The purpose of this study is to provide knowledge about the use of nursing homes in the post-acute phase and quality indicators among Medicare beneficiaries in Puerto Rico, compared to the continental United States (USA). UU.). Medicare data from 2015 to 2017 were used to identify new registrations to skilled nursing (SNF) facilities using the Minimum Data Set and the analysis of Medicare providers and reviews. **Context and participants: ** post-acute care patients admitted to SNF in Puerto Rico and the United States UU. Our final cohort included 4,732,222 Medicare beneficiaries under traditional Medicare or Medicare Advantage programs, admitted to an SNF (N=15,197) after an acute hospitalization. Demographic, clinical, and facility-level characteristics were compared between patients in Puerto Rico and the United States. UU. In addition, two quality indicators were described: a) 30-day hospital readmission rates; and b) successful discharge from the center to the community. Medicare patients in Puerto Rico showed better physical and cognitive conditions than patients in the United States. UU. However, Puerto Ricans were more likely to be admitted to lower-quality housing than their U.S. counterparts (2.5 vs. 3.4). Finally, the rate of successful discharges to the community was higher in Puerto Rico (17.6, 95% CI 13.0 - 22.3), although they also had higher rates of hospital readmission after 30 days compared to patients in the United States. UU. (11.2, 95% CI, 6.2 — 16.3). These differences were maintained when comparing Puerto Ricans with only Hispanics in the United States. UU. SNFs both in the U.S. The U.S. and Puerto Rico now face financial penalties for high readmission rates. Currently, Medicare does not measure readmission rates for patients under Medicare Advantage, despite the fact that in some states, including Puerto Rico, there is a high proportion of beneficiaries in this program. Given the continued increase in enrollment in Medicare Advantage, our results highlight the importance of evaluating the performance of these patients and analyzing the disparities in the quality of post-acute care between Puerto Rico and the United States. UU. Medicare beneficiaries in Puerto Rico were admitted to lower-quality skilled nursing homes and had 30-day readmission rates that were more than eight percentage points higher than patients in the continental United States.