Medicare Advantage enrollment expands each year, with 2.3 million new people covered in 2022. As the program grows, however, its payment system could need a significant reboot.
Puerto Rico, which has the highest proportion of Medicare Advantage enrollees among all states and territories, offers a glimpse of what insurers in other jurisdictions may face. The territory’s low rates of traditional fee-for-service Medicare enrollment—on which Medicare Advantage payments are based—present challenges for insurance companies trying to run effective programs there.
Puerto Rico’s unique position as a territory means it doesn’t provide an exact road map for companies in the states. But insurers and policymakers can learn from their Puerto Rican counterparts’ experiences.
“We always say Puerto Rico is sort of the canary in the coal mine, because at some point when some jurisdiction gets to very highly penetrated (Medicare Advantage) … they’re going to face the same issue,” said Orlando González Rivera, president of Puerto Rican insurance company MMM Healthcare and Elevance Health’s Medicare East Region.