Governor González-Colón Welcomes Congressional Support to Advance Medicare Advantage Payment Improvements

House of Representatives led by Congressman Greg Murphy (North Carolina), Co-Chair of the House Republican Doctors Caucus, has urged the U.S. Department of Health and Human Services (HHS) to address the longstanding Medicare Advantage (MA) funding dilemma affecting Puerto Rico.

In a letter to HHS Secretary Robert F. Kennedy Jr., the Members of Congress called on HHS and the Centers for Medicare & Medicaid Services (CMS) to use their existing statutory authority to establish, beginning in 2028, a minimum Medicare Advantage benchmark equal to 70 percent of the national Average Geographic Amount (AGA), consistent with the level currently used for the U.S. Virgin Islands.

Congressman Murphy’s letter, cosigned by U.S. Representatives Don Bacon (Nebraska), Gus Bilirakis (Florida), Earl “Buddy” Carter (Georgia), Mario Díaz-Balart (Florida), Brian Fitzpatrick (Pennsylvania), Carlos Giménez (Florida), Mike Kelly (Pennsylvania), Riley Moore (West Virginia), James Moylan (Guam), Amata Coleman Radewagen (American Samoa), María Elvira Salazar (Florida), Pete Sessions (Texas), and Claudia Tenney (New York), represents yet another significant milestone in Governor Jenniffer González-Colón's broader efforts to secure a fairer Medicare Advantage payment system for Puerto Rico's seniors.

"My Administration will continue its sustained efforts to secure better healthcare treatment for the people of Puerto Rico and is producing tangible results, I am grateful to my former colleagues in Congress who have raised their voices in support of Puerto Rico, and I encourage others to join and support that our seniors receive the treatment they have earned as American citizens," stated Governor González-Colón

“I strongly support the Governor’s request to HHS and CMS to address the longstanding funding shortfalls that continue to undermine the Medicare Advantage program in Puerto Rico and other disproportionately high-enrollment regions throughout the nation,” Congressman Murphy stated.

Congressman Bacon added, “Fixing Medicare Advantage in Puerto Rico is preferable to maintaining a system that forces providers and patients to leave the Island in search of better-funded healthcare systems in the 50 states. Thus, strengthening healthcare delivery in Puerto Rico is in the best interest of beneficiaries, providers, American taxpayers, and the federal and state governments alike.”

More than 670,000 seniors in Puerto Rico—approximately 96 percent of all Medicare beneficiaries on the Island, the highest Medicare Advantage enrollment rate anywhere in the United States—depend on MA for their healthcare coverage. Despite the program's overwhelming success, benchmark payment rates for Puerto Rico remain approximately 41 percent below the national average and roughly 20 percent below those of the U.S. Virgin Islands.

The signers urged HHS and CMS to use their existing statutory authority to modernize the Medicare Advantage payment methodology by establishing a national benchmark floor that more accurately reflects today's Medicare landscape.

"Puerto Rico's seniors contribute to Medicare on the same basis as every other American worker by paying the same federal payroll and Social Security taxes and deserve a payment system that better reflects today's Medicare Advantage landscape rather, than one that relies on an outdated payment methodology," said Gabriella Boffelli, Executive Director of the Puerto Rico Federal Affairs Administration (PRFAA). "This proposal represents a practical administrative solution that would strengthen patient access to care, support healthcare providers, improve chronic disease management, and reinforce the long-term sustainability of Medicare Advantage, not only in Puerto Rico, but nationally as enrollment patterns continue to evolve."

The congressional letter builds upon momentum generated earlier this year when CMS finalized the 2027 Medicare Advantage Rate Notice, providing Puerto Rico with a 4.01 percent increase, compared with the national average increase of 2.48 percent. While welcomed by the Island’s healthcare community and the González-Colón Administration, the underlying structural payment formula that continues to disadvantage Puerto Rico must still be addressed.

Puerto Rico illustrates a broader structural challenge facing the Medicare Advantage program nationwide. As enrollment continues to shift away from traditional fee-for-service Medicare, other regions are likely to encounter similar payment challenges if the benchmark methodology is not modernized.

Boffelli also recognized the collaborative efforts of healthcare industry leaders, private-sector partners, and the Governor's Multisector Healthcare Task Force, noting their coordinated advocacy has played an important role in advancing the issue in Washington.

"The González-Colón administration has diligently worked alongside healthcare providers, patient advocates, the private sector, and the Multisector Healthcare Task Force in support of Puerto Rico’s Medicare Advantage beneficiaries," Boffelli said. "The meaningful progress we have achieved reflects the strength of this broad coalition, and we remain fully committed to continuing our work with the Trump Administration, Congress, and all relevant stakeholders to advance practical reforms that strengthen Medicare Advantage, improve healthcare access for Puerto Rico's seniors, and ensure the long-term sustainability of the program nationwide," PRFAA Executive Director Boffelli added.

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