Paul Sanchez
Puerto Rico has a well-rounded healthcare system, with high-quality medical facilities, modern equipment, and English-speaking staff in big cities like San Juan and Ponce. The territory's healthcare system is based on that of the US, but it is important to note that Puerto Rico is not a US state, and therefore, the insurance from your home state may not cover you in Puerto Rico. Expats and tourists are advised to purchase appropriate medical insurance, as healthcare in Puerto Rico is not free. There are several options for health insurance in Puerto Rico, including private insurance, public insurance, and international health insurance plans. The Puerto Rico Medicaid program provides free or low-cost services exclusively through public facilities, and approximately half of the territory's population is eligible. The Children's Health Insurance Program (CHIP) is another option for children in families with moderate incomes that are too high to qualify for Medicaid but cannot afford private coverage.
| Characteristics | Values |
|---|---|
| Healthcare costs | As of 2020, healthcare costs in Puerto Rico were more than 30% cheaper than the US average |
| Healthcare system | One of the best in the Caribbean |
| Medical facilities | Highest-quality |
| Medical equipment | Modern |
| Medical staff | English-speaking staff available in big cities, especially San Juan and Ponce |
| Medical insurance | International health insurance plans can be purchased through local or international insurance providers |
| Medical insurance for expats | Customisable and tailored plans are available |
| Medical insurance for children | CHIP insurance covers children in families with incomes too high to be eligible for Medicaid but who cannot afford private health insurance |
| Medicaid | Unlike the 50 states and the District of Columbia, where the federal government will match all Medicaid expenditures, in Puerto Rico, the FMAP is applied until the Medicaid ceiling funds and the Affordable Care Act available funds are exhausted |
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What You'll Learn
International health insurance for expats
As Puerto Rico is a territory of the US, rather than a state, an insurance plan from your home state may not cover you. Therefore, it is important to look into international health insurance plans for expats. These plans can be purchased through local or international insurance providers and can be customised to your needs.
International health insurance plans can protect expats from high medical bills during their time in Puerto Rico. They also offer the benefit of being globally portable, connecting you to a worldwide network of providers. Some top international insurance providers for expats in Puerto Rico include Cigna, Allianz, and AXA. Cigna, for example, offers silver, gold, and platinum plans with various levels of coverage. Allianz offers three tiers of coverage for their international health insurance plans: Care, Care Plus, and Care Pro.
Expats should consider securing international health insurance for themselves and their families, especially as Puerto Rico has low standards of public healthcare and infrastructure volatility arising from natural disasters. Most health insurance plans in Puerto Rico cover all major medical expenses, but it is important to check what your policy covers ahead of time. Many plans cover common healthcare costs, but they may not cover serious injuries or illnesses requiring medical evacuation. Therefore, it is best to check whether your plan includes an emergency evacuation plan in the policy.
Public healthcare in Puerto Rico is managed under a government-run programme, which provides medical and healthcare services through contracted private health insurance companies. The quality of public healthcare is generally good, but due to a shortage of doctors, expats should expect long waiting times. Most expats opt for private healthcare instead, which has shorter waiting times and is of a high standard. Private health insurance can be purchased through local health insurance providers in Puerto Rico or through international insurance providers.
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Public healthcare and government-funded programs
Puerto Rico's healthcare system is similar to that of the mainland US, with a combination of private services and Medicaid-funded public services. The territory's healthcare system is under the umbrella of US federal control, but without the rights and privileges of a full state.
Puerto Rico's public healthcare system is funded by Medicaid and Medicare reimbursements. The Medicaid program in Puerto Rico is unique and differs from the programs operating in each of the 50 US states and the District of Columbia. It operates within a larger, centrally administered healthcare delivery system, and approximately half of the territory's population is eligible for the program. The eligibility criteria are income-based, and the program provides free or low-cost services exclusively through public facilities.
The Children's Health Insurance Program (CHIP) was established in 1997 to provide coverage for children in families with incomes too high to qualify for Medicaid but who cannot afford private coverage. CHIP is jointly funded by the federal government and states. In Puerto Rico, CHIP is done through a Medicaid Expansion program. As of August 2021, 1.5 million individuals were enrolled in Medicaid and CHIP in Puerto Rico.
The Mi Salud program is available to those who are eligible for Medicaid but not Medicare. It includes inpatient and outpatient hospital care, primary care, prescriptions, dental work, and transportation.
Puerto Rico's public healthcare system has faced challenges, including funding caps, increasing medical costs, and the impact of Hurricane Maria, which devastated the island in 2017. The hurricane exacerbated existing issues, with the territory already facing stagnating public health resources, debt, and an aging population.
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Private healthcare and insurance
Puerto Rico's healthcare system is similar to that of the mainland US, with high-quality medical facilities and modern equipment. The cost of healthcare in Puerto Rico is lower than in the US, and the island's healthcare system is considered one of the best in the Caribbean. Most cities and towns have clinics and hospitals, with San Juan and Ponce boasting the most modern equipment and English-speaking staff.
Expats and foreigners seeking shorter wait times and multilingual staff should opt for private hospitals, and can purchase private health insurance to offset the financial burden of private healthcare costs. International health insurance plans are also available and offer the benefit of being globally portable. The cost of private health insurance in Puerto Rico is lower than on the mainland, with premiums around half the rate. However, prices vary depending on the health plan and provider.
For low-income Puerto Ricans, there are public health insurance options including Medicaid and CHIP (Children's Health Insurance Program). Approximately half of the territory's population is eligible for the Medicaid program, which provides free or low-cost services exclusively through public facilities. For those only eligible for Medicaid and not Medicare, they can enrol in the Mi Salud program, which includes inpatient and outpatient hospital care, primary care, prescriptions, dental work, and transportation.
Ambulance services in Puerto Rico are run by private companies and require upfront payment, which may or may not be covered by your health insurer. It is best to check this beforehand.
Examples of international health insurance providers in Puerto Rico include Cigna, AXA, and Bupa Global.
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Eligibility for Medicaid and CHIP
Puerto Rico uses a local poverty level, rather than the federal poverty level (FPL), to determine eligibility. Most Medicaid eligibility and CHIP eligibility are based on Modified Adjusted Gross Income (MAGI). As of August 2021, Puerto Rico had enrolled 1.5 million individuals in Medicaid and CHIP. The Children's Health Insurance Program (CHIP) was established in 1997 to provide coverage for children in families with incomes too high to qualify for Medicaid but who cannot afford private coverage. CHIP is administered by the state and is jointly funded by the federal government and the state. In Puerto Rico, CHIP insurance is provided through a Medicaid Expansion program, covering children up to age 19 with family incomes up to 266% of the local poverty level.
Expats moving to Puerto Rico can purchase health insurance through local or international insurance providers. International health insurance plans can be customized and tailored to the individual's needs and can protect against high medical bills. To be considered a bona fide resident of Puerto Rico, one must pass the closer connection test, which means convincing the IRS that one has stronger ties to Puerto Rico than to the rest of the United States.
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Bona fide residency requirements
Puerto Rico is a territory of the United States and not a state, so the rules that apply on the mainland do not necessarily apply in Puerto Rico. This means that prospective residents will likely need to terminate their current health insurance policy and purchase a new one for Puerto Rico.
Expats and foreigners can purchase health insurance through local or international insurance providers. International health insurance plans can protect expats from high medical bills during their time in Puerto Rico.
For low-income Puerto Ricans, there are a couple of public health insurance options including Medicaid and CHIP (Children's Health Insurance Program). Approximately half of the territory's population is eligible for the Medicaid program, with eligibility criteria being income-based. The Puerto Rican Medicaid program provides free or low-cost services exclusively through public facilities. For those only eligible for Medicaid and not Medicare, they can enroll in the Mi Salud program, which includes inpatient and outpatient hospital care, primary care, prescriptions, dental work, as well as transportation. CHIP insurance covers children in families with incomes too high to be eligible for Medicaid but who cannot afford private health insurance.
To be considered a bona fide resident of Puerto Rico, you must pass the closer connection test, which means convincing the IRS that you have stronger ties to Puerto Rico than to the rest of the United States. The bona fide residence test for US citizens and lawful permanent residents is not the same test that is applied to non-resident aliens. For non-resident aliens, the presence test is the most important element. They will meet the presence test if they meet the substantial presence test, substituting the term Puerto Rico for the United States.
The residence rules for US persons who want to claim bona fide residence in Puerto Rico are very complicated and require the taxpayer to meet very specific residence rules. Midyear movers may qualify as bona fide residents in the first year by satisfying the Presence Test, Tax Home, and Closer Connection Tests for the last 183 days of the year, and remaining bona fide residents of Puerto Rico for the next three years.
To defend your Puerto Rico bona fide residency against an IRS Campaign Audit, taxpayers claiming bona fide residency should make their Puerto Rico homes, home. If a former US home is retained, it should not retain the trappings of a continued residence. Taxpayers should be wary of lengthy stays outside of Puerto Rico, especially in the first year of bona fide residency.
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Frequently asked questions
The insurance you have in your home state might not cover you in Puerto Rico. This is because Puerto Rico is a territory, not a US state, so the rules are different. You may need to buy a new insurance plan that covers Puerto Rico.
Puerto Rico has a well-rounded healthcare system. It has both public and private healthcare sectors. The public healthcare sector is generally well-managed and is handled via a government-run program. The private healthcare system is of a high standard and has shorter wait times.
Expats can purchase health insurance through local or international insurance providers. International health insurance plans can protect expats from high medical bills during their stay in Puerto Rico.
