Jane Dotson
Abortion is a medical procedure that more than 920,000 US women obtain every year. The cost of an abortion can vary depending on the trimester and location, with an in-clinic abortion in the first trimester costing up to $800, and a second-trimester abortion costing up to $2000. Due to the high costs, many women rely on insurance coverage to access abortion services. However, insurance coverage for abortion varies widely by state and insurance type. While some states require insurance plans to cover abortion, others prohibit it. Additionally, certain types of insurance, such as Medicaid, may have limited coverage for abortion services. As a result, it is important for individuals to understand their insurance plan's coverage and seek assistance from organizations that provide financial support for abortion if needed.
| Characteristics | Values |
|---|---|
| Average cost of a first-trimester in-clinic abortion | $600 |
| Average cost of a second-trimester abortion | $715-$2,000 |
| Median cost of a medication abortion in 2021 | $568 |
| Median cost of a first-trimester abortion procedure in 2021 | $625 |
| Median cost of a second-trimester abortion procedure in 2021 | $775 |
| Percentage of abortion providers that accepted insurance in 2021 | 71% |
| Number of states with limits on whether private insurers can cover abortion | 10 |
| Number of states that require private insurance plans to cover abortion | 10 |
| Number of states that require nearly all insurance plans to provide coverage of abortion | 3 (California, New York, Oregon) |
| Number of states that use their own funds to make sure women enrolled in Medicaid have coverage for abortion | 17 |
| Number of states that have laws prohibiting insurance plans from offering coverage of abortion | 26 |
| Number of states that prevent all private insurers from offering coverage of abortion | 11 |
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What You'll Learn
Abortion coverage varies by state and insurance type
According to the National Women's Law Center, 26 states have laws prohibiting insurance plans from offering coverage for abortion services in the insurance marketplaces set up by the ACA. Of these, 11 states prevent all private insurers from offering coverage for abortions as part of a comprehensive healthcare plan. This means that women in these states may not be able to purchase a plan that provides coverage for abortion services, regardless of where they live and how they are insured. However, most of these state laws contain exceptions for extreme situations, such as when the pregnancy endangers the woman's life or results from rape or incest.
On the other hand, some states require insurance plans to provide coverage for abortion services. For example, California, New York, Oregon, and Washington require all state-regulated private health plans to include coverage for abortions. Maine has a similar law, requiring all private health insurance plans covering maternity care to also cover abortion services.
The cost of an abortion can range from $568 for a medication abortion to $2,000 for a second-trimester abortion procedure. Without insurance coverage, many individuals may struggle to pay for an abortion, especially considering that 40% of US adults do not have enough savings to cover a $400 emergency expense.
It is important to note that even within states that require insurance coverage for abortions, there may be limitations. For example, California's requirement does not apply to employers that provide "self-funded" healthcare coverage or grandfathered plans. Additionally, individuals should confirm that their chosen abortion provider accepts their insurance plan, as not all providers may be in-network.
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Federal funds are banned for abortions unless in extreme cases
The use of federal funds for abortions has been banned since 1977, except in cases of rape, incest, or if the pregnancy endangers the woman's life. This rule, known as the Hyde Amendment, initially only applied to funding for abortions under Medicaid, but it has since been expanded to include federal employees and women in the Indian Health Service. The Hyde Amendment is not a permanent law but has been approved annually by Congress as part of the Congressional appropriations bills.
The ban on federal funding for abortions has had a significant impact on access to abortion services, particularly for low-income individuals and those without insurance. In states that prohibit abortion or place restrictions on insurance coverage for abortions, individuals may struggle to access abortion services due to financial barriers. This can lead to delays in obtaining an abortion or even force some women to carry unwanted pregnancies to term.
While federal funds are generally banned for abortions, there are some sources of financial assistance available. Some states, such as California, New York, Oregon, and Washington, require all state-regulated private health plans to include coverage for abortion. Additionally, 17 states use their own funds to ensure that women enrolled in Medicaid have coverage for abortion, with 13 of these states providing coverage under court orders. Abortion funds, such as the National Network of Abortion Funds, can also provide financial and logistical support for individuals seeking abortions, including help with transportation, lodging, and childcare.
It is important to note that the availability of insurance coverage for abortion varies widely by state and type of insurance. Ten states have limits on whether private insurers can cover abortion, while 10 states require private insurance plans to cover abortion. However, these state laws only apply to fully insured employers, and most large employers are self-insured, which means they are not bound by state laws restricting abortion coverage. Individuals can check their insurance plan documents or contact their insurer directly to understand their coverage for abortion services.
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Private insurance plans may be restricted by state laws
The ability to use health insurance to pay for an abortion depends on several factors, including the state in which the insured woman resides, the type of insurance involved, and the location where the procedure is carried out. State laws have a significant influence on whether private insurance plans can cover abortions.
Ten states impose restrictions on whether private insurers can provide abortion coverage, while ten other states mandate that private insurance plans include abortion coverage. These laws, however, only apply to fully insured employers, where the employer pays an insurer to provide policies for their employees. Self-insured employers, who assume financial liability for individuals in the plan, are not bound by these laws.
Some states, such as California, New York, Oregon, and Washington, require all state-regulated private health plans, including Marketplace plans, to cover abortion services. California law specifically considers abortion care as basic healthcare, and most insurance plans in the state must cover fundamental healthcare services. In contrast, Utah does not permit riders for abortion coverage, leaving women with private insurance plans in these states without coverage options.
The laws regarding abortion coverage in private insurance plans vary across states. Twenty-six states have laws prohibiting insurance plans from covering abortion as part of a comprehensive health care plan in the insurance marketplaces. Eleven of these states extend this prohibition to all private insurers, preventing them from offering abortion coverage in any comprehensive health care plan.
The political landscape surrounding abortion coverage in insurance plans is dynamic and subject to ongoing debates and legislative efforts at the state and federal levels.
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Medicaid coverage is limited by state and federal regulations
Medicaid is a joint federal and state program that provides health coverage to over 77.9 million Americans, including children, pregnant women, parents, seniors, and individuals with disabilities. While federal law sets broad requirements for Medicaid and mandates coverage of some populations and benefits, states have the responsibility of making policy and operational decisions that determine eligibility, covered services, and provider payments through their state plans.
State plans must be approved by the Centers for Medicare & Medicaid Services, but can be amended to reflect changes in state policy and federal law and regulation. This flexibility allows states to address unique challenges and make decisions based on their specific circumstances. However, this has also led to variations in Medicaid coverage for abortion services across different states.
Since 1977, the Hyde Amendment has banned the use of federal funds for abortions unless the pregnancy results from rape or incest or endangers the woman's life. This rule has primarily affected Medicaid funding, but its reach has broadened over time. While some states follow the Hyde Amendment's restrictions for private plans, others have imposed more restrictive policies.
For example, Utah has exceptions for cases of rape, incest, or to save the woman's life for Marketplace plans, but restricts abortion coverage to life endangerment for other private plans. In contrast, ten states require private insurance plans to cover abortion, while ten others limit coverage only to cases of rape, incest, or to save the mother's life. These varying regulations impact the availability of abortion coverage, with many women left without coverage options even in cases of rape or incest.
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Employers may provide self-funded healthcare excluding abortions
The ability to use health insurance to pay for an abortion depends on multiple factors, including the insured woman's state, the type of insurance involved, and where the procedure is carried out. In the United States, employer-sponsored health insurance is the largest source of coverage, with 153 million people under 65 covered in 2023.
Self-funded healthcare plans, which are common among larger firms, are exempt from most state insurance laws. This means that employers can choose to exclude abortion from their health plan in at least some circumstances. In 2019, 10% of covered workers were employed by a firm that had asked to exclude abortion from their health plan in at least some circumstances. This figure rises to 17% for the largest firms (5,000 or more workers), with only 3% of small firms (3-199 workers) specifically requesting any exclusion of abortion coverage.
Self-funded plans are more likely to be chosen by larger firms because they can spread the risk of costly claims over a large number of workers and dependents. However, it is important to note that even if an employer has not excluded abortion coverage, the plan may still not cover it, depending on state laws.
Ten states have laws prohibiting all state-regulated private plans from covering abortions, while ten states require coverage of abortion services in all state-regulated private plans. In addition, some states follow the Hyde Amendment, which bans federal funding for abortions unless the pregnancy is a result of rape, incest, or if it is determined to endanger the woman's life.
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Frequently asked questions
It depends on several factors, including the state you live in, the type of insurance you have, and the specific insurance plan. Some states have laws prohibiting insurance plans from covering abortions, while others require insurance plans to include abortion coverage. Even within a state that mandates abortion coverage, there may be exceptions for certain employers or insurance providers.
You can refer to your plan documents or call your insurer to ask directly. If you have health insurance through your job, your HR department may also be able to answer your question or direct you to someone who can.
Your insurer is obligated to arrange an appointment with a local out-of-network provider. You can also contact your state's Department of Insurance for assistance.
