General — TransplantLyfe


Insurance question for US patients

michelleTransplant Patient
September 25, 2023 in General

This question is for post-transplant patients in the US and how you found the right insurance.

Right now, I have pretty amazing insurance coverage through my employer. However, my husband and I are exploring the possibility of relocating from our urban lives (and corporate jobs with good health insurance) to a rural lifestyle in the next 5-7 years. One of the big questions (and potential roadblocks) is getting insurance coverage that will cover my meds and post-transplant / chronic care management.

If anyone is willing to share, I am looking to better understand others' experiences in seeking out insurance on your own in the commercial insurance market. Which health plans (either national or in those focused in the mid-Atlantic) cover transplant meds and chronic care management with reasonable cost-sharing and/or copays? What's the monthly insurance premium I'll be looking at? What's the typical out of pocket cost for monthly meds. (I know that's dependent on a bunch of factors, but I'm trying to get any understanding of the range in cost.)

Thanks for any insights that anyone is willing to share.

1 - 5 of 5 Replies

  • DebTransplant Patient

    I feel I’ve been very lucky with insurance. My husband was put on disability about a year before I had to start it and we were able to keep his insurance until I found my own. I found a broker who worked with me and my hospital helped me as well and I didn’t pay hardly anything for my pre or post transplant care. I, as most people come under review and my insurance goes up a little each year until my Medicare kicked in. Again the same broker helped us work through it all and my monthly payment is around $250. We looked at my meds and future testing and that’s how we chose my Anthem policy. Good luck and ask remember ask questions and take notes it helps. You can choose higher or lower deductibles and that will base your monthly payment.

    September 25, 2023
  • michelleTransplant Patient

    Thanks Deb! That’s really helpful information.

    September 26, 2023
  • MelsammTransplant Patient

    Hi Michelle, I worked w/my financial coordinator and social worker to help me find the best plan for me. Each state is so very different. I know they base everything on income so take that into account also. Your social worker can help w/coupons to help pay for your meds too. With you relocating that is going to be your challenge. I am 63 y/o I am on Medicare,BCBS supplement my drug plan is separate my total I pay each month is $526.00 I chose to stay w/ traditional Medicare. I had to make sure my Drs. r on the plan I also chose the lowest deductible which is 266. Then my insurance pays 100%.

    Good Luck.. I hope u r doing well with your Liver Transplant! I am almost 3years.💚😊

    September 26, 2023
  • michelleTransplant Patient

    Thanks Melsamm! Those are helpful insights!

    September 26, 2023
  • JeanmarieTransplant Patient

    I've been battling insurance and transplant for 17 years. My best advice is to check with your transplant center. My center does not accept anything but plain Medicare. They don't take any of the advantage plans etc. So, if I need a change in insurance I make an appointment with the financial coordinator. Even if you are stable and you do not always need to go to your transplant center, there is always a risk of rejection through the years. I usually only trust my current transplant team to help me through all that vs going to get established at a new center.

    Just keep those things in mind too. Each state also has programs to help with the cost of Medicare. Something to also look into.

    September 28, 2023
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