Even before the Supreme Court overturned Roe v. Wade ruled June 24 that the ability to use health insurance to pay for an abortion depends on a number of factors, including the status of the covered woman, the type of insurance involved, and where the procedure takes place.
Lack of insurance means most Americans who receive abortions pay out of pocket, said Katie Keith, J.D., a researcher at Georgetown University’s Center for Health Insurance Reform .
“That’s not to say you shouldn’t try it if you have insurance,” she said. “The average cost of an abortion is over $500, and when you add in travel and everything else, the cost can be a huge hurdle.”
Here’s a look at whether health insurance covers abortion:
How do you know your Does the plan cover abortion?
As with any medical procedure or drug, you can find out if your plan covers abortion by checking your plan documents (available through your online portal) or call your insurance company and ask directly. If you have health insurance through work and you feel you can ask HR about coverage, they may also answer that question or direct you to someone who can.
Even if your insurance company covers abortion services, your It’s also necessary to find a provider that accepts your insurance and is in your plan’s network. Learn from
Your company will not know from medical bills or health records whether you have an abortion.
Even self-insured employers often have separate entities that handle health benefits. “They get an overall report on the types of funding programs, but they don’t identify individuals who use them,” said Dr. Joel Abramowitz, a health policy economist at the University of Michigan’s Institute for Social Research. “That information is subject to HIPAA Protections.”
HIPAA, or the Health Insurance Portability and Accountability Act, is a law that protects the privacy of your health records.
Provider medical abortions may fall under the same rules as medical procedures. However, this is not always the case if done through telemedicine.
“The question is whether telemedicine is generally covered, and telemedicine medical abortion in particular,” Abramowitz said. “Best check with your insurance plan.”
If you have insurance, is it protected by law, or does it vary by state?
It varies by state. Eleven states have restrictions on whether private insurance companies can cover abortions, and seven states require insurance plans to cover abortions.
That is, state law applies only to fully insured employers, that is, those where the employer pays the insurer to provide the policy to the worker on their behalf. Only about one-third of workers participate in these types of programs.
Most large employers are self-insured, which means they cover all financial responsibilities for those on the plan.
“Even in states where the law does not allow coverage for abortion, self-insurance plans are not subject to such laws,” Abramowitz said.
The rules are also different for those who do not have coverage from an employer-provided plan.
The Kaiser Family Foundation for Analysis found that 34 states and Washington, D.C. limited Medicaid coverage of abortion to cases of rape, incest, or saving the mother’s life, while about half of States have restrictions on plans offered through the state health insurance marketplace. You can check your state’s rules here.
Not clear. Health insurance plans may cover abortions performed out-of-state (most likely at out-of-network rates), but they may not cover travel costs — or they may cover both. Check your plan details or contact your health insurance company.
Some employers have pledged to help pay for employees who need to travel for abortions. But legal experts say companies’ ability to do so will depend on their state’s rules.
For example, in Texas, anyone who helps someone travel interstate to have an abortion can face civil penalties for “aiding and abetting” them, employer and insurance Companies may need to consider their potential liability for doing so.
A Flexible Spending Account (FSA) may be a way to pay for part of your travel expenses. “Even if travel expenses are not covered by an insurance plan, they can be reimbursed through accounts such as the FSA,” Abramowitz said.
Do they have to notify you if your plans change mid-year?
Yes, although insurance companies rarely make such changes.
“They can change coverage to have an abortion before the new year, so when people look at their plans during open enrollment, that’s probably something to think about or ask about at the time,” Abra Movitz said.
Will coverage be affected if a pregnant woman has a potentially life-threatening medical condition?
Yes. Even in some states that now ban abortion, exceptions are often made to save mothers’ lives. In most cases, insurance will cover abortion if the provider provides it as part of a life-saving medical intervention.
“Emergency procedures of any kind are medically necessary, so there should be no doubts about reporting,” Keith said. “If someone is in the emergency room and needs care for an ectopic pregnancy or other reason, it should be covered.”