High blood pressure – also called hypertension – is one of the major risk factors for cardiovascular disease, the leading cause of death in the U.S.[1] So it is vital to find ways you can afford to treat your high blood pressure.
With high blood pressure, your primary out-of-pocket costs will likely be for doctors’ visits and prescription medications. And what are out-of-pocket costs? They are the costs your Medicare insurance plans may not pay, whatever plans you have. For example, costs could include deductibles (the amounts you must spend before your insurance starts paying), copays or coinsurance.
Original Medicare
The government’s Original Medicare comprises Part A (hospital insurance) and Part B (medical insurance). However, it does not include prescription drug coverage, so you will probably want to buy a private Medicare Part D (prescription drug) policy.
Part A will cover you if you are hospitalized as an inpatient because of your high blood pressure and it's complications, and includes prescription medications. But Part A’s deductibles, copays and coinsurance will be your responsibility.
Part B will cover your preventive, diagnostic and treatment expenses. Preventive services, including some screenings, are covered 100% by Medicare. But diagnostic procedures (stress tests, scans and echocardiograms) and treatment are subject to the 20% copayment of Medicare-approved costs.
Medicare covers standard blood tests once every five years as prescribed by your doctor.[2]
Medicare does not usually cover the cost of regular “cuff-type” blood pressure monitors. But, once a year, it does partly cover the cost of using an ambulatory blood pressure monitor (ABPM) that measures and stores readings over time when ordered by your doctor.
Part D covers the medication you need to control your hypertension, based on your drug plan’s formulary or drug list. Compare the cost of the prescribed medication through various Part D plans before signing up. Part D plans classify medicines into tiers, with the lowest having lower prices. Find a plan where your medication is in a low tier.
Needing multiple medications to control your high blood pressure can complicate your plan selection as you search for a formulary that includes all the medicines. You may have to work with your doctor to find substitutes to minimize your exposure to uncovered costs.
If your medications change, you can change your Part D prescription drug plan during the following enrollment period.
Medicare Part C
Medicare Advantage (Part C) plans must cover everything covered by the government’s Original Medicare (Part A and Part B). However, most Part C plans usually also cover your drug prescriptions. First, find the most cost-effective medications that meet your blood pressure-related needs. Then choose a Medicare Advantage plan with the best prices and conditions.
Some plans offer “over-the-counter” money that can be used to buy blood pressure monitors, for example. And most Medicare Advantage plans cover the rental of an ambulatory blood pressure monitor (ABPM) if you follow your plan’s requirements.
You can change your Part C plan each year for any (or no) reason, including if your high blood pressure medications change.
Five ways to save on high blood pressure-related costs
Supplemental insurance. Doctors’ visits, medications, hospital stays and surgeries can become very costly. But if you have Original Medicare (Part A and Part B), buying a Medicare Supplement plan will cover all or most of the Medicare-approved out-of-pocket expenses Original Medicare doesn’t cover.
Takeaway action step: Check the Medicare.gov website for available Medigap plans.
Generics. You can save 50% to 75% by buying the generic version of name-brand medications, and they can be just as effective. In addition, generic medicines are usually on the lower tiers of formularies and have a lower out-of-pocket cost.
Takeaway action step: Ask your doctor to recommend generic products to meet your health care needs.
Online pharmacies. Medicare Part D and Medicare Advantage plans work with retail chains and online pharmacies. Online pharmacies may be cheaper.
Takeaway action step: Check your medication’s copay through your insurance company, and compare that with online pharmacy pricing.
Pharmacy assistance programs. Many drug manufacturers have programs to help patients afford their medications. These programs might lower your out-of-pocket cost-sharing, but your purchases may not count towards your plan’s annual deductible.
Takeaway action step: Especially if it is a brand name, contact the pharmaceutical manufacturer to see if they are willing to help you with the cost.
Extra Help. Extra Help is a government program that helps with out-of-pocket costs for prescription drugs if you have limited resources. For example, it might cover premiums, copays and coinsurance.
Takeaway action step: Call 1-800-MEDICARE to check on available help, then ask your Medicare plan provider if that is the best approach for you.
Wrapping up, high blood pressure is a condition that can exist for years without symptoms. Meanwhile, damage is being done to your heart and other organs. Don’t let the cost of care keep you from checking with your doctor regularly and being able to afford the treatment if something is needed.
[1] National Institutes of Health. “High Blood Pressure and All-Cause and Cardiovascular Disease Mortalities in Community-Dwelling Older Adults.” ncbi.nlm.nih.gov (accessed March 2, 2022). [2] Centers for Medicare & Medicaid Services. “Cardiovascular disease screenings.” Medicare.gov (accessed March 2, 2022).