Is United Healthcare Accepted in Puerto Rico?

UnitedHealthcare is one of the largest health insurance providers in the United States and also offers coverage options for residents of Puerto Rico. Here is an overview of UnitedHealthcare’s presence in Puerto Rico and details on plan options, provider networks, and how to get the most out of your UnitedHealthcare health plan if you live in Puerto Rico.

UnitedHealthcare in Puerto Rico

UnitedHealthcare insurance plans are widely available across the United States. The company also serves international markets, including Puerto Rico.

Some key facts about UnitedHealthcare in Puerto Rico:

  • Offerings: UnitedHealthcare provides private health insurance plans to individuals, families, and employers in Puerto Rico. This includes group plans sponsored by employers.

  • Membership: UnitedHealthcare covers over 300,000 members in Puerto Rico across its different plans.

  • Provider network: UnitedHealthcare has contracted with many of the major hospitals systems and physician groups in Puerto Rico to form its provider network. There are over 4,500 physicians and 50 hospitals and facilities in-network.

  • Plan types: UnitedHealthcare offers PPO and HMO plans in Puerto Rico. This includes options compliant with the Affordable Care Act.

  • Prescription drugs: Prescription drug coverage is included with most plans. Members have access to the OptumRx network of over 68,000 pharmacies.

  • Customer service: UnitedHealthcare provides a dedicated customer service team for members in Puerto Rico with support available in both Spanish and English.

UnitedHealthcare Plan Options in Puerto Rico

UnitedHealthcare offers a range of plan options to meet the diverse needs of individuals, families, and employer groups in Puerto Rico.

Some of the main plans available include:

  • PPO plans – These preferred provider organization plans offer flexibility for members to see providers both in- and out-of-network. PPOs have higher premiums but lower costs when receiving care.

  • HMO plans – With these health maintenance organization plans, members select a primary care physician (PCP) to coordinate care and referrals. Non-emergency care from out-of-network providers is not covered. HMOs have lower premiums but restrictions on providers.

  • HDHPs – High deductible health plans have lower premiums but higher deductibles that must be met before coverage kicks in. They can be paired with a health savings account (HSA).

  • Medicare Advantage – For Puerto Rico residents eligible for Medicare, UnitedHealthcare offers Medicare Advantage plans that provide all Original Medicare benefits along with added features.

Within each type, UnitedHealthcare offers plans at different metal tiers – Bronze, Silver, Gold, and Platinum. Bronze plans have the lowest monthly premiums but highest out-of-pocket costs when receiving care. Platinum plans have the highest premiums but lower deductibles and copays.

Finding In-Network Providers with UnitedHealthcare

A key benefit of having a UnitedHealthcare plan in Puerto Rico is access to the company’s extensive network of physicians, hospitals, and pharmacies across the island.

To find in-network providers and facilities:

  • Use the online search tool – UnitedHealthcare members can search for providers and clinics by specialty and location via their website or mobile app.

  • Check your plan documents – Details on network hospitals and pharmacies are usually listed in your plan membership materials.

  • Call customer service – Speak with a UnitedHealthcare representative to get assistance locating an in-network provider near you.

  • Ask your doctor – When making appointments, ask your physician and their office staff to confirm they are in the UnitedHealthcare network.

Staying in-network means you will pay reduced rates for services versus going out-of-network. This helps minimize healthcare costs. Review your plan details so you understand the differences in cost-sharing.

Making the Most of Your UnitedHealthcare Plan in Puerto Rico

Here are some tips for Puerto Rico residents to get the most value out of a UnitedHealthcare health plan:

  • Take advantage of preventive care – Most plans provide preventive services like immunizations, screenings, and annual checkups at no cost when you see in-network providers.

  • Use generic prescriptions – Ask for generic drug options which are available at lower cost tiers on most plans.

  • Check your ID card – Carry your UnitedHealthcare ID card with you and present it when you receive medical services to confirm coverage.

  • Get a primary care physician – Having one doctor coordinate your care helps ensure continuity and avoid unnecessary duplicate services.

  • Use online services – Manage your plan and track claims through the UnitedHealthcare website and mobile app.

  • Compare costs – When given a choice for labs, testing, or procedures, compare prices between facilities.

  • Understand your benefits – Don’t hesitate to contact UnitedHealthcare customer service with any questions on what is covered by your specific plan.

Finding a UnitedHealthcare Mental Health Provider in Puerto Rico

In addition to medical care, many UnitedHealthcare plans also provide coverage for mental health services like therapy and psychiatry.

If you are looking for a mental health provider that accepts UnitedHealthcare insurance in Puerto Rico, there are a few options:

  • Search the online directory – Use the Find a Provider search on UnitedHealthcare’s website, filtering for psychiatrists or mental health counselors.

  • Contact Customer Service – A representative can look up mental health providers in your area that are in-network.

  • Check your Summary Plan Description – Details on mental health benefits like copays and visit limits are outlined in your plan documents.

  • Use a therapist directory – Sites like Zencare allow you to search for therapists in Puerto Rico by insurance plan, specialty, online options and more.

When comparing providers, consider their expertise treating your condition, office location, available appointment times, and cost per session. Meet with potential therapists for a consultation to ensure a good fit.

Adding Supplemental Insurance from UnitedHealthcare

In addition to major medical insurance, UnitedHealthcare offers supplemental health insurance plans to Puerto Rico residents.

These policies help pay for expenses that may not be covered by your primary health plan. Options include:

  • Dental insurance – Plans help pay for routine dental care and procedures like fillings and crowns.

  • Vision insurance – Coverage for routine eye exams and discounts on glasses and contacts.

  • Critical illness insurance – Pays a lump sum upon diagnosis of a serious illness like cancer, stroke or heart attack.

  • Accident insurance – Provides benefits for injuries resulting from covered accidents.

  • Hospital indemnity – Pays fixed dollar amounts for hospital-related events like admission, stays and observation.

Bundling supplemental plans with your UnitedHealthcare health insurance provides more comprehensive coverage. The additional benefits and financial protection may be worth the extra monthly premiums. Speak to a UnitedHealthcare agent about available supplemental plan options.

Traveling Abroad with UnitedHealthcare

For Puerto Rico residents planning international travel, most standard health plans from UnitedHealthcare and other carriers do not provide coverage outside of the United States.

That is why UnitedHealthcare offers SafeTrip travel medical insurance plans. Key features include:

  • Coverage for medical treatment and emergency services abroad
  • Emergency medical evacuation benefits
  • 24/7 travel assistance services
  • Options for trip cancellation/interruption

SafeTrip helps protect against the high costs travelers could incur if faced with an unexpected injury or illness while overseas. Having comprehensive travel medical insurance gives peace of mind.

The Bottom Line

UnitedHealthcare offers a variety of plan options and has a robust provider network available to residents of Puerto Rico. By understanding your coverage details, utilizing in-network providers, and considering supplemental policies, you can get the most out of your UnitedHealthcare health insurance.

United Healthcare Medicare | What to Know before you buy it.


Does my US health insurance work in Puerto Rico?

However, even if not for being issued a visa, the fact that your domestic health insurance including US Medicare provides little coverage in Puerto Rico, it is important for international travelers to buy Puerto Rico travel health insurance..

Can I use my UnitedHealthcare in another country?

No matter where your assignment takes you, you have access to the health care resources you need. Your UnitedHealthcare Global insurance plan works efficiently and simply, wherever you are in the world.

Can UnitedHealthcare be used in different states?

You need to sign up for a new plan if you move to another state.

Does the Affordable Care Act cover Puerto Rico?

Puerto Rico elected to expand Medicaid eligibility to the new adult group under the Patient Protection and Affordable Care Act (ACA, P.L. 111-148, as amended) (CMS 2016a). Puerto Rico also provides Medicaid coverage to aged, blind, and disabled individuals through the medically needy option.

Leave a Comment