Understanding Health Insurance in Puerto Rico

Coverage, Differences, and International Options

Health Insurance in Puerto Rico

Understanding health insurance in Puerto Rico is crucial, as Puerto Rico’s health insurance system is similar to the US mainland in many ways, but there are key differences that individuals should be aware of when relocating or traveling. While conventional health insurance in Puerto Rico offers comprehensive local coverage, they often provide limited benefits outside the island. Expats, digital nomads, and frequent travelers may need to consider international health insurance options for broader coverage. For those seeking an in-depth understanding, exploring the nuances of health insurance in Puerto Rico is essential.

How is Puerto Rico’s Health Insurance Different?

Health insurance in Puerto Rico operates under a private and public healthcare system. The public system, known as Vital, is Puerto Rico’s Medicaid equivalent, covering low-income residents. The private sector includes major local providers such as Triple-S, MCS, and Humana, offering plans similar to those in the mainland U.S. but often with regional restrictions.

Most local insurance plans:

  • Provide full coverage within Puerto Rico
  • Offer limited coverage on the U.S. mainland (emergency care only)
  • Do not typically cover elective or routine medical care outside of PR

Because of these limitations, many professionals and retirees in Puerto Rico opt for international health insurance plans to ensure full coverage while traveling.

(Related: Puerto Rico’s Healthcare System Overview)

The Impact of Low Insurance Provider Rates on Healthcare in Puerto Rico

The impact of doctor shortages has on patients needing medical attention.

One of the most pressing issues in Puerto Rico’s healthcare system is the low reimbursement rates from insurance providers, which contribute to lower doctor and nurse salaries. This has led to a shortage of medical professionals, particularly among Primary Care Physicians (PCPs), as many leave for the mainland U.S. where salaries are significantly higher.

Key Statistics:

  • The average Primary Care Physician salary in Puerto Rico is $170,000, compared to $265,000 in the U.S.
  • Specialists in Puerto Rico earn $285,000, whereas in the mainland U.S., they earn around $382,000.
  • Registered Nurses in Puerto Rico earn an average of $35,000, significantly lower than the $81,000 U.S. average.

This shortage has resulted in:

  • Longer wait times for appointments, especially with specialists.
  • Limited availability of doctors accepting new patients.
  • Higher patient-to-doctor ratios, leading to potential declines in care quality.

Given these challenges, many expats and residents seek private concierge healthcare or international health insurance for greater flexibility and access to a broader network of healthcare providers.

(Related: Medical Professional Shortages in PR)

How to Improve Your Healthcare Access and Quality in Puerto Rico

Despite the challenges, there are ways to enhance healthcare access in Puerto Rico:

  1. Choose a Health Plan with a Strong Provider Network – Look for insurance plans that include access to top-tier hospitals and specialists to reduce wait times and ensure high-quality care.
  2. Consider Private or Concierge Medical Services – Many expats and business professionals opt for concierge medicine, which provides direct access to physicians, personalized care, and faster appointment scheduling.
  3. Use Telemedicine Services – Many international health plans offer telehealth options, allowing patients to consult with U.S.-based doctors remotely without needing to travel.
  4. Supplement Local Insurance with an International Plan – For those who frequently travel or want broader coverage, international health insurance can provide access to hospitals and specialists outside of Puerto Rico.
  5. Seek Out Medical Tourism Options – Some residents choose to receive elective or specialized medical care in Florida, Texas, or other nearby locations, where provider availability is greater and costs can be competitive.

(Related: Telemedicine in Puerto Rico, Expat Health Insurance in Puerto Rico)

International Health Insurance Options for Expats and Frequent Travelers

If you live in Puerto Rico and frequently travel to the mainland and/or abroad and want medical coverage in multiple locations, you might consider international health insurance plans that provide global benefits. You might find it useful to book a consultation with a Puerto Rico-based health insurance agent that can counsel you about which option works best for you. Here are some of the options available:

(Related: Best International Health Plans)

1. Cigna Global

  • Extensive global network with coverage in Puerto Rico and worldwide.
  • Customizable plans with flexible deductibles and add-ons.
  • 24/7 multilingual customer support and digital claim submission.

(Related: Cigna Global Health Insurance)

2. Allianz Care

  • Strong reputation for international health coverage, including Puerto Rico.
  • Comprehensive plans covering inpatient, outpatient, dental, and maternity care.
  • Emergency medical evacuation and repatriation services included.

(Related: Allianz Care Health Insurance)

3. IMG (International Medical Group)

  • Affordable international health insurance options with global reach.
  • Specializes in long-term expat and traveler health plans.
  • Offers telemedicine services and easy online claim filing.

(Related: Expat Health Insurance – IMG)

4. GeoBlue

  • Exclusive plans designed for U.S. citizens living or working abroad.
  • Access to Blue Cross Blue Shield’s extensive U.S. and Puerto Rico network.
  • Mobile app for easy provider search, claim submission, and telehealth.

(Related: GeoBlue Travel Insurance)

5. AXA Global Healthcare

  • Worldwide coverage with premium options for high-net-worth expats.
  • Direct billing with a vast network of hospitals and clinics.
  • Multilingual support and second medical opinion services.

(Related: AXA Global Healthcare)

6. Redbridge International Health Insurance

  • Specializes in Latin America and the Caribbean, including Puerto Rico.
  • Competitive pricing and flexible plan options.
  • 24/7 assistance with multilingual customer support.

(Related: Redbridge International Health Insurance)

Final Thoughts: Finding the Right Plan for Your Needs

Understanding PR’s health insurance system is essential for both residents and expats. While local insurance plans provide strong coverage on the island, they may lack comprehensive benefits outside of Puerto Rico. For those who travel frequently or want peace of mind with global access to healthcare, an international health insurance plan may be the best choice.

However, it’s also crucial to recognize the broader healthcare challenges in Puerto Rico. Due to low provider reimbursement rates, many doctors and nurses relocate to the mainland U.S., leading to specialist shortages and longer wait times. Those moving to Puerto Rico should carefully evaluate their healthcare access options, which may include concierge medical services or international coverage for flexibility and peace of mind.

To explore your best options, consult with a licensed insurance advisor who can match you with a plan tailored to your healthcare needs.

Looking for guidance on health insurance in Puerto Rico and other relocation concerns? Contact Puerto Rico Advantage for expert insights and personalized recommendations!

The Cost of Living in Puerto Rico

Comparing the Cost of Living in PR to Major U.S. Cities

View of Condado neighborhood in San Juan, Puerto Rico
Condado neighborhood in San Juan, with combination of residential condos, hotels, restaurants, and shopping

For many individuals and businesses looking to relocate, Puerto Rico offers not just stunning beaches and a tropical lifestyle but also significant financial advantages. The cost of living in Puerto Rico is often lower than in major U.S. cities, making it an attractive destination for those seeking affordability and tax benefits. But how do everyday expenses compare, and how do tax incentives balance out living costs? Let’s break it down.

Comparing Puerto Rico’s Cost of Living to Major U.S. Cities

In general, Puerto Rico’s cost of living is lower than that of major metropolitan areas like New York, San Francisco, or Miami. While some expenses, like electricity and imported goods, can be higher, the overall affordability—especially in housing—makes Puerto Rico an attractive option. To provide an accurate comparison, we used data from sources such as Numbeo, Expatistan, and local market research as of 2024.

Expense CategoryPuerto Rico (Avg.)New York CitySan FranciscoMiamiMedian U.S. City
Rent (1-bedroom, city center)$1,000 – $1,500$3,500+$3,200+$2,500+$1,500 – $1,800
Utilities (electricity, water, etc.)$150 – $300$150 – $200$100 – $200$120 – $180$150 – $250
Internet$50 – $90$60 – $100$60 – $100$50 – $90$60 – $80
Groceries (monthly) (Household of 2)$500 – $700$600 – $1,000$700 – $1,200$500 – $800$450 – $700
Dining Out (mid-range restaurant for two)$50 – $80$80 – $120$90 – $150$70 – $100$50 – $80
Gasoline (per gallon)$4.00 – $4.50$3.50 – $4.50$4.00 – $5.00$3.50 – $4.50$3.50 – $4.00
Public Transportation (monthly)$50$127$81$112$70 – $90

(Related: Cost of Living in San Juan, PR)

Budget Breakdown: Everyday Expenses in Puerto Rico

1. Housing in Puerto Rico

A great example of apartment complexes being built to modernize outdated neighborhoods.
Bayshore Villas in San Juan’s Punta de Tierra neighborhood
In contrast to modern apartment complexes, you can also find architecture that still represents Puerto Rican culture.
Homes in Old San Juan

The cost of housing in Puerto Rico is significantly lower than in major U.S. cities. Rent for a middle-class one-bedroom apartment in San Juan’s prime locations, like Condado or Old San Juan, ranges from $1,000 to $1,500, whereas high-end apartments in these areas can exceed $2,000 per month. By comparison, similar apartments in New York or San Francisco cost over $3,000 per month.

For those looking to buy, real estate prices can be attractive, with beachfront condos available for as low as $200,000 to $400,000 in some areas. Additionally, Puerto Rico offers luxury gated communities and high-end condo buildings with extensive amenities for those seeking a more upscale lifestyle.

Tip: If you’re flexible with location, areas outside of San Juan—such as Mayagüez, Ponce, Rincón or other towns outside of the main metro area—offer lower rent while maintaining a high quality of life.

(Related: Puerto Rico Real Estate Market)

2. Utilities in Puerto Rico

Utility costs in Puerto Rico can be higher than on the mainland due to the island’s reliance on imported fuel for electricity. The average electricity bill runs between $150 and $300 per month, depending on air conditioning use. The power grid in PR is also a bit fragile, so it is important to look into mitigation strategies such as generators and solar panels should you experience a power outage.

Tip: Solar energy is becoming more popular, and many homeowners invest in solar panels and battery backup systems to reduce electricity costs and avoid being without power. Additionally, solar panel installations may be eligible for tax credits, providing further incentives for homeowners looking to lower their energy bills.

3. Food & Groceries in Puerto Rico

This shows one of the many alternatives where expats can get locally grown fruits & vegetables to mitigate the Cost of Living in Puerto Rico
Plaza de Mercado de Santurce – Interior
This shows one of the many alternatives where expats can get locally grown fruits & vegetables to mitigate the Cost of Living in Puerto Rico
Plaza de Mercado de Santurce – Shoppers

Grocery prices are generally higher than in the U.S. mainland due to import costs. Expect to pay around $300 – $400 per person per month for groceries. Local markets offer fresh produce at lower prices, so shopping at farmers’ markets or buying local brands can help save money.

Tip: Opt for locally grown fruits, vegetables, and seafood to save on imported grocery costs.

4. Transportation in Puerto Rico

A full street view of Old San Juan's traffic on an average day.
Old San Juan Streets at night, with Christmas decorations on display

Car ownership is common in Puerto Rico, and gas prices are comparable to mainland averages, around $4.00 – $4.50 per gallon. However, vehicle purchase prices tend to be higher due to import taxes, as there are no cars manufactured in Puerto Rico. Public transportation options are limited outside of San Juan, so having a vehicle is often necessary.

Public Transit: The Tren Urbano metro system operates in the San Juan metropolitan area but it is not as extensive as subway systems in major U.S. cities. While it provides some connectivity, most residents still rely on personal vehicles or rideshare services for daily transportation.

Tip: If living in San Juan, you can reduce costs by using Uber (currently the only rideshare app in PR) or walking. Several attractive neighborhoods allow residents to walk to most daily necessities, minimizing the need for a car.

How Tax Savings Can Offset Living Costs

One of the biggest financial incentives for moving to Puerto Rico is the potential tax savings under Act 60 (formerly Acts 20 and 22, and others). Here’s how these world-class tax incentives can benefit you:

  • 0% Capital Gains Tax – Investors relocating to Puerto Rico can benefit from no tax on both short and long-term capital gains, compared to the 15-20% tax rate on the mainland.
  • 2 or 4% Corporate Tax Rate – Entrepreneurs setting up qualifying businesses in Puerto Rico can enjoy a flat 2 or 4% corporate tax rate versus the 21% federal rate in the U.S.
  • No State Taxes – Unlike the mainland, which levies both state and federal taxes, residents of Puerto Rico are only taxed by PR for income sourced there.

For example, a business owner earning $500,000 per year could potentially save over $100,000 in taxes compared to living in a high-tax state like California or New York. (This estimate is based on Puerto Rico’s tax incentives versus combined federal and state tax rates in high-tax jurisdictions. Actual savings depend on individual circumstances, and consulting a tax professional is advised. Contact Puerto Rico Advantage to schedule a free initial consultation)

For more details, see our overview of the Act 60 tax incentives.

(Related: Puerto Rico Act 60 Guide)

Final Thoughts: Is Puerto Rico Affordable?

For those relocating primarily for tax benefits, Puerto Rico offers substantial savings. While some costs, like utilities and groceries, can be higher, the reduced housing costs and major tax incentives often result in a significantly improved financial outlook.

For those less concerned about affordability but looking for a transparent picture of what to expect, Puerto Rico provides a mix of high-end and budget-friendly living options. Luxury accommodations, fine dining, and premium services are available, but so are cost-saving opportunities for those who seek them.

If you’re considering a move, it’s important to weigh not just the numbers but also the lifestyle trade-offs. If you’re looking for an island paradise with financial perks, Puerto Rico may just be the perfect fit.

Need help with your move? Contact Puerto Rico Advantage for guidance on relocation, tax incentives, and settling in!

Webinar: Puerto Rico Health Insurance

Webinar: Puerto Rico Health Insurance

The health insurance system in Puerto Rico is very similar to the mainland US in many ways but also has some differences. Conventional health insurance plans in PR offer comprehensive local coverage but include very limited coverage outside of PR. This webinar will explain more about how the insurance system works and introduce some options to consider.

Some of the topics we will explore:

  • Why is Puerto Rico insurance different?
  • What coverage does a regular PR insurance plan offer?
  • If you are travelling outside of Puerto Rico, is there a way to be fully insured for any medical needs?

Free Webinar registration:

Tuesday, February 11, 2025
3pm PR time / 5pm EST – Click here to register
6pm PR time / 5pm EST – Click here to register

How to Maximize Puerto Rico’s Tax Incentives

How to Maximize Puerto Rico’s Tax Incentives

Free Webinar - Friday, August 16, 12-12:30pm (Eastern time)

Register here.

Learn from investors and business owners who have succeeded with Puerto Rico’s world-class tax advantages.  

Topics covered:

  • Will Puerto Rico tax incentives work for you?
  • How many people have moved to Puerto Rico for the tax benefits?
  • What has changed in Puerto Rico recently?
  • How long does it take to acquire Puerto Rico tax incentives?
  • What is it like to live in Puerto Rico?

Register here for our free webinar on Friday, August 16, 12-12:30pm

Email us here if you have questions you hope to be covered during the webinar.

Shipping in Puerto Rico

Shipping in Puerto Rico

Shipping – The Differences and Similarities of Mail and Express Shipping Services in Puerto Rico vs. the U.S.

Shipping to Puerto Rico has its challenges. You can expect some delays, and there are some online stores that don’t ship to PR – it’s always good to check this up front on a new online shopping site.

The USPS mail service is used in Puerto Rico and standard mail rates apply in Puerto Rico as they would in the US.  USPS is often the fastest and least expensive option! It’s very reasonably priced compared to FedEx, UPS, and any other Express mail services.  Packages sent via USPS generally arrive very quickly, sometime faster than interstate mail. 

There are post offices all over the island and like their U.S. counterparts, they also complete U.S. Passport services.  For Expedited and/or special passport services you should locate the nearest Federal office in Puerto Rico.  https://travel.state.gov/content/travel/en/passports.html 

For those shopping on Amazon, Prime shipping does apply in Puerto Rico although standard Prime items tend to take an average of 5+ days to arrive.  However, some sub-vendors under Amazon don’t ship to Puerto Rico, so be sure to go all the way through to the shipping section at checkout, to check on whether your selected items can reach you in Puerto Rico.  In some cases it is not until check-out that you may find an item cannot be shipped to Puerto Rico.

The FedEx/UPS and other express mail services in Puerto Rico treat Puerto Rico as an “international” location and all shipping rates are international rates.  As a result, shipping things via these express services from Puerto Rico tend to be considerably more expensive than these same mail services on the mainland U.S.

Two good local shipping locations to visit for services are:

We Can Help

Our company helps people like you take advantage of Puerto Rico’s excellent tax incentives!  We can help you determine which tax incentives are right for you, help you plan your residency and relocation strategy, and simplify the entire process for you.

Contact us for a free initial consultation.

Get Started

Bringing Your Pet to Puerto Rico

In general it is totally fine to bring your pet with you to Puerto Rico, either on vacation or when moving here permanently. There is no quarantine period required when bringing a pet to Puerto Rico.

There are lots of grooming, veterinary, and other services for pets. You’ll want to check with the place you will be staying to ensure they allow the type of pet you’d like to bring; is in the mainland, there may be an extra deposit required by some landlords.

Check this link for additional details on local government regulations around pets. It’s important to note that currently, you can’t bring any of the following dog breeds to Puerto Rico:
* All types of Staffordshire bull terrier, including American
* American Pit Bull terrier
* Hybrids produced by crossbreeding with the above breeds with others.

When traveling to Puerto Rico with your pet, if you have a small enough animal that you can bring it onboard a plane with you, the process is much simpler, apart from the required documents and carrying specifications.  However, if you have a larger animal that must ride in cargo, check individual airline regulations about this. Some airlines do not permit the transport of animals in cargo during certain months of the year, like the summer months, because of the exposure to extreme heat during such months.  If you do transport a larger animal in cargo you will need to go, with your own transportation, to a different location, upon arrival to pick up your animal.

We Can Help

Our company helps people like you take advantage of Puerto Rico’s excellent tax incentives!  We can help you determine which tax incentives are right for you, help you plan your residency and relocation strategy, and simplify the entire process for you.

Contact us for a free initial consultation.

Get Started
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Free Webinars

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* Puerto Rico Health Insurance Options 

* The Basics of Transfer Pricing

* The Rules of Puerto Rico Residency

* Puerto Rico Charitable Donation Options

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