Can we ever go home to the U.S.?/Treatment in U.S.

I am U.S. citizen expatriate living outside of the U.S. for many years and been living in Singapore with my family. My wife was diagnosed with Stage IV breast cancer last year. She has been receiving the most fantastic medical care here in Singapore. Before my wife's diagnosis, we were planning to return home to the U.S. since our children were getting older and we were missing home.

My wife's treatment has been radiation therapy, chemotherapy (Vinorelbine) and targeted therapy with herceptin and perjeta (pertuzumab) we have been extremely fortunate that she has responded very well to the treatment and with all of her incredible hard work fighting this. Right now she is no longer on chemotherapy but only on herceptin and perjeta. Since my wife has responded well, we are now re-visiting our plan to return home the U.S. since that is home and where we wish for our children to spend the rest of their childhood growing up. However, this past week my wife's Dr. told us that my wife will need to be on herceptin and perjeta for the next 5 years.

My concern is whether my wife will continue to have the same level or better medical treatment if we were to return to the U.S. I used to think as an American that the U.S. had the best medical care in the world but after living overseas for a while I realize that sadly that may not necessarily be true. I understand (but I am not sure if it is true) that the chemotherapy drug that my wife was given (Vinorelbine) is not approved in the U.S. for breast cancer treatment but approved in Europe and Singapore. If you are not familiar with Vinorelbine, it cause little to no hairloss and relatively milder side effects compared to other chemotherapy drugs. My wife had very little hair loss and no one noticed or even aware that my wife is battling cancer.

I am hoping to gather information from the community on whether heceptin + perjeta is easily available for treatment in the U.S. and covered by most medical insurance and the costs for treatment.

Right now we have a Singapore only medical insurance policy that covers the entire cancer treatment including immunotherapy (up to an annual limit of approximate US$450,000). The annual renewal premium I just paid for my wife's policy was Singapore $2,175 (which is approximately US$1,550). We currently do not have any U.S. medical insurance since we made a financial decision a few years ago to terminate it because the premiums were extremely expensive. Unfortunately, now that my wife has cancer she now has a serious pre-existing condition and under the current Administration/Congress plans to replace/nullify the ACA I am not sure if she would be able to get any medical insurance coverage when we return to the U.S.

The costs of each treatment for my wife has been herceptin = SG$5,400 (approx. US$3,840) and perjeta SG$8,600 (approx US$6,120). She is now on a 3 week cycle now so the total expenses are US$10,000 to US$20,000 per month.

I look forward to hearing the community. Many thanks for your assistance.

Repeating, because it is an important point. You'll be fine if you will be employed and get insurance through your employer. In that situation, you are protected despite the pre-existing condition issue. Neither the employer nor the insurer can ask about your health issues. Nothing going on with ACA changes that.

The chemo you mention won't be available. H+P will be available. Immunotherapy is not approved here yet, but available through clinical trials. Options increasing every year. If you have insurance through an employer, returning to the US should be fine. I am so glad your wife is doing well. I've lived abroad, I know what it feels like to want to come home. Hope it works out for you.

>Z<

I don't quite understand some of the responses to your question. The ACA has not been changed with this new administration. Nothing has been passed in Congress to change the ACA. Having a pre-existing conditions does not mean that you can not get insurance, nor do you pay more than your peers. Depending on which state you plan to return to, your choices for health insurance plans [self-pay] can be very good or wretched. Choose your state wisely. Even the most draconian proposals for changing the ACA, which do not have enough votes to pass, will continue to allow people with illness to continue to buy insurance if they have been covered for the previous year. BUT, those changes have NOT been voted into law.

Some states have accepted extra money so that if you return without a job, you might very well be heavily subsidized.

I have no employer. I have never had an employer. I have always had self-pay and I have insurance that has covered absolutely all of my treatments.

That said, insurance is expensive and will probably become more so now that the IRS has been told to NOT apply the penalties for not having insurance.

*susan*

EDITED to ADD: Every single one of us is covered under the ACA, regardless of who pays for the coverage. The ACA dictates who and what must be covered as a minimum.

I didn't think they could even get that amendment out of committee. Do you have the bill number so that I can investigate? A quick google search didn't find anything. Obviously, this is really important to all of us.

I am not living in the US but your insurance is dirt cheap for me, too. And given the options there, which she may end up needing within the next 5 years, I would stay put in Singapore for the moment.