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Health Insurance: One of P.R.’s Most Competitive Markets

By on August 20, 2017

(Christopher Furlong/Getty Images)

Editor’s note: The following article originally appeared in the August 17 print edition of Caribbean Business.

SAN JUAN — While 94% of Puerto Rican respondents surveyed so far in 2017 mentioned having health insurance, 44% of them said they are insured by the government’s Mi Salud program, according to this week’s Gaither International survey. There are four types of health insurance on the island: Mi Salud for the medically indigent, employer-based, personal and Medicare plans.

The Health Insurance Administration, the Puerto Rico government agency that administers Mi Salud, has divided the island into eight regions, contracting different insurance companies to provide healthcare within each region. The participating insurers are: Triple-S, First Medical, MMM Multi Health (part of MMM Healthcare Inc.) and Molina Health Care. These provide health insurance to about 1.5 million people. There are many other health insurance companies on the island that compete for the other pieces of the pie: employer, personal and Medicare health plans.

“The majority of people are currently subscribed to a government healthcare plan, and combined with the island’s increasingly aging population who qualifies for Medicare as soon as they turn 65, leaves less room for growth for private health insurance providers. This presents a challenge for the remaining providers, such as personal, employer and Medicare Advantage, since they are left to compete with each other for the remaining market share,” said Melanie Dederick, a client service associate at Gaither International.

The other top health insurance companies that respondents mentioned as their insurers are Triple-S (14%), MMM (originally known as Medicare y Mucho Más) (12%), MCS (Medical Card System Inc.) (10%), First Medical (10%) and Humana (3%), Gaither reported.

“Taking a look at what population each type of insurance serves, obviously Mi Salud is overrepresented in the Low and Middle-Low lifestyle tiers, while Triple-S is the plan for the Middle- to High-Income population, and First Medical, which is overrepresented in the Middle-Low life style tier,” Dederick said.

When asked which is the first health insurance plan that comes to mind, the top-three mentioned among respondents were: Mi Salud, also known as La Reforma, with 29%; Triple-S (24%) and MMM (16%). “Mi Salud and Triple-S’ TOM (top of mind) mentions were higher among the 18-to-54 age segments. Obviously, MMM’s TOM is among the 65 and older age group,” she added.

MCS has been the health insurer that has shown the most growth in this segment within the past three years, with 65% being new clients who have spent six years or less with this provider, she added.

In terms of client satisfaction among the population, within the 18-to-54 age segments, the providers with the highest satisfaction scores were First Medical and MCS. Among respondents, both scored 90%, respectively, as “satisfied” or “very satisfied.” Among the 55-and-older age groups, MCS (95%) and MMM (94%) achieved the highest scores.

Dederick said Gaither would soon release related survey results on the three Medicare plans: Traditional, Advantage and Platino.

The results are from Gaither International’s Media Brand Profiles syndicated survey, which interviews about 500 people weekly from among a representative sample of the island’s population ages 12 and older.

Polling is conducted by Gaither International and results are reported exclusively by CARIBBEAN BUSINESS.

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