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"Dual-qualified" plans have U.S. domestic trusts that cover Puerto Rican employees and qualify under both the Puerto Rico Code and the Internal Revenue Code to provide the Puerto Rican participants with favorable tax benefits.
Regardless of the HHS' recent clarification, however, since the Puerto Rico Health Insurance Code had previously incorporated the ACA, until new guidance is issued under Puerto Rico law, such provisions will continue to apply to Puerto Rico through local law (and not through federal law).
The public healthcare sector in Puerto Rico is generally well-managed and is handled via a government-run program. No, healthcare is not free. However, the government provides insurance for those who qualify for the ?la Reforma?, a government-funded program.
Unfortunately, the insurance you have in your home state won't necessarily cover you in Puerto Rico. That's because the island is not a U.S. state. It's a territory, so not all of the rules on the mainland apply here. Healthcare providers here are different, so insurance providers are different too.
Healthcare in Puerto Rico is not free. You will need an insurance plan to help cover your medical costs. If you are briefly visiting Puerto Rico, you can continue using your U.S. health insurance, but consider double-checking your coverage before traveling.
One study by Suchman found that compared with persons of other ethnic groups in New York City, the Puerto Ricans are more suspicious of scientific medical care, tend to use general health services less, have more limited health horizons than any other ethnic group.
Puerto Rico's health system continues to face longstanding funding issues, hospital financial struggles, and a shortage of healthcare workers. Although the challenge is clear and present to all who work in this industry, there is a significant opportunity to pull us away from pessimism.