puerto rico Archives

Understanding Health Insurance in Puerto Rico

Coverage, Differences, and International Options

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.

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.

How to Improve Your Healthcare Access and Quality in Puerto Rico

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

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.
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.
Use Telemedicine Services – Many international health plans offer telehealth options, allowing patients to consult with U.S.-based doctors remotely without needing to travel.
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.
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.

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:

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.

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!

How to Maximize Puerto Rico’s Tax Incentives

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

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?

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

Puerto Rico Labor Laws

Did you realize that the Puerto Rico labor laws are different in many key ways than in the mainland US? They are substantially more labor-friendly than you might expect. If you own or are starting a Puerto Rico business and have employees in PR, it’s very important to understand these key differences.

Additionally, there have been changes to these laws. Some have favored the employer, but some more recent changes, just passed in June of 2022, are more beneficial to employees.

Some key points

Puerto Rico labor laws are based on “right to work” rather than the “at will” employment in the mainland.
Employees in PR must be paid a Christmas bonus.
Paid vacations, sick leave, and government holidays are dictated by law.
Employment can begin under a probationary period of up to 3 months (which can be extended for up to another 3 months if you get permission from the PR Department of Labor).
Should you need to terminate an employee for cause, it’s important to show a history backing this up.

New Webinar

We had scheduled a webinar on this topic which incorporated the PR labor law changes enacted last year, but a new change is causing us to delay this webinar. A court connected to PROMESA recently declared the new laws void, and the results of this are still being worked out. We will reschedule the webinar once more details become available.

Puerto Rico Residency – Free Webinar

Establishing legal, “bona-fide” residency is the first step in a successful strategy to take advantage of Puerto Rico’s tax incentives. Maintaining it ongoing is also critical! Should you be audited and found to not be in compliance with the Puerto Rico residency requirements, you could be subject to significant back taxes and penalties.

For a presentation used in our recent free webinar, click here to download the PDF.

Audit Risk – Recent Developments

Even if you have already moved to Puerto Rico, you may be at risk of not be fully compliant with the Puerto Rico residency requirements. The IRS is staffing up to focus more on audits of Puerto Rico residents. It is more important than ever to ensure your strategy is sound and that you’re sticking to it.

It is fairly easy to comply with the rules for Puerto Rico residency. Invest a little time in educating yourself, and then check now and then to ensure you are maintaining this all-important part of your tax reduction strategy.

Questions – How to Become a Bona Fide Resident of Puerto Rico

We recently co-hosted a free webinar with an experienced CPA firm, to explain in more detail how to stay compliant with the residency rules so that your PR tax breaks can continue. If you missed it, you can click here to download the PDF and we do intend to schedule a replay in the future.

The webinar discussed topics such as:

What is the minimum you need to do to first establish Puerto Rico residency?

Are there exceptions to the 183-day rule?

Can I keep a house outside of Puerto Rico and still be a legal PR resident?

What happens if the IRS audits you and finds you not to be a bona fide resident of Puerto Rico?

Is there a way to “game the system”? Why is this risky?

What are the benefits of moving to PR?

Does moving to PR automatically mean I will pay lower taxes?

Transfer Pricing Webinar

PR Advantage is pleased to offer a free webinar series on transfer pricing!

What is transfer pricing?

Some entrepreneurs who relocate to Puerto Rico have existing businesses that continue after their move, which gives them the opportunity to use a PR Export Services company to provide management and other services from PR. Once they have relocated to PR, formed a new business here, and applied for the Act 60 Export Services tax incentive, their new PR company becomes a service provider to the pre-existing business.

Such business owners may have controlling interest in both companies, which means the relationship of the two businesses is not “arm’s length”, from a tax perspective. If this describes your strategy, you may need to consider transfer pricing. It doesn’t affect everyone who moves to Puerto Rico, but for some business owners, it can be an important consideration. This page provides a bit more detail.

Free Webinar Schedule

Because many of our clients have had questions about transfer pricing, PR Advantage has partnered with an experienced firm to offer a free, educational webinar series about transfer pricing. Come and get your questions answered by an expert who has helped many other Act 60 applicants. We are offering the following timeslots:

Session date	Registration link
Tuesday, February 14, 2023	4-4:30pm PR time (12-12:30pm Pacific time)
Wednesday, February 15, 2023	1-1:30am PR time (12-12:30pm Eastern time)

FAQ

Here are some common questions about this issue, as a preview for what we will discuss on the webinar. We encourage you to send additional questions in advance of the session, to ensure the best chance that we can accommodate them.

Q: What is transfer pricing?	A: Fees paid by a company you own or control to another company you own or control.
Q: Why does it matter?	A: This type of vendor relationship is not “arm’s length”, because you control both sides of the transaction.
Q: When would this affect you?	A: In an audit, transactions that are not “arm’s length” could result in fees, penalties, and back taxes owed.
Q: What can you do about this?	A: Obtain a Transfer Pricing Study from a qualified 3rd party vendor to set the prices one of your companies charges the other company.

We look forward seeing you on the webinar! Don’t forget to send us your questions in advance.

« Older Entries

Search

About Our Blog

Puerto Rico is a land of economic opportunity, endless beaches, a rich culture, and friendly people. The weather is amazing year-round, and Puerto Rico offers many beautiful and safe places to live. Let us help you discover the many benefits and joys that life in Puerto Rico has to offer!

Latest News

Understanding Health Insurance in Puerto Rico March 5, 2025
The Cost of Living in Puerto Rico March 4, 2025
Webinar: Puerto Rico Health Insurance February 7, 2025