Does Medicare Cover Blood Pressure Medicine?
Navigate Medicare's prescription drug coverage for blood pressure medication. Discover how plans work, manage costs, and secure your essential prescriptions.
Medicare is a federal health insurance program for individuals aged 65 or older, certain younger people with disabilities, and those with End-Stage Renal Disease. For beneficiaries managing chronic conditions like high blood pressure, understanding prescription drug coverage under Medicare is important.
Understanding Medicare Prescription Drug Coverage
Original Medicare (Part A and Part B) generally does not cover outpatient prescription drugs. Part A covers drugs administered during a hospital stay or in a skilled nursing facility. Part B covers a limited number of outpatient drugs administered by a medical professional, such as injectables. For most outpatient medications, including those for high blood pressure, coverage comes from other parts of Medicare.
Most people get outpatient prescription drug coverage through a Medicare Part D plan, offered by private insurance companies. These standalone policies can be added if you have Original Medicare. Another option is a Medicare Advantage Plan (Part C) that includes drug coverage (MA-PD plan). Medicare Advantage plans bundle Part A, Part B, and typically Part D coverage into one plan, often with additional benefits. If you have an MA-PD plan, a separate Part D plan is not needed.
Costs and Specifics of Drug Plans
Medicare prescription drug plans involve financial considerations like premiums, deductibles, copayments, and coinsurance. Beneficiaries pay a monthly premium, with the average Part D premium in 2025 estimated at $46.50. Plans also have an annual deductible, the amount paid out-of-pocket before coverage begins. In 2025, no Part D plan can have a deductible higher than $590, though some offer lower or $0 deductibles.
After meeting the deductible, you pay a copayment or coinsurance for covered medications. A copayment is a fixed amount, while coinsurance is a percentage of the drug’s cost. These amounts vary based on the drug and its placement on the plan’s formulary, the list of covered drugs. Formularies organize drugs into tiers; lower-tier generics usually have lower costs than higher-tier brand-name or specialty drugs.
Medicare prescription drug plans operate through different coverage stages impacting your annual out-of-pocket costs. These stages include the deductible period, initial coverage, and catastrophic coverage. As of 2025, the coverage gap (or “donut hole”) has been eliminated. Once your out-of-pocket spending on covered drugs reaches $2,000 in a calendar year, you enter catastrophic coverage, and your plan covers 100% of costs for the rest of the year.
Steps to Obtain Coverage for Medications
Obtaining Medicare coverage for blood pressure medication requires timely enrollment. Enroll in a Part D plan or a Medicare Advantage plan with drug coverage during your Initial Enrollment Period when you first become eligible. Missing this period without other creditable drug coverage can lead to late enrollment penalties, added to your monthly premium for as long as you have Part D coverage.
Before choosing a plan, compare options based on your medication needs, preferred pharmacies, and costs. The Medicare.gov Plan Finder tool allows you to enter your prescriptions and pharmacies to compare plans and estimate annual costs, including premiums, deductibles, and copayments. Discuss your medication requirements with your doctor to ensure prescriptions are sent to a network pharmacy and your blood pressure medication is on your chosen plan’s formulary.
Review your drug coverage annually, as formularies, costs, and plan benefits can change. The Open Enrollment Period (October 15 to December 7) allows you to switch plans to ensure coverage meets your needs for the upcoming year. Certain life events may also qualify you for a Special Enrollment Period, allowing changes outside standard enrollment times.