Health sector leaders and experts convene to propose solutions to Puerto Rico’s healthcare system challenges
March 20, 2026, San Juan, P.R. – The Puerto Rico Chamber of Commerce (CCPR), together with its Health Committee, hosted the Puerto Rico Health Insurance Conference 2026, titled “The Puerto Rico Opportunity: From the Perpetual Crisis Narrative to a Masterclass in Fiscal Discipline, Access to Care & Clinical Excellence.”
The event brought together leaders and experts from Puerto Rico’s healthcare and insurance sectors, creating a space for analysis and dialogue focused on addressing structural challenges within the healthcare system and identifying viable, sustainable solutions.
“This forum goes beyond the traditional conversation about crisis and focuses on action. At the Chamber of Commerce, we are promoting a data-driven dialogue grounded in collaboration and fiscal responsibility, with the goal of advancing a more accessible, efficient, and patient-centered healthcare system. We must address critical issues such as mental health and Medicare, because we are the U.S. jurisdiction with the highest Medicare Advantage performance; yet, ironically, we receive the lowest reimbursement in the nation. The math simply doesn’t add up,” said CCPR President, Margaret Ramírez Báez.
Meanwhile, Health Committee President, attorney Luis E. Pizarro, stated:
“Puerto Rico has the capacity and talent to transform its healthcare system, but it requires alignment between public policy, financial sustainability, and real access to services—with the support of both the private sector and government. This meeting achieves exactly that: bringing all sectors to the same table to build concrete, measurable solutions that positively impact patients’ lives.”
Medicare Advantage Challenges
Data presented at the Puerto Rico Health Insurance Conference 2026 revealed a significant disparity in federal healthcare funding that continues to affect access and system stability on the Island.
Currently, Medicare Advantage (MA) covers 96% of eligible beneficiaries in Puerto Rico, representing more than $10 billion annually and serving as the backbone of the healthcare system. However, despite its high participation and performance, the Island receives the lowest payments under the program nationwide. In 2026, the average monthly Medicare Advantage payment in Puerto Rico is $730, compared to $1,228 in the United States—a 68% difference. This gap has widened significantly in recent years, increasing by more than 160% since 2011.
This disparity has direct consequences for beneficiaries. Unlike in the rest of the United States, low-income seniors in Puerto Rico do not have access to the Medicare Savings Program (MSP), forcing them to pay out-of-pocket costs and limiting their ability to cover essential needs such as food and medications.
“Puerto Rico has proven it can deliver high-quality healthcare services; however, it does so with fewer resources than any jurisdiction in the United States. Correcting this funding inequality is not only an economic necessity—it is a matter of equity for millions of American citizens living on the Island. The time to act is now. Without structural interventions, the funding gap will continue to widen, putting access to healthcare services at risk for thousands of families in Puerto Rico,” added the CCPR President.
Despite these challenges, Puerto Rico stands out for the quality of its health plans, with 82% of beneficiaries enrolled in five-star plans—well above the national average. In light of this, healthcare organizations have joined forces to call for concrete action from the federal government, including establishing a minimum funding level for Medicare Advantage based on the geographic adjustment applied in the U.S. Virgin Islands, in order to reduce the existing gap. Additionally, stakeholders are proposing the implementation of the Medicare Savings Program in Puerto Rico, a measure that could positively impact more than 300,000 seniors and individuals with disabilities by easing their financial burden and strengthening the local economy.
In the area of Medicaid, it is estimated that Puerto Rico requires approximately $8 billion annually to adequately serve its population, including expanding essential benefits such as long-term care services and support programs for low-income individuals.
“We must bring the message to Congress that every dollar allocated to Medicare will be used in the best possible way for our patients. There is still much work to be done,” said Roberto Pando, President of MCS Advantage and MCS Life Insurance Company.
Penelope Kokkinides, Senior Vice President and General Manager of Medicare at Triple-S, noted that the Island faces reimbursement challenges while also serving a large aging population in need of Medicare Advantage services.
“Nearly nine out of ten eligible beneficiaries on the Island are enrolled in MA—the highest penetration rate in the U.S. Additionally, 24.6% of residents are aged 65 or older, one of the highest proportions nationwide, along with higher prevalence of diabetes, cardiovascular, and renal diseases. The Island also faces low median income, food insecurity, lack of transportation, and social isolation. It is not a perfect system, but in terms of managed care execution, it is one of the most advanced real-world examples in the U.S.,” Kokkinides stated.
According to her, Puerto Rico represents the best case of high enrollment and coordinated care, but struggles with underpayment, provider shortages, and access gaps. She emphasized that it presents a low-risk, high-return investment opportunity for CMS, which should drive necessary policy changes.
“Yes, we can showcase what Puerto Rico is doing to strengthen our case for additional funding. It should be recognized and supported as a high-value MA market where targeted reimbursement adjustments can generate disproportionate returns in quality, equity, and cost control,” Kokkinides added.
She further emphasized that Puerto Rico’s MA program is not a high-risk funding environment, but rather a proven and highly efficient market operating below its full potential due to structural reimbursement limitations.
On federal healthcare priorities, Greg Murphy, member of the Ways and Means Committee and Co-Chair of the Congressional Doctors Caucus, highlighted the need to attract physicians who have migrated due to low compensation. He also urged continued consistent messaging to Congress regarding necessary changes for Puerto Rico.
“Many people are unaware of what is happening in Puerto Rico’s healthcare system, which is why educating Congress is critically important. Achieving an affordable healthcare system is essential,” Murphy stressed.
Resident Commissioner Pablo José Hernández emphasized that the lack of healthcare sector data is a priority issue that must be addressed clearly and consistently, as it remains a recurring topic in Congress. He added that bipartisan efforts continue to focus on reducing costs and improving patients’ ability to afford medical visits and hospitalizations.
“The changes we need go far beyond Medicare Advantage, including improving service coordination to achieve social equity in Puerto Rico. I have had many conversations with members of Congress, and the goal is for us to be treated equally and to protect funding for Plan Vital. The challenges are complex, but I am confident we will overcome them by working together—both the public and private sectors,” he said.
In the same vein, Leonardo Valentín, President of Professional Hospital, underscored the importance of maximizing the Wage Index through improved data reporting, while Ricardo Hernández, CEO of Menonita Health, warned that Puerto Rico has 42 hospitals, 62.6% of which operate with negative margins, and 17 are at risk—highlighting that the current healthcare model is not sustainable.
Media contact:
Karen Garnik, APR, Fellow PRSA – 787-502-2424
karen@globalvisioncomms.com
Isadora Hernández- 787-310-3807
isadora@globalvisioncomms.com
mailto:isadora@globalvisioncomms.com
Wilnelia Dávila – 787-547-0282
wdavila@prma.com
mailto:wdavila@prma.com