Gap continues for Medicare Advantage beneficiaries 

Representatives of Puerto Rico’s health care sector are lamenting a decision by the Center for Medicare and Medicaid Services (CMS) not to implement recommendations to increase funding for these programs by 2025. Without the changes, approximately 657,000 beneficiaries on the Island covered by Medicare Advantage will receive lower benefits compared to those available to their peers on the mainland and the U.S. Virgin Islands. Compared to the states, the disparity is approximately 31%, according to Roberto Pando, president of the Medicaid and Medicare Advantage Products Association (MMAPA.)

In an unprecedented effort, the association, and a large group of stakeholders -more than 60 government officials and community organizations- highlighted the special circumstances surrounding the program in Puerto Rico and provided new data and analysis, providing HHS an opportunity to  address the health care inequities on the Island. “All the community is disappointed that, after presenting new data on the funding gap and historic anomalies in the formulas applied, HHS and CMS did not make the fair and necessary administrative adjustments needed for low-income US senior citizens in our island,” said Pando who also believes there is the hope that Congress could intervene. The Medicare program on the Island will have to manage a deficit of more than $400 million in 2025 due to payment cuts and the inflation of health care expenditures. Meanwhile, based on statutory financial statements submitted to the National Association of Insurance Commissioners (NAIC), health care plans in the Medicare Advantage segment of Puerto Rico reported an unprecedented aggregate loss of over $500 million in 2023.

Thousands of policyholders still owed claims from 2017 hurricane 

Almost seven years after Hurricane Maria hit Puerto Rico, nearly $22.3 million in claims is still owed to policyholders, new data show.  Condominium owners are among those most affected by the outstanding claims, according to El Vocero.  The Office of the Insurance Commissioner reports that there are 303,924 pending claims, about two-thirds of which involve residential property.  Industry experts say that insurers would be equipped to handle another natural disaster of the magnitude of the 2017 hurricane, pointing out that the companies are financially solvent.

Massive dredging project underway

Despite opposition from environmentalists, a $62 million project to dredge San Juan’s seaport began last week. The project will enable larger vessels to use San Juan Bay, including ships serving a new liquid gas terminal on the Island’s north coast.  The U.S. Army Corps of Engineers is overseeing the project, which is expected to last until October and will result in the removal of nearly 3 million cubic yards of sea floor.  San Juan’s governor estimated that the project will inject $400 million into the local economy.  However, environmental groups have warned of the project’s impact on humans and wildlife.  A lawsuit filed against the government by the nonprofit Center for Biological Diversity is pending in Washington, D.C.  The organization says that the project, which was approved by the U.S. EPA, threatens corals, seagrass beds, turtles, and other marine life.