Managing the Cost of Chronic Conditions

Controlling expenses when you have a long-term illness

Updated on: March 2, 2020

Originally posted on: November 10, 2015
The Roadmap for Medicare staff specialize in all topics related to Medicare Part D, choosing a Medicare plan, and making smart health decisions in retirement.

Retirees are living longer than ever, and the odds of being diagnosed with a chronic condition, such as hypertension or diabetes, increase with age. Knowing the likelihood of developing a chronic condition may not mean you’ll be prepared for the costs associated with treating a chronic condition, and that can be an unwelcome surprise. However, there are ways to reduce those costs and improve your health.

Take medications as prescribed: This is one of the most important things you can do to improve your health and reduce costs. When you’re feeling the financial burden of treatment, it may be tempting to skip doses so your medication lasts longer. Or, you may be tempted to stop taking medication for conditions like high cholesterol or high blood pressure, where you do not feel any symptoms. These behaviors may help you save in the short term, but they can cost you in the long term.

Your doctor has prescribed medications dosages to have a specific effect over a set period of time. By skipping doses, your body may experience swings that can decrease the medicine’s effectiveness. It can also result in increased side effects and a worsening of your condition that can require additional doctor or emergency room visits, and even long-term hospital stays. Any of these events can cost you far more than if you followed your doctor’s orders and recommended medication schedule. Further, your doctor may draw incorrect conclusions about whether you are on the right dosage not really understanding that you may not be taking as he/she prescribed.  So, while you may not want to admit “noncompliance” to your doctor, it is important.

Also, many chronic conditions require regular testing to ensure your condition is stable or improving.  Following the testing schedule ordered by your doctor can help prevent the need for more costly doctor and hospital visits.

Another reason it is important is because there is help.  Once we – your doctors and your pharmacists – understand what makes it harder for you to follow your regimen there are often suggestions we can make to help reduce costs, manage side effects, or help with reminders.

Use cost-effective pharmacy alternatives: If you’re having difficulty affording your medications, don’t skip or alter doses – talk to your doctor or call your Part D plan to speak with a pharmacist. Pharmacists can be a great resource for helping you manage your condition and your costs. Your plan’s pharmacist may be able to change your prescription to a generic medication by calling your doctor or suggesting a potentially less-expensive alternative. They may also recommend longer-term supplies (such as 90-day vs. 30-day), or using home delivery or preferred pharmacy to save money. You can also check out State Pharmaceutical Assistance Programs (SPAP) through your Medicare Part D plan. This type of assistance can also provide financial relief in some cases.

Reassess your Part D plan: If you’ve been recently diagnosed with a chronic condition, it may be a good time to reconsider your Part D plan options to make sure you’re getting the best coverage for your new health situation. Look for a plan with good coverage for the medications you’re currently taking and also those you might need in the future. If you have reason to suspect that you’ll be dealing with another chronic condition in the future (based on family history, prior health condition, for example), keep that in mind, too, when considering which plan will be best for you. Talk with your doctor to see what medications may be needed in the coming years.

When evaluating a plan, remember that a lower deductible or out-of-pocket costs may make a plan with a higher premium (the plans monthly cost) a better value in the long run. Plans that help their members manage their medications and costs tend to earn a higher Star Rating, so try to select a plan with at least three stars.

Live healthy: A healthy lifestyle overall is also a great way to help reduce your medical spending. People who stay physically active and eat a balanced diet tend to have stronger immune systems and shorter recovery periods from injuries and surgeries. This can reduce associated healthcare costs. Good health can also help reduce your risks of developing certain chronic conditions, like diabetes.

Unfortunately, many of us will experience a chronic condition and its costs. When possible, planning in advance can help cushion the financial blow. But even when there are unexpected diagnoses, there are safe ways to reduce treatment costs that can help.