All Medicare found 6 Medicare Part D prescription drug plans available in Puerto Rico for 2023. See Plans
Puerto Rico Part D Plans By The Numbers
- Average premium: $59.87 per month.
- Lowest premium: $15.00 per month.
- Average deductible: $438 per year.
- Plans with no deductible: 0.
- Plans rated 4-stars or better: 0%.
- Basic benefit plans: 3.
- Enhanced benefit plans: 3.
- Full Low-Income Subsidy plans: 0.
- Plans with extra gap coverage: 2.
3.5 out of 5
|AARP MedicareRx Preferred (Basic PDP)||$75.40||$505||No||No|
3.0 out of 5
|Cigna Extra Rx (Enhanced PDP)||$108.40||$100||No||Yes|
3.0 out of 5
|Cigna Saver Rx (Enhanced PDP)||$15.00||$505||No||No|
3.0 out of 5
|Cigna Secure Rx (Basic PDP)||$40.80||$505||No||No|
2.5 out of 5
|Humana Basic Rx Plan (Basic PDP)||$42.50||$505||No||No|
2.5 out of 5
|Humana Premier Rx Plan (Enhanced PDP)||$77.10||$505||No||Yes|
Medicare Part D Cost-Sharing Phases
Medicare Part D plans are optional coverage you can buy in Puerto Rico to add prescription drug coverage to your Original Medicare (Part A and Part B) or a Medicare Advantage plan that does not include Part D benefits. If you are new to Medicare, the Medicare Part D plan cost-sharing concepts may be confusing. Let's start with an overview.
Phase 1: Your Deductible
The deductible is the amount you pay before the plan's initial coverage phase begins. You pay the full amount for your prescriptions until the deductible is met, then the plan will start paying its share. For example, if you join a plan with a $325 deductible, you'll pay that amount at the pharmacy for your prescriptions. After you've spent that amount, you will pay the copay amount only until you reach the coverage gap phase.
TIP: Some plans in Puerto Rico exclude Tier 1 drugs from the annual deductible. With these plans, you get first-dollar coverage on most of your generic drugs.
Phase 2: The Initial Coverage Limit
The Initial Coverage Limit begins after the deductible phase and is the same for all plans. This year the amount is $4,660. In this phase, you and your plan share all costs until the total retail spending on your prescriptions reaches $4,660. You pay the amount specified in the plan's formulary, and the plan pays the remainder. For example, if your medication is $64, and the formulary says you pay a 20% copay, then your share is $12.80.
CRITICAL: When the total cost of your prescriptions exceeds $4,660, you enter the Coverage Gap phase (aka, "donut hole").
Phase 3: The Coverage Gap
You'll pay 25% of the full retail price for brand-name medications while you're in the Coverage Gap phase (aka, "donut hole"). The manufacturer is required to give you a discount of 70%, and your Medicare Part D plan will pick up the remaining 5%. The 25% payment plus the 70% discount will be added to your True Out Of Pocket Costs (TrOOP). Once your spending reaches $7,400, you move into the catastrophic phase.
TIP: Some Puerto Rico plans offer additional gap coverage, so look for it on the plan information pages.
With generic drugs it's a little different. You will still need to pay 25% of the cost, and your plan pays the rest. However, only the 25% you pay counts towards your TrOOP.
Phase 4: Catastrophic Prescription Coverage
Once you've spent $7,400 out-of-pocket in 2023 you are out of the coverage gap phase and will receive catastrophic coverage. This happens automatically and ensures that you only pay a small amount for all covered drugs for the remainder of the year. This is a feature that's built into every Medicare prescription drug plans sold in Puerto Rico.
Costs That Help You Get Catastrophic Coverage
- Your plan's deductible;
- What you paid during the initial coverage limit period;
- Most of the full cost of brand-name drugs (and the manufacturer’s discount) purchased in the coverage gap;
- The amount paid by others, including family members, most charities, and other persons on your behalf; and
- The amount paid by State Pharmaceutical Assistance Programs (SPAPs), AIDS Drug Assistance Programs, and the Indian Health Service.
Medicare Part D is Bundled with Most Puerto Rico Medicare Advantage Plans
There's more than one way to get prescription drug coverage with your Medicare benefits. The first way is by enrolling in one of the Medicare prescription drug plans available in Puerto Rico. The second way is to get prescription coverage through one of the many Puerto Rico Medicare Advantage Plans or Puerto Rico Medicare Special Needs Plans that include Part D benefits. Most Medicare Advantage plans available in Puerto Rico include Part D as an additional benefit.
Medicare Part D and Medicare Supplement Insurance Work Together
Just like Medicare Advantage, Original Medicare does not cover all of your hospitalization and medical bills. In fact, it only covers about 80 percent of your major medical costs, and there isn't an annual cap like there is with Medicare Advantage. That's why All Medicare maintains an up-to-date directory of Puerto Rico Medigap plans, also called Medicare supplements, with a free quoting tool that lets you get rates from all carriers in your area. Best of all, Medicare Part D plans are fully compatible with Puerto Rico Medigap plans.
Medicare Part D for Dual Eligible Puerto Rico Residents
Are you eligible for both Medicare and Medicaid (aka "dual eligible")? If you are, you may be enrolled in the Extra Help program and a Medicare Prescription Drug plan that's been pre-selected for dual-eligible people in Puerto Rico. The Extra Help program covers most of your prescriptions if you meet certain eligibility requirements. Contact your local Medicaid office to learn more about benefits for dual-eligible people.
The 2023 Medicare Part D Plan information for Puerto Rico was last updated by the All Medicare team on