Understanding your insurance coverage is crucial for managing chronic conditions like high blood pressure, which may require a combination of diet, lifestyle changes, regular checkups, and medication.
Insurance coverage varies depending on many factors. Not only are there many types of plans, but within those types, there can be a lot of variety in what’s covered, what’s not, and how much you will need to pay out of pocket.
Understanding your benefits can help you get the most out of your coverage, especially when living with a chronic condition like high blood pressure.
While it may be possible to manage high blood pressure through diet and lifestyle strategies, regular doctor checkups and medication may also be an important part of a hypertension management plan.
There are several types of insurance plans. Some common plans include:
- High Deductible Health Plan (HDHP): While this plan typically has a lower monthly premium, the deductible is often higher than other types of plans.
- Preferred Provider Organization (PPO): The monthly premiums are often higher for these plans, but they provide the flexibility to work with healthcare professionals and providers who are out of network without a referral. You often need to pay an additional fee when seeing out-of-network providers, however.
- Exclusive Provider Organization (EPO): This plan is a managed care plan. You will only be able to use healthcare professionals and providers within the plan network, with exceptions for emergency services.
- Health Maintenance Organization (HMO): This plan generally has limited out-of-network coverage and requires a referral to see a specialist.
When budgeting for healthcare costs, add up your monthly premiums plus your out-of-pocket maximum amount to identify the maximum amount you may owe.
Depending on how often you visit the doctor, the number of specialists you visit (and if they are in or out of network), medications you need, and hospitalizations, you may spend less than that amount.
But knowing that number can be a good place to start when planning ahead for your healthcare needs.
Potential medical expenses for hypertension management
If you have hypertension, you may need:
- regular checkups and monitoring
- prescription medications
- access to local specialists, like a cardiologist
- lifestyle support, like dietitians and wellness programs
- equipment, like at-home blood pressure monitors
If you want to know if your plan covers anything from this list, you can call your health insurance provider to talk through your coverage.
You can ask about specific coverage, how much you may expect to pay, and if certain healthcare professionals you may already visit are covered.
Depending on your plan, many preventive services may be available at no cost to you, including blood pressure screening.
Before making an appointment, call the doctor’s office and confirm how the appointment will be classified to make sure it falls under your plan’s definition of preventive screening. You can also ask about your expected costs for the appointment.
Some insurance plans also offer wellness benefits, like diabetes management, weight loss, gym memberships, and more. Exercise and weight loss programs may help with managing high blood pressure.
You can check the insurance website or call your provider to learn about wellness benefits and programs.
Sometimes, it’s necessary to seek assistance to help cover healthcare costs.
Government programs and subsidies, like Medicaid and Medicare, can help bridge the gap.
Medicare
This federal health insurance program was created to help U.S. citizens ages 65 years and older cover medical costs. It can also benefit U.S. citizens under age 65 if they have specific health conditions or disabilities.
Medicare Part B may provide coverage in scenarios where someone with hypertension needs medical equipment, like an at-home blood pressure monitor. However, Medicare coverage for medications varies.
People who have a Medicare Part D prescription drug plan can ask about coverage for high blood pressure medications. A copay may be required.
Medicaid
This government-funded program focuses on assisting U.S. citizens who have low incomes with medical expenses, ranging from routine visits to more significant hospitalization and medical treatments.
The program doesn’t have age restrictions, so it can benefit children, adults, and people with disabilities regardless of age.
Ask your plan about any specific medication coverage you may need for hypertension to learn any costs you may be responsible for.
In some cases, people can qualify for dual eligibility and may receive benefits from Medicare and Medicaid.
Other financial resources
Some medications may not be covered by your insurance plan, or they may be classified at a higher deductible. Talk with your doctor about your options. In many cases, a generic medication may be just as effective as a brand name but can cost a fraction of the price.
If your medication is not covered, or if the costs are high even with coverage, you may be able to find a manufacturer’s coupon. Ask your doctor if they know of any coupons.
You can also look for manufacturer coupons online. If applicable to you, you may also find helpful resources by visiting your local senior center. These centers often offer public benefits counseling, which may help you find financial assistance.
Routine visits to a doctor for checkups play an important role in a high blood pressure management plan.
When reviewing your coverage, pay attention to copays, out-of-pocket maximums, and any restrictions or limits to number of appointments. That can help you build a budget to support checkups.
You can also talk with the doctor’s office about payment plans or assistance they may offer if you are underinsured.
Wellness programs are also available through many plans. These are designed to help give you the tools to manage your health outside of the doctor’s office. Programs may include weight management, smoking or alcohol cessation, or mental health offerings.