Haris Ashley
The ability to use health insurance to pay for an abortion depends on several factors, including the state, the type of insurance, and where the procedure is carried out. Six states in the US require nearly all private insurance plans to cover abortions: California, Illinois, Maine, New York, Oregon, and Washington. In California, abortion care is considered basic healthcare and is covered by most insurance plans. In Illinois, state-regulated private insurance plans must cover medication abortions, and Illinois insurance laws prohibit discrimination based on sex, gender identity, or sexual orientation. In 2021, about 71% of abortion providers accepted insurance, and this number is expected to decrease.
| Characteristics | Values |
|---|---|
| Can you get an abortion with medical insurance? | It depends on the state, the type of insurance involved, and where the procedure took place. |
| States that require private insurance plans to provide coverage for abortion | California, Illinois, Maine, New York, Oregon, and Washington |
| States that use their own funds to make sure women enrolled in Medicaid have coverage for abortion | 16 states, including Illinois and 9 states that provide coverage under court orders |
| States that prohibit insurance issuers from offering health care plans that include abortion coverage | 25 states |
| States that prevent all plans from offering coverage of abortion | 11 states |
| Percentage of abortion providers that accepted insurance in 2021 | 71% |
| 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 |
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What You'll Learn
State-regulated insurance plans and abortion coverage
The availability of abortion coverage depends on several factors, including the type of insurance coverage, the state in which the individual resides, and whether the Hyde Amendment's restrictions are applicable to the abortion.
State-regulated insurance plans' coverage of abortion varies from state to state. Some states have laws prohibiting insurance providers from offering abortion coverage. For example, Louisiana and Tennessee do not allow insurance coverage for abortions, even in extreme circumstances. Other states, like California, Illinois, Maine, New York, Oregon, and Washington, require private insurance plans to provide abortion coverage.
In some states, all private, state-regulated health plans must provide abortion services. Conversely, certain states ban such coverage. Additionally, ten states require marketplace health plans to cover abortion, with some mandating no out-of-pocket expenses for enrollees. The rest of the states leave the decision to include abortion coverage to the discretion of each insurance company.
State-regulated HMO plans typically do not require a referral for abortion services from a participating provider. However, if the provider is not part of the HMO network, a referral is necessary. Self-funded private employer plans may require prior authorization for abortions, but state-regulated plans do not.
Illinois, for instance, has enacted laws requiring state-regulated health insurance plans that offer pregnancy-related benefits to cover abortions, including medication abortions. Beginning in 2024, Illinois will also require state-regulated private insurance plans to cover follow-up services related to medication abortions, such as side-effect management and mental health strategies.
The availability of abortion coverage under state-regulated insurance plans is subject to change due to evolving state laws and policies. It is essential to review the specific regulations and restrictions in your state to understand the coverage provided by state-regulated insurance plans.
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Private insurance and abortion coverage
Private insurance coverage of abortions varies depending on the state and the type of insurance plan. In 2021, about 71% of abortion providers accepted insurance, down from 82% in 2017, according to research by the Abortion Facility Database Project at the University of California, San Francisco.
State-regulated private insurance plans are required to provide coverage for abortion services, including medication abortion ("abortion pills") and follow-up services related to abortion, such as side-effect management, medication adherence counselling, and mental health strategies. However, self-funded private employer plans are not required to cover abortions and may require prior authorization.
The ability to use health insurance to pay for an abortion depends on several factors, including the state, the type of insurance, and the location of the procedure. For example, in Texas, abortion is only legal if a woman's life or health is at serious risk, so health insurance in Texas would only cover abortion in those cases, if the plan covers it at all.
Some states, like California and Illinois, require marketplace plans to cover abortion, while other states give companies the choice to cover abortion or not, and this coverage can be restricted by state abortion laws. Only about 10 states require private health insurance plans to include abortion coverage.
Additionally, it is important to note that anti-abortion conservatives have been working to eliminate private insurance coverage of abortion, and this has already been successful in restricting coverage under Medicaid and other federal programs.
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Medicaid coverage and abortion
Medicaid coverage for abortion varies depending on the state in which you live and the type of coverage you have. The Hyde Amendment, a federal law, restricts federal funding for abortions under Medicaid to cases of rape, incest, or life endangerment of the pregnant person. This amendment has been a source of controversy, with some states seeking to repeal it.
In 17 states and Washington, DC, state funds are used to pay for abortions for Medicaid enrollees with low incomes beyond the Hyde Amendment limitations. These states include California, Connecticut, Delaware, Hawaii, Illinois, Maryland, Massachusetts, Minnesota, Montana, New Jersey, New Mexico, New York, Oregon, Vermont, Washington, and West Virginia. However, it is important to note that these states may have different gestational limits and other restrictions on abortion access.
For those with Marketplace plans, there is no federal requirement to cover abortion services, and about half of the states prohibit these plans from doing so. On the other hand, some states require plans to cover abortion services and prohibit cost-sharing.
It is essential to check with your state's Medicaid office or a local community health center to understand your specific coverage and eligibility. Additionally, Medicaid will only cover your abortion if you live in the same state where the procedure takes place.
While insurance coverage for abortion can be complex and ever-changing, it is important to know your rights and the resources available to you.
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Employer-sponsored health plans and abortion coverage
Employer-sponsored health insurance is the largest source of health coverage in the United States, covering 153 million people younger than age 65 in 2023. However, the availability of abortion coverage in employer-sponsored health plans varies from one employer's plan to another.
The specific benefits and services covered by those plans are shaped by several factors, including costs, employer policies and beliefs, and state and federal regulations. For example, some states ban abortion coverage on all state-regulated plans, while some require abortion coverage on at least some plans.
Self-funded plans established by private employers are exempt from most state insurance laws, including mandated benefits. Self-funding is a common practice among larger employers, with about 59% of covered workers at private-sector firms enrolled in a self-funded plan. In the absence of state insurance laws requiring or prohibiting abortion coverage, private employers offering self-funded plans may choose whether to offer coverage for abortion or only cover it under limited circumstances, such as in cases of rape, incest, or health endangerment of the pregnant person.
According to a 2023 KFF survey, one-third of large firms that offer health benefits cover abortion in most or all circumstances in their largest health plan. Additionally, 18% of these firms also provide or plan to provide financial assistance for travel out of state to obtain an abortion. However, four in ten respondents do not know whether their largest plan covers abortion.
It is important to note that even in states that prohibit abortion, there is usually an exception to save the life of the mother. In such cases, if providers perform the abortion as part of a life-saving medical intervention, insurance will typically cover it.
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Discrimination and abortion coverage
In the United States, the ability to use health insurance to pay for an abortion depends on several factors, including the state where the insured woman lives, the type of insurance involved, and where the procedure takes place. Even before the Supreme Court overturned Roe v. Wade in 2022, more than half of Americans who had abortions paid out of pocket. The median cost of a medication abortion in 2021 was $568, while a first-trimester abortion procedure was $625, and a second-trimester abortion procedure was $775.
In Illinois, state-regulated private insurance plans must provide coverage for follow-up services related to medication abortion, such as side-effect management, medication adherence counselling, and mental health strategies. Illinois insurance laws also prohibit discrimination based on sex, actual or perceived gender identity, or sexual orientation.
Despite these protections, abortion remains inaccessible to many due to criminalisation, social stigma, and intersectional discrimination and marginalisation. For example, transgender and gender non-conforming people often face harassment in medical settings and are refused treatment due to their gender identity. Denying abortion is a form of gender discrimination against women, girls, and anyone else who can get pregnant, as recognised by multiple UN treaty bodies.
Federal laws in the United States explicitly allow healthcare professionals and institutions to refuse to provide abortion services, citing religious or moral objections. Title VII of the Civil Rights Act prohibits employers from discriminating against employees based on their religious beliefs and practices. However, this has also been used to protect healthcare providers who refuse to perform abortions. Additionally, 46 states allow individual healthcare providers to refuse to provide abortion services, and 44 states permit healthcare institutions to do the same.
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Frequently asked questions
It depends on the state and insurance plan. Six states (California, Illinois, Maine, New York, Oregon, and Washington) require nearly all private insurance plans to provide coverage for abortions. Illinois and California laws are clear that abortion care is basic health care, and most insurance plans must cover basic health care services. However, self-funded private employer plans are not required to cover medication abortion. In about half of the states, Medicaid coverage for abortion is limited to cases of rape, incest, or life endangerment of the pregnant person.
It depends on the state and insurance plan. In California, until December 31, 2022, your insurer may ask you to seek approval before receiving an abortion, but they cannot prevent you from obtaining one or refuse to cover it. Starting in January 2023, insurance plans that cover abortion will be required to do so with no prior authorization and no cost-sharing.
No. California and Illinois laws prohibit private health insurers from discriminating against you for receiving any reproductive healthcare, including abortions. Illinois insurance regulations also prohibit discrimination based on sex, actual or perceived gender identity, or sexual orientation.
