Insurance coverage

Every health insurance plan is different. Some plans don’t pay for transplant at all. Others pay for transplant, but not for the cost to find a donor or cord blood unit. Even if your insurance will pay for many of your costs, you may still have copays for your medicines and clinic visits. You may also have to pay for transportation and temporary housing. The financial coordinator at your transplant center can help you find out what your insurance will pay and what you can expect to pay. 

You can also contact your insurance company to find out about your costs. You could ask a trusted family member or friend to call for you, so you can focus on your health. Your insurance company will need your permission before they’ll talk to someone else about your case. 

Download or print (Opens in a new tab) the financial planning before transplant worksheet.

• Ask to talk to a case manager from your insurance company. Write down their name and phone number. Take notes about what you discuss, including the date of your conversation. 
• Ask for a copy of your health insurance policy and for information about how much your insurance pays for transplant. 
• You may want to ask these additional questions: 
• Does my health plan pay for transplant for my specific disease? 
• Does my health plan pay for the donor search? 
• Does my health plan pay for finding and shipping cord blood? 
• Does my health plan cover all parts of the transplant process? If not, what doesn’t it cover? 
• Does my health plan pay for all the prescription medicines I will need before and after a transplant? 
• Does my health plan require use of a special pharmacy company or store? (Your doctor or transplant center pharmacist can give you a list of common medicines after transplant.) 
• What is my maximum out-of-pocket cost? 
• Does this include prescription medicines? 
• Does my health plan provide travel or lodging benefits for me or for my caregiver? 
• If you have not chosen a transplant center yet, here are some more questions to ask your insurance company: 
• Do I have a case manager assigned to help me? 
• Where can I find a list of in-network transplant centers? 
• If I don’t have a transplant center in-network, does my plan provide any coverage for me at an out-of-network transplant center?

If you don’t have insurance coverage or are going to lose your coverage because of a change in your work or employment, you do have some options to get on an insurance plan. The Affordable Care Act (ACA) prevents insurance companies from denying coverage to patients who have pre-existing conditions. They also can’t put a lifetime limit on essential health care benefits. 

• Through the ACA, you can sign up for insurance through the health insurance marketplace or through expansions in Medicaid. Learn more at healthcare.gov (Opens in a new tab). 
• Medicare is a health insurance program run by the federal government. This might be an option if you’re over 65 years old or if you have certain disabilities or health conditions. People who need transplant usually qualify for disability. If you go on Medicare, consider adding a Medicare supplement plan, to help with costs that Medicare doesn’t cover. You can find more information at cms.gov (Opens in a new tab). 
• If you have a spouse with health insurance through an employer, talk with their employer about getting added to your spouse’s plan.
• COBRA (Consolidated Omnibus Budget Reconciliation Act) gives people the right to keep their insurance coverage for a certain amount of time after leaving their job. COBRA payments can be high, but the cost of losing insurance would be higher. Talk with your employer to learn more about COBRA.
• Joining a state risk-pool program. Some states have risk pools that serve people who have trouble getting other insurance.

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