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

BURLINGTON, Mass., Jan. 13, 2014 /PRNewswire/ -- 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.

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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 García 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.

About Health Plan Data & Analysis

NEW: Health Plan Analysis reports are now released on an event-driven schedule, so you can tap into updated data and insights when you most need them.

Health Plan Data & Analysis is the tool for understanding the competitive managed care organization landscape, providing state health plan information that drives meeting preparation, strategic planning, and sales strategy development. It provides event-driven insights into the latest state health plan trends that drive local-level sales and planning strategy development and includes updates on:

  • Commercial Carriers
  • Managed Medicare Markets
  • Managed Medicaid Markets
  • Pharmacy Benefits
  • Patient Care Management
  • Legislation
  • Healthcare Reform
  • Key Market Events

About Decision Resources Group
Decision Resources Group is a cohesive portfolio of companies that offers best-in-class, high-value information and insights on important sectors of the healthcare industry. Clients rely on this analysis and data to make informed decisions. Please visit Decision Resources Group at www.DecisionResourcesGroup.com.

All company, brand or product names contained in this document may be trademarks or registered trademarks of their respective holders.

For more information, contact:

Chris Comfort
Decision Resources Group
[email protected]

SOURCE Decision Resources Group