What U.S. Families Need to Know Before Moving an Older Parent

If you live in the continental United States and are considering moving an aging parent or relative to Puerto Rico, Medicare may be one of your first questions.

Will their Medicare still work? Do they need a new plan? Can they see doctors in Puerto Rico? Will Medicare help pay for an elderly home?

The short answer is that Medicare does work in Puerto Rico, but there are several important differences and limitations that families should understand before making care arrangements.

Puerto Rico Is Part of the United States for Medicare Coverage

One of the most common misconceptions is that moving to Puerto Rico is like moving to a foreign country for Medicare purposes.

It is not.

For Medicare coverage, Puerto Rico is considered part of the United States, along with the 50 states, District of Columbia and other U.S. territories. Someone with Original Medicare can generally receive covered services from doctors and hospitals in Puerto Rico that accept Medicare, just as they can elsewhere in the United States.

That does not mean, however, that every health plan from the mainland will simply follow your parent to Puerto Rico.

The type of Medicare coverage they have matters.

Original Medicare Usually Travels More Easily

Original Medicare consists of:

Part A — primarily hospital insurance.

Part B — physician services, outpatient care, many preventive services, durable medical equipment and other medically necessary services.

With Original Medicare, a beneficiary can generally use any doctor or hospital anywhere in the United States that accepts Medicare—including Puerto Rico.

For a family moving an older parent from Florida, New York, Texas or another state, this can make Original Medicare relatively straightforward from a geographic standpoint.

You should still confirm that the physicians, hospitals, laboratories, therapy providers and other professionals your parent expects to use in Puerto Rico accept Medicare.

The Puerto Rico Part B Rule Is Different

This is one of the most important Medicare differences families should know about.

In the 50 states and Washington, D.C., many people who are already receiving Social Security or Railroad Retirement Board benefits are automatically enrolled in Medicare Parts A and B when they become eligible.

Puerto Rico is different.

People living in Puerto Rico who qualify for automatic Medicare enrollment are generally automatically enrolled in premium-free Part A, but they must actively enroll in Part B if they want Part B coverage. CMS specifically identifies Puerto Rico as an exception to the normal automatic Part B enrollment rule.

Someone who already has Part A but needs Part B can use Medicare Form CMS-40B, although the appropriate enrollment method depends on the individual’s circumstances.

This distinction is especially important for someone who moves to Puerto Rico before becoming Medicare eligible.

If your parent already has Part A and Part B while living in a state and then moves to Puerto Rico, the move itself does not mean that Part B must be obtained again. The concern is primarily making sure that Part B is already active and that premiums continue to be paid.

Missing the proper Part B enrollment period can result in delayed coverage and, in many cases, a late-enrollment penalty.

Medicare Advantage Is Where Families Need to Be Particularly Careful

Medicare Advantage, also known as Medicare Part C, is different from Original Medicare.

Medicare Advantage plans are offered by private insurance companies approved by Medicare. Plans generally have geographic service areas and may require members to use particular networks of doctors, hospitals and other providers for non-emergency care.

That means a Medicare Advantage plan your parent uses in a mainland state may not be appropriate—or even available—after a permanent move to Puerto Rico.

Fortunately, Medicare provides a Special Enrollment Period when someone moves outside their plan’s service area. This allows the beneficiary to select another Medicare Advantage plan or Medicare prescription drug plan available at the new address. A beneficiary may also return to Original Medicare when moving outside the Medicare Advantage plan’s service area.

If the plan is notified before the move, the Special Enrollment Period can begin the month before the move and continue for two full months afterward. If the plan is notified after the move, different timing applies, so families should handle this before relocation whenever possible.

Do not simply assume that your parent’s existing Medicare Advantage card will provide the same routine coverage in Puerto Rico. Contact the plan before the move.

Prescription Drug Coverage Also Needs to Be Checked

Prescription coverage deserves its own review, particularly when an older adult takes several medications.

A change of residence can affect Medicare Part D or the prescription component of a Medicare Advantage plan. Moving outside a plan’s service area is one of the circumstances that can create a Special Enrollment Period for changing Medicare drug coverage.

Before the move, families should verify:

• Whether the current prescription plan will continue after the change of residence.
• Whether the medications are covered by the new plan.
• Whether the pharmacy your parent expects to use in Puerto Rico participates in the plan’s network.
• What should be done to prevent interruptions in medication during the transition.

For someone taking medications every day, this deserves attention before the flight to Puerto Rico, not after arriving.

Medicare Usually Does Not Pay for Living in an Elderly Home

This may be the most important financial misunderstanding to clear up.

Medicare is health insurance. It is not general long-term-care insurance.

Medicare generally does not pay for long-term custodial care when the primary need is assistance with everyday activities such as bathing, dressing, eating or using the bathroom. Medicare also generally does not pay the ongoing cost of living in a nursing home or assisted-living setting simply because an older person needs help with daily life.

That distinction is very important when looking at elderly homes in Puerto Rico.

An elderly home may provide housing, meals, supervision, personal assistance and help with everyday activities, but families should not assume that Medicare will pay the home’s monthly residential fee.

Medicare may continue paying for individual covered health-care services the resident receives. For example, Part B can cover qualifying physician visits and certain physical, occupational or speech therapy even while someone is living in a nursing home.

Medicare Part A can also cover qualifying short-term skilled nursing or rehabilitation care under specific conditions. That is very different from paying for permanent residential elder care.

This distinction should be discussed directly with any facility you are considering.

Before Moving a Parent to Puerto Rico, Check These Seven Things

A family considering Puerto Rico for an elderly parent’s care should know the answers to these questions before finalizing the move:

1. Does my parent currently have Part A and Part B?
2. Do they have Original Medicare or Medicare Advantage?
3. If they have Medicare Advantage, will their current plan cover them after becoming a Puerto Rico resident?
4. Will they need to select a new Medicare Advantage or Part D plan?
5. Do the doctors and hospitals they expect to use in Puerto Rico accept their coverage?
6. Will their medications remain covered, and which Puerto Rico pharmacies are in network?
7. Which costs associated with the elderly home itself will be private-pay or covered through another program rather than Medicare?

Getting these answers before relocating can prevent a difficult situation in which a parent arrives in Puerto Rico only for the family to discover that a physician is outside the plan network, a drug plan has changed, or the cost of residential care is not covered.

Medicare Is Only One Part of the Decision

A parent’s Medicare coverage should be evaluated alongside the larger care arrangement.

Families should also consider the home’s monthly cost, licensing status, level of care provided, proximity to hospitals and physicians, medication management, transportation to medical appointments, emergency procedures and how the facility communicates with relatives who remain in the mainland United States.

If you are searching for an elderly home in Puerto Rico, HogarDeAncianos.com can help you identify homes throughout the island and begin comparing possible options.

The important thing is to separate two questions:

Where will my parent live and receive daily care?

and

How will their medical care be insured?

They are connected, but they are not the same question—and Medicare generally does not pay for the first simply because it helps pay for portions of the second.

A Final Recommendation for Families Outside Puerto Rico

Before purchasing a ticket, signing an agreement with an elderly home or changing a parent’s permanent address, review the person’s Medicare coverage directly with Medicare and, when applicable, with their Medicare Advantage or prescription drug plan.

Have the Medicare card and current plan information available and explain clearly that the beneficiary is considering a permanent move to Puerto Rico.

Ask specifically what will happen to the existing coverage on the date of the move and what must be done to avoid a gap.

Medicare rules, plan networks and available plans can change. Individual circumstances also differ. Information on this page is intended as a practical starting point for families and should not replace information provided directly by Medicare, Social Security or the beneficiary’s health plan.

Official Medicare assistance: 1-800-MEDICARE (1-800-633-4227)

Social Security: 1-800-772-1213