Does Medicare work in Puerto Rico? And what about my US insurance?

Medicare's publication on coverage outside the United States explains that "outside the U.S." means anywhere other than the 50 states, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, Guam, American Samoa and the Northern Mariana Islands.

In practice, Puerto Rico is not "abroad" for Original Medicare. But Medicare applying here doesn't mean every provider accepts it: ask the hospital, office or pharmacy before you are seen.

Medicare Advantage, employer and marketplace plans have their own networks and rules. Some cover emergencies outside their service area and limit other care. Only your plan can tell you what it covers.

Before using a provider in Puerto Rico, call the number on the back of your card and ask:

Call 911 or go to the nearest ER. Emergency rooms at hospitals that take part in Medicare must screen and stabilize you regardless of ability to pay (the federal EMTALA law). Insurance gets sorted out later. See ER vs urgent care in San Juan.

We don't bill Medicare, Medicare Advantage or any health plan, and there is no membership or subscription. You pay only for the visit you choose, by card, when you request it. The price is the same for every age.

• Doctor visit, US$79: a new problem, virtual urgent care for non-emergencies, primary care, children, birth control, STIs, skin and visitors.
• Follow-up visit, US$49: a refill of a medicine you already take (anyone can book this) or a review of lab results (existing patients only).
• School and work forms, US$35: school, university or job forms, and the certificado de salud lab order. Not forms that need a vision exam.

If the visit can't take place, you get a full refund. If a US$49 or US$35 visit turns out to need a full doctor visit, the doctor explains why and, only with your consent, you pay the difference. A doctor's note after your visit is included at no extra charge. Details are on pricing.

On request, we give you an itemized receipt (superbill) to claim from your plan, HSA or FSA yourself. We can't promise your plan will reimburse you. If you have Medicare, call 1-800-MEDICARE (1-800-633-4227) to ask first.

You see Dr. Diana Nieves Castro, MD, a Puerto Rico-licensed general practice physician with several years of emergency-department experience, in English or Spanish. We evaluate, diagnose and treat; if needed, we give you a lab order for a lab near you. If appropriate, the doctor prescribes and we send your prescription to your pharmacy. We do not prescribe controlled substances.

You must be physically in Puerto Rico during the visit, because the doctor's license is a Puerto Rico license; see Puerto Rico telemedicine law. If the patient is under 21, a parent with patria potestad or a legal guardian stays on the video for the whole visit and shows photo ID. Start with an online doctor visit.

On vacation? See sick on vacation in Puerto Rico. Arrived by ship? See the cruise passenger guide. Just moved and not yet covered locally? See doctor without insurance in Puerto Rico. Prefer to see a doctor in English? See an English-speaking doctor in Puerto Rico.