It seems that my last post about comparing cost-of-living in Puerto Rico to USA and Spain, sparked quite a bit of discussion. Even argument. WOW!
As a result, I’ve been bombarded with questions on details. Many of you wanted to know more about health insurance costs, options, and overall taxes, so I’m going to tackle insurance and tax topics separately.
Today’s post is about health insurance costs in Puerto Rico, as well as the options you have here.
In the beginning, when we first moved here, we didn’t buy health insurance. We basically, self-insured, i.e. paid everything ourselves. We did this mainly because we wanted to:
- Save money
- See how cheap/expensive care actually was.
Yes, yes, I know this was a risk but we’re both pretty healthy and we thought we’d do fine without insurance for a while.
What we found was that indeed the costs of care are much cheaper in Puerto Rico than in the mainland USA. For example, a doctor’s appointment is about $40.00 here. Many medications do not need prescriptions and are very cheap at just $4 to $15. X-rays, Sonograms, Mammograms, etc. are also a ton cheaper – in the $65-150 range. Emergency services are more expensive but not terribly. So, overall everything is petty affordable in PR.
However, after we added up all our medical expenses for a year, we realized that we were paying about the same as we would pay for medical insurance. And since you never know what will happen (accidents, sudden illnesses, and so on) we decided to err on the side of caution and get private medical insurance.
VA Health Benefits
We’ve also been told by many friends that Tim should apply for VA benefits because he is a veteran. Tim was so sure that he would not qualify for anything that for 1.5 years he resisted putting in his application. Don’t make the same mistake! When he finally did apply, not only did he qualify, he was approved the same day! And, since he started using the VA system, he has been very, very happy with the level of care he’s received. They are good, efficient, and nearly always on time!
This was a very nice surprise to us because we’ve heard some horror stories about the VA.
It just goes to show that it pays to look for yourself. In fact, the San Juan VA hospital is the main VA facility for all of Caribbean and it is very good. We’ve not had any problems and we are very pleased with their efficiency. There is, also, a VA clinic and laboratory within a 15-20-minute drive from us, that makes getting care even easier. So, if you’re a veteran, I would highly recommend that you consider this medical care option.
Other Health Insurance Options
So, now, the good news for us was that we only needed to purchase health insurance coverage for me. I began my research and here is what I found.
There are three main options for insurance on the island (I’m sure there are more small ones too, but I didn’t bother looking into them):
- Triple-S Salud
- Humana Puerto Rico
- First Medical
Note: There are also health-system-specific options available, like Auxilio Plan de Socios (http://auxilioplandesocios.com/). But, to use them, you can only go to their facility for care and they usually require a physical before they will set your cost/rate. I was not interested in them, mainly because they were just too far away for me to drive to for routine healthcare.
So, I got quotes from all three of the main insurances. For me, the cheapest option was First Medical. Here is a summary for my findings:
Price range (for me): $191 – $267 /month – that’s for 1 person, double it for 2 people
- This is the most widely accepted insurance plan on the island and nearly every doctor takes it.
- Pretty much accepted by every hospital.
- Relatively low deductibles ($300-900).
- Co-pays can be high (as much as 60%) on certain things.
- There are deductibles – although they are relatively inexpensive when compared to USA plans.
- Out of pocket total expenses can really add up: up to $6,350 individual or $12,700 family – ouch! – that’s about as bad as Obamacare.
Humana Puerto Rico
Price range: $220 – $290 /month
- Big company, reputable and widely available.
- If you currently have Humana in USA, it would be easy to transfer to PR.
- Their rates were highest for me
- Co-pays can be higher
- There are deductibles and they are higher than the other two options
- Their website sucks! Can’t really get quotes online, you must go in and see someone
- As with Triple-S deductibles and copays, it can really add up and out of pocket expenses can be as much as in the USA under Obamacare.
Price range: $173 /month
- Prices available online.
- Options to stay in network and also go outside of network (with higher copays).
- Very low deductibles ($250/individual).
- If you stay in network, the costs are very cheap.
- You only get the low copays if you go to their First Medial facilities, otherwise its comparable to the other 2 plans.
- Limited number of facilities.
- They don’t have the best reputation (depending on whom you ask) for their in-network facilities.
- Out of pocket maximum: $6,350 individual.
Note: For Humana and Triple-S, we expected that family plans would be cheaper (per individual), instead of individual plans. You would think that, but we didn’t find it to be true. The insurances we looked at where cheaper when priced out per individual, not per family.
Compare to USA and Spain
I’m including a comparison to the USA and Spain, because.. why not?
Health Insurance in the USA
I think everyone here already knows about Obamacare, or Healthcare.gov. Insurance costs there vary wildly based on the state you live in and your income. If you want to get some quotes, now is a good time (Nov-Dec) because it’s open enrollment and you can look up actual numbers.
Here is an article about costs for insurance in different States: http://www.huffingtonpost.com/gobankingrates/10-best-and-worst-states_b_9030422.html
Be sure to compare apples to apples. You shouldn’t be comparing your health insurance based on your working income, unless your income will stay the same. For example, if you live in Ohio and are making $60,000/yr but after you move to PR, your income will go down to $30,000/yr, obviously, you need to compare health insurance costs on the lower income since lower incomes tend to get government subsidized rates under Obamacare.
Health Insurance in Spain
In my cost-of-living estimates, I included Spain. And I quoted $275/mo. I got some questions about that. So, let me clarify. Tim’s VA insurance doesn’t work in Spain (clearly), and hence he would need to be covered by private health insurance, as well.
So, the $275 is for both of us (yes, two individuals, i.e. $138/pp), it includes the national health insurance (which is actually quite good) AND includes retirement. If you pay into it for 7 years, you can withdraw a small amount at retirement. If you put in for 15 years, you can withdraw a slightly bigger amount – around $600/mo. So, essentially, their system is almost like a investment account. You pay in, you get health insurance coverage for 2 and you get a small retirement check in the end. Cool, eh?
In any case, I hope this gives you an idea of what to expect. As you can see, there are several health insurance options to choose from in Puerto Rico and they are actually pretty good and relatively inexpensive. Obviously, if you have Medicare or Medicaid, any supplemental private insurance options are going to be much cheaper.
Next up, a post about taxes and running a small business in Puerto Rico.