Mortality gap between Puerto Rico and the US mainland among Medicare Advantage enrollees

Health care and outcomes in Puerto Rico (PR) have been impacted by US federal policies, including those pertaining to the Medicare Advantage (MA) program. The MA enrollment rate in the US mainland is 54%, but in PR, it is more than 90%. In addition to this stark difference in MA enrollment rate, MA plan payments and quality-which may impact mortality of enrollees-also differ between PR and the US. Despite these differences, little is known about the mortality gap between PR and the US among MA enrollees. We compared mortality rates between Hispanic MA enrollees in PR and Hispanic and White enrollees in the US from 2010 to 2022, adjusting for age and sex in each year. We found that among MA enrollees, the mortality of Hispanic enrollees in PR was significantly higher than that of Hispanic enrollees in the US. The findings may be explained by lower quality of care provided to PR Hispanic enrollees compared with US Hispanic enrollees, particularly within MA plans. Our results provide insights into existing disparities among MA enrollees in PR and the US mainland.