Obamacare: Choosing a plan as an organ transplant patient

Hello from Texas! What would be the best insurances to get as an organ transplant post-patient? I am considering either Blue Shield/Blue Cross or Aetna under PPO category (not HMO). Your input would be much appreciated!

Lone Star State Survivor

Dear Lone Star State Survivor,

Because of health reform, you will find that plans are more similar to one another than they used to be.  So, there is no such thing as a “bad” plan or a “good” one at least not insofar as what drugs or services are covered.  There are wide differences in co-pays and deductibles, and perhaps in rates depending upon how many carriers are competing.  The Texas health insurance exchange has 12 carriers, though not all may have coverage statewide.

Insurers cannot turn you away, or charge you more based upon your being an organ transplant patient.  However, this is only true during open enrollment or when you have a family status change that lets you change or join a plan mid-year.

As an organ transplant patient, you will be affected by the plan’s benefit for prescription drugs and the provider network.  You will want to find out whether your doctor is in the plan, and how much you will have to pay for your anti-rejection drugs.  You might want to “screen” plans based upon this criteria, and then look at the deductibles, co-pays, and rates.

It’s always a good idea to get help from an insurance agent, who can advise you about your specific situation.  You can find a licensed agent at the National Association of Health Underwriter’s directory.

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Linda Riddell

About Linda Riddell

A published author and health policy analyst with 25 years’ experience, Linda Riddell's goal is to alleviate the widespread ailment of not knowing what your health plan can do for you.