Enrollment Growth in Government-Based Healthcare Coverage Drastically Outpaces Commercial Insurance in Puerto Rico

Puerto Rico Plans to Expand Mi Salud (Medicaid) to an Additional 278,000 Residents, According to a New Report From Decision Resources Group

January 13, 2014 – Burlington, Mass.  Decision Resources Group’s newly released Puerto Rico Health Plan Analysis report finds that 2.3 million people access healthcare through Medicare and Mi Salud, the island’s Medicaid program. The market dominance of government-based healthcare coverage in Puerto Rico is driving managed care organizations to cover more generic drugs as fewer residents can afford more expensive plans.
Key Facts:
  • Sixty-three percent of Puerto Rico residents participate in Mi Salud (Medicaid) or Medicare while only 35 percent of the residents participate in commercial insurance plans.
  • Puerto Rico’s governor, Alejando GarcĂ­a Padilla, plans to add 278,000 more residents to the Mi Salud program.
  • Triple-S will be the sole third party administrator for the Mi Salud program, eliminating Humana from Puerto Rico’s Medicaid market.
  • Seventy-two percent of Puerto Rico residents who are eligible for Medicare participate in a Medicare Advantage (MA) plan. For many Puerto Rico residents, MA plans offer the best affordable option and access to medications that they may otherwise forgo.
  • More than 39 percent of Puerto Rico residents age 65 and older live in poverty.
  • “Industry insiders, physicians and patients worry about the effective delivery of—and access to—care, given that Triple-S may control 60 percent of Puerto Rico’s insurance market when commercial, Medicare and Medicaid business segments are combined,” said Decision Resources Group Market Analyst Jacqueline Cavnar.
  • “Responding to market conditions in Puerto Rico, many insurance carriers tweaked their 2014 Medicare Advantage plans to ensure that all generic drugs will be covered in the gap for next year,” adds Jacqueline Cavnar, Market Analyst for Decision Resources Group.

Additional Resources:
  • Ms. Cavnar has written a blog on the subject, which can be found here.
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