy — though Medigap policies sold in Puerto Rico are different from those sold on the mainland and may not cover as much.

If you are a U.S. citizen or permanent resident moving to Puerto Rico, you can maintain Medicare. If you are not a U.S. citizen or permanent resident, your Medicare may be able to access depends on your immigration status and how long you have lived in Puerto Rico. Contact Social Security or Medicare directly to confirm your status before you move.

Prescription drug coverage in Puerto Rico

If you have Medicare Part D (prescription drug coverage), it works in Puerto Rico, but the pharmacy network is limited. Not all U.S. pharmacies operate there, and some medications available on the mainland may not be stocked or may be harder to find. You should contact your Part D plan before you move or travel to Puerto Rico and ask which pharmacies in your area are in-network.

If you cannot find your medication at an in-network pharmacy, you may be able to use an out-of-network pharmacy, but you will pay more out-of-pocket and may not receive the same level of reimbursement. Some people who move to Puerto Rico find it easier to have medications mailed from the mainland, though you should check your plan's rules about mail-order prescriptions and whether they cover medications shipped from outside Puerto Rico.

Prices for medications in Puerto Rico can be different from mainland prices. Some drugs are cheaper; others are more expensive. If you are on a tight budget, ask your doctor whether there are generic alternatives or lower-cost options available in Puerto Rico.

Medicare Advantage and Medigap coverage does not extend to Puerto Rico

If you have a Medicare Advantage plan (Part C), it will not work in Puerto Rico. Medicare Advantage plans are run by private insurance companies and are only available in the 50 states, Washington D.C., and U.S. Virgin Islands. If you move to Puerto Rico or spend more than a certain amount of time there, you will lose your Medicare Advantage coverage and must switch to Original Medicare (Part A and Part B).

Medigap (supplemental insurance) also does not work in Puerto Rico. If you have a Medigap policy and move to Puerto Rico, your coverage will end. You will not be able to buy a Medigap policy in Puerto Rico because they are not sold there. This means your deductibles and coinsurance will be higher, and you will be responsible for a larger share of your healthcare costs.

If you are only visiting Puerto Rico temporarily and have a Medicare Advantage plan or Medigap policy, your coverage should continue while you are there, but you should contact your plan before you travel to confirm. Some plans have limits on how long you can be out of your service area.

What to do before you travel to or move to Puerto Rico

If you are planning to visit Puerto Rico, contact Medicare at 1-800-MEDICARE (1-800-633-4227) at least a week before you leave. Ask whether your current coverage will work where you are going and what to do if you need care. If you have a Medicare Advantage plan or Medigap policy, also contact your plan directly to confirm your coverage while you are away.

Bring your Medicare card with you. Even though many providers in Puerto Rico do not participate in Medicare, your card is still your proof of coverage. Keep receipts for any medical care you receive, because you may need to file a claim yourself.

If you are moving to Puerto Rico permanently, start the process at least two months before you leave. Contact Social Security to update your address, contact your current insurance plan to understand what happens to your coverage, and research healthcare options in Puerto Rico. You may want to talk to a Social Security representative or a Medicare counselor about your specific situation, because the rules can vary depending on your citizenship status and how long you have been in the U.S.

Healthcare costs and out-of-pocket expenses in Puerto Rico

Because most providers in Puerto Rico do not participate in Medicare, your out-of-pocket costs will usually be higher than they would be on the mainland. You will not have the benefit of Medicare's negotiated rates, and you may face balance billing. Your deductible, coinsurance, and copayments will still explore, but you may also owe the difference between what the provider charges and what Medicare considers reasonable.

If you are on a limited income, look into whether you are may be able to access for the Medicare Savings Program or the Low-Income Subsidy program. These programs help pay for Medicare premiums, deductibles, and coinsurance. They are available in Puerto Rico, though the process process and income limits may differ from the mainland. Contact your local Social Security office or call 1-800-MEDICARE to learn more.

Some people who move to Puerto Rico choose to keep their mainland address and travel back to the U.S. for major medical procedures. This is a personal decision that depends on your health, your finances, and your family situation. If you are considering this, talk to your doctor about whether it is safe for you to travel and whether your Medicare coverage will work where you plan to receive care.

Frequently Asked Questions

Can I use my Medicare Advantage plan in Puerto Rico?

No. Medicare Advantage plans do not operate in Puerto Rico. If you move there, your plan will end and you must switch to Original Medicare (Part A and Part B). If you are only visiting, contact your plan to confirm whether your coverage continues while you are away, as some plans limit how long you can be outside your service area.

Do I have to give up my Medicare if I move to Puerto Rico?

No. Your Medicare Part A and Part B coverage continues if you move to Puerto Rico, as long as you are a U.S. citizen or permanent resident. However, you must notify Social Security within 30 days of moving, and your may be able to access for other benefits like SSI may change.

What should I do if a doctor in Puerto Rico will not accept my Medicare?

You can still receive care and file a claim yourself. Pay the bill, keep your receipt, and send it to Medicare with a claim form. Medicare will reimburse you based on what it considers a reasonable charge. You may owe the difference between what the provider charged and what Medicare paid.

Can I buy Medigap insurance in Puerto Rico?

No. Medigap policies are not sold in Puerto Rico. If you move there, your Medigap coverage will end and you cannot buy a new policy. You will have higher out-of-pocket costs for deductibles and coinsurance under Original Medicare.

Will my prescriptions from the mainland work in Puerto Rico?

Your prescriptions are valid in Puerto Rico, but you will need to fill them at a pharmacy there. Not all U.S. pharmacies operate in Puerto Rico, and some medications may not be available. Contact your Part D plan before you move to find out which pharmacies are in-network in your area.