Question

Investigate the current insurance policy regarding “Reforma” or Puerto Rico’s State insurance. How does it work? Who is elegible?

• Support your answers and comments with specific references.

Answer 1

Puerto Rico is the United States’ largest territory, home to nearly 4 million American citizens.Uninsured rates were significantly lower in Puerto Rico (unadjusted 7.4% versus 15.0%, adjusted difference: −12.0%, p < 0.001). Medicaid was far more common in Puerto Rico. Reference ( https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4567854/)

Puerto Rico's program caps eligibility for individuals at $6,600 a year in 2019 and for a family of three at $9,000, compared to $17,236 and $29,435, respectively, in states that have expanded Medicaid

Reference 2 (https://www.cbpp.org/research/health/puerto-ricos-medicaid-program-needs-an-ongoing-commitment-of-federalfunds#:~:text=This%20means%20that%20Puerto%20Rico's,states%20that%20have%20expanded%20Medicaid.)

Public health insurance

For low income Puerto Ricans, there are a couple of public health insurance options. Here are the few main ones. ( reference : https://www.pacificprime.com/country/americas/puerto-rico-health-insurance-pacific-prime-international/)

Medicaid:

Approximately half of the territory’s population are eligible for the Medicaid program, with the eligibility criteria being income based as above

Children’s Health Insurance Program (CHIP):

Children must meet all of the following requirements:

• Aged 19 or below
• Have a total household income of up to 266% of the local poverty levels

Medicare:

For those eligible for the Puerto Rican Medicaid program, they might also be eligible for Medicare. Eligibility for both gives access to the Medicare Platino program. This covers everything the Mi Salud program does, plus inpatient and outpatient behavioral health services.

Users need to meet any of the following requirements:

• Aged 65 or older
• Receiving Social Security Disability Income (SSDI) for at least 25 months
• Diagnosed with Amyotrophic Lateral Sclerosis (ALS) or End-Stage Renal Disease (ESRD)

Private health insurance

There are a number of private health insurers in Puerto Rico and costs are much lower than in the US. Many insurers also tend to be more open to covering things like pre-existing conditions. In most policies, small co-payments are common. One thing to note is that healthcare providers aren’t always able to take card payments, so you should always bring some cash with you.