14 Congress Members Demand Higher Medicare Advantage Payments for Puerto Rico, 41% Below National Average

A bipartisan group of 14 federal lawmakers sent a letter to the administrator of the Centers for Medicare and Medicaid Services (CMS), Mehmet Oz, demanding that the disparity in Medicare Advantage (MA) payments in Puerto Rico be corrected. The delegation reports that the island receives 41% less per beneficiary compared to the national average, putting at risk the health coverage of more than 600,000 seniors and people with disabilities ¹.

The letter, signed by legislators from both parties including Nydia Velazquez (D-NY), Darren Soto (D-FL), and Maria Elvira Salazar (R-FL), was sent on August 7, 2026 after months of pressure from health organizations on the island ¹.

Context: a chronic funding crisis

The Medicare Advantage program is the primary source of medical coverage for seniors in Puerto Rico. Unlike in the states, where traditional Medicare is the predominant option, on the island more than 70% of Medicare beneficiaries are enrolled in MA plans — the highest proportion of any jurisdiction in the United States ¹.

However, federal payments to insurers operating these plans in Puerto Rico are significantly lower. According to the analysis presented by the congress members, the average payment per beneficiary on the island is approximately 41% below the national average. This disparity is not new: since the implementation of the Affordable Care Act (ACA) in 2010, Puerto Rico has received different treatment in the MA benchmark calculation formulas ¹.

The practical result is devastating. Insurers operating on the island — including Triple-S, PMC Medicare Choice, and MMM — have had to reduce additional benefits, increase copays, and limit provider networks. Several plans have already eliminated dental and vision coverage that is available in the states ¹.

El Vocero reported that Puerto Rico's Health Secretary, Carlos Mellado, has backed the congressional effort and has warned that without a payment adjustment, more insurers could abandon the MA market on the island, leaving thousands of beneficiaries without viable options ¹.

What this means for you

If you or a family member depend on Medicare Advantage in Puerto Rico, this congressional battle directly affects the quality and cost of your coverage. Higher copays, more limited doctor networks, and the absence of benefits like dental and vision are a direct consequence of this federal payment disparity.

For health providers — doctors, hospitals, and clinics — reduced payments mean lower reimbursements for services rendered, which contributes to the flight of medical professionals to the states and worsens the specialist shortage on the island.

How to take action / Checklist

• Check your current Medicare Advantage coverage: review what benefits it includes and compare them with those offered by equivalent plans in states like Florida.
• If you are an MA beneficiary, call 1-800-MEDICARE to confirm you are in the plan that best fits your needs among available options.
• Contact your representative in Washington — Resident Commissioner Jenniffer Gonzalez-Colon — to express your support for payment equalization.
• If you are a health provider, document cases where payment reductions have affected your ability to offer services and share them with professional organizations pushing for changes.
• Stay informed: the next key date is the publication of preliminary MA rates for 2027, expected in February 2027.

What comes next

The congressional letter arrives at a politically complex moment. With Mehmet Oz leading CMS under the current administration, health organizations in Puerto Rico hope that bipartisan pressure will generate movement in negotiations. However, any change to payment formulas requires a regulatory process that could take months.

Meanwhile, the Puerto Rico Hospital Association has announced it will present updated data on the disparity's impact at a congressional hearing scheduled for September. The battle for Medicare Advantage equity is one of the most important — and least visible — fights being waged for Puerto Ricans' health.

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Sources ¹ El Vocero, "14 congresistas urgen al gobierno federal a aumentar pagos de Medicare Advantage en Puerto Rico," August 8, 2026