Puerto Rico Medicare Advantage organizations (MAOs) have consistently seen profit margins in line with or below the national average for all MAOs from 2022 to 2025. Each year, as part of annual statement filings, health insurance companies are required to fill out the exhibit “analysis of operations by line of business.” Part of this exhibit details the profitability of MAOs. In this paper, commissioned by MCS Advantage, Inc. on behalf of the Medicaid and Medicare Advantage Association of Puerto Rico, we used this publicly available information to examine how MAO margins in the territory compare with margins of the rest of the United States over the period of 2021 to 2025. We also comment on the level of the Puerto Rico MAOs’ medical loss ratios (MLRs).
Key findings include the following.
- Five-year profitability comparison: Puerto Rico MAOs show a loss of 0.7%, versus a profit margin of 0.6% for their U.S. counterparts.
- Annual profitability comparison: Every year, the average profit margin for Puerto Rico MAOs has been within 1% or lower than the U.S. national average.
- Annual Puerto Rico MLR: The ratio for ACOs exceeds 85%, indicating that Puerto Rico is allocating a greater amount of premium revenue to medical and prescription drug benefits than the required minimum.
This report was commissioned by MCS Advantage, Inc. on behalf of the Medicaid and Medicare Advantage Association of Puerto Rico.