Introduction: Traditionally, acute uncomplicated type-B aortic dissections (auTBAD) are managed with best medical therapy. Recent literature has focused on identifying high-risk patients who might benefit from early endovascular repair based on dissection anatomy characteristics, but socioeconomic factors are less often considered despite relationships between disparities and vascular disease outcomes. Aim: To understand the presentation, management, follow-up, and outcomes among patients presenting with auTBAD, focusing on insurance status. Methods: In this single center, observational study, demographics, medication prescription patterns, follow-up, and outcomes of patients with auTBAD managed medically from 2013-2018 were analyzed. Patients with complicated, chronic, type-A dissection, PAU, or IMH were excluded. Area deprivation index (ADI) was determined from patient’s home addresses. Comparisons between age, ADI, prescription patterns, follow-up, and outcomes were made between groups based on payer status. Payer status was defined as insured or self-pay (i.e., no insurance). Results: 57 patients presented with auTBAD and were managed medically. 30% of patients were self-pay. Self-pay patients were from areas with higher deprivation indices (74 vs 62, p = 0.041), presented with higher blood pressures (138 vs. 118 mmHg, p = 0.006), and were on fewer home antihypertensives (0.29 vs 0.95, p = 0.030). Self-pay patients required more antihypertensives at discharge (3.6 vs 3.0, p = 0.049) and were less likely to follow-up (29% vs. 70%, p = 0.008). Self-pay patients had worse freedom from aortic intervention (p = 0.023), were more likely to represent urgently or emergently for repair (75% vs 0%, 0.033), and trended towards earlier time to intervention (8.5 months vs. 30 months, p = 0.060). Conclusions: Self-pay insurance was associated with worse hypertensive disease characteristics, follow-up patterns, and long-term outcomes in patients presenting with auTBAD managed with medical therapy. These findings suggest prohibitive compliance and surveillance trends in this cohort, which underscores the importance of considering patient factors, particularly payer status, when deciding between auTBAD treatment options.