Will obamacare help cover a heart transplant?


The coverage of a transplant depends upon insurance, but ObamaCare can help as many of it's new protections limit costs and what one can be denied for. So let's look at the facts:

  • The ACA mandates that all plans cover essential benefits. This applies to essential surgery you need and medications, plus in-patient and out-patient care.
  • The ACA limits out of pocket maximums and has no dollar limits on essential care. This applies to all in-network covered benefits up to an allowed amount.
  • The ACA mandates that insurers must accept someone regardless of health status and can't charge them more for insurance.
  • However, things like waiting lists and drugs and treatments that aren't covered under essential benefits (but are still needed) can still factor in.

In short, the ACA can and should be helping someone needing a transplant in many ways, but one should always check with their insurer and appropriate healthcare providers to better understand major non-emergency health services like this.

Please feel free to comment with any experince or further questions to help others understand the implications under the law. Remember healthcare and health insurance can differ wildly by region, so feel free to include your state and region in the comment.

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Chris gutierrez on

I’m helping my fried they have obama care his wife heart is 31 percent with stage5 kidney dieease.he knows how to do nothing im helping him he has very littel time desoaration is at stake.

ObamaCareFacts.com on

Someone in this position needs to call HealthCare.Gov directly and in an emergency go to a public hospital. Likely they will have Medicaid, Medicare, or ObamaCare options. Since each state is different the official HealthCare.Gov website is always a smart choice.

Chris gutierrez on

We are in desperation for a heart transplant for my best friends wife he doesn’t know how to do any of this she has stage 5 kidney disease with 31% of her heart is functioning with Obamacare does it cover

ObamaCareFacts.com on

So all major medical plans cover all essential treatment under the Affordable Care Act. Probably the best be would be to go with a platinum or gold marketplace plan from a major insurer and max out an HSA.

Lareina on

A friend of mine over 80 years needs heart surgery but is being denied and the doctor’s say its because obamacare wont cover it after age 80. Is this a law for obamacare or is this a rumor?

ObamaCareFacts.com on

That is just some random lie. Don’t know where it came from or how else to respond.

Kenna Hiddleston on

Does ObamaCare also cover the need for xenotransplant surgeries? I am doing research for a speech in FFA and would like to know in case one of the judges asks a question about it.Thank you!

ObamaCareFacts.com on

Don’t know, but will post this incase someone else does.

Chris on

The maximum out of pocket or OOP includes the ‘allowed amount’ of ‘covered services’ by ‘in network doctors’. Those phrases along with ‘mandates’ and ‘coverage depends on insurance’ make cost predictions near impossible and devalue your answer. My ‘in network’ doc referred me to an ‘out of network’ audiologist (in his office). The ACA covered colonoscopy doesn’t include the anesthesiologists bill. ‘Essential services’ are included in the policy but don’t have to be included in the premium. At least they’re covered. The ACA added few protections, contributed different but still confusing language and bumped up medical expenses – especially penalizing the middle class. Which is why I’m still going to fundraisers for people who’s catastrophic medical issues aren’t covered by insurance. I would predict a heart transplant falls in the same category. What did the ACA change? It simply encourages people to quit their jobs, divorce their spouses and file for Medicaid. Unfulfilled promises. Demoralizing.

Nate on

This page has a lot of lies on it. My daughter of 4 months just had a liver transplant. The doctors at the clinic say the insurers through Obama care will drag feet until the hospital will do the operation regardless due to laws that he put in place Obama care is a fraud. I don’t have obamacare thank the Lord cause my daughter couldn’t wait for 9 holes to have a NON EMERGENCY operation as Obama puts it in the description there’s your answer folks. Good luck everyone hope you all figure it out get private insurance it cover 100% of the transplant and had us go to mayo clinic look into local programs or call the mayo clinic and they will set you up with programs that help people instead of screw them

David C. on

In 2015, I received a complete and successful liver transplant. While on the waiting list, my medical insurance went from a relatively affordable premium to an astronomically, cost-prohibative Cobra plan. The ACA,(Obama Care), rolled-out just in time and saved my life and thousands of dollars in insurance premiums. The thought of the ACA being repealed saddens me beyond comprehension.
David C.
PS, I live in a Red state, (TX), but vote Blue!

cc on

This tells me nothing about what the out of pocket costs would be for a heart transplant patient.

ObamaCareFacts.com on

You should talk to your insurer regarding that one.