Insurance coverage and financial planning for a blood or marrow transplant

Every health plan is different. Some cover the transplant itself but not the cost of finding a donor or cord blood unit.

Here is how to start learning what your plan covers:

• Call your insurance company. Ask to talk with a case manager who can explain your transplant benefits.
• Ask your transplant center’s financial coordinator to review what is covered and what is not.
• Take notes during your calls, including who you spoke with, the date and key details about your plan.

If you would like someone to help you make those calls, you can give a trusted family member or friend permission to speak with your insurance company on your behalf.

An NMDP^SM patient navigator can also help you get answers about your insurance. They can work with you to put together a list of questions to ask your insurance company. They can be on the phone with you when you call your insurance company or make the call for you, too.

Download or print the financial planning before transplant worksheet.

Talking with your insurance company can feel overwhelming, but being prepared makes it easier. Here are steps and questions to help you get the information you need about transplant coverage.

• Ask to talk to a case manager from your insurance company who can help guide you through the process.
• Write down their name, phone number and the date of each call.
• Take notes about what you discuss, especially any coverage details or next steps.
• Ask for a copy of your health insurance policy and written information about how much your insurance pays for transplant.

• Coverage and eligibility:
  • 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?
• Medicines and pharmacy
  • Does my health plan pay for all the prescription medicines I will need before and after a transplant? (Your doctor or transplant center pharmacist can give you a list of common medicines after transplant.)
  • Does my health plan require use of a special pharmacy company or store?
• Costs and coverage limits
  • 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?

Ask these additional questions to understand your options:

• Do I have a case manager assigned to help me?
• Does my plan require me to get treatment at a Center of Excellence (COE) or Designated or Preferred Transplant Center? Where can I find a list of these centers?
• 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
• 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
• 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.
• Some states have high-risk health insurance pools (HRPs). HRPs are state-established programs designed to provide coverage for people who have trouble getting insurance in the private market.

After you learn about your insurance coverage, you will have a better idea of the transplant costs you will have to pay, so you can make a plan. There are some financial assistance grants that you may qualify for. It’s also a good idea to consider fundraising.