Congress Introduces Bill to Fix Medicare Funding Disparity in Puerto Rico
What happened
A bipartisan group of lawmakers introduced the Puerto Rico Medicare Advantage Fairness Act on October 16, 2026, to address funding disparities in Puerto Rico’s healthcare system. The legislation targets a structural gap that results in federal reimbursement rates for island seniors being significantly lower than the U.S. national average. Under the current system, Puerto Rico receives roughly 40 percent less per Medicare Advantage beneficiary than the U.S. national average, according to.
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Why it matters
Federal payments to Medicare Advantage plans rely on the Average Geographic Adjustment (AGA) formula, which uses local spending data from traditional Medicare. Because over 90 percent of Medicare beneficiaries in Puerto Rico are enrolled in Medicare Advantage, the AGA formula severely understates the actual cost of medical care on the island,. The proposed bill aims to eliminate this disparity by adjusting the calculation of federal reimbursement rates.
Medicare coverage extends to Puerto Rico, and health costs are currently being compared between Puerto Rico and the Dominican Republic.
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Who's involved
- Puerto RicoUnincorporated territory whose healthcare funding is the subject of the legislation.
- CongressHolds the legislative authority to create, fund, and regulate the Medicare program.
- Raul RuizLed the introduction of the Puerto Rico Medicare Advantage Fairness Act.
- Gus BilirakisCo-sponsored the legislation to fix PR healthcare funding.
- Darren SotoCo-sponsored the legislation to fix PR healthcare funding.
- Pablo José HernándezCo-sponsored the legislation to fix PR healthcare funding.
Who could feel it
Possible knock-on effectsThese are possibilities Brind reasoned out, not predictions, and not advice. Most are not stated in any report.
- Puerto RicoSpeculative
Puerto Rico might see changes in healthcare funding access due to the proposed legislation.
- MedicareSpeculative
Medicare could face changes to its funding formula for Medicare Advantage plans in Puerto Rico.
Keep exploring
The entities involved
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Puerto Rico
unincorporated territory of the United States of America
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Medicare
US federal health insurance
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