Even before the Supreme Court reversed Roe v. Wade on June 24, the possibility of using health insurance pay for one Abortion depended on many things, including the condition of the insured, the type of insurance involved and the location of the procedure.
Lack of coverage means most Americans who get abortions pay in the pocket for that, says Katie Keith, JD, research faculty member at Georgetown University’s Center on Health Insurance Reforms.
“That’s not to say you shouldn’t try to use insurance if you have it,” she says. “The average cost of an abortion is over $500, and if you add travel and all that, the cost can be a huge barrier.”
Here are answers to common questions about health insurance coverage for abortion:
How do you know if your plan covers abortion?
As with any medical procedure or medication, you can find out if your plan covers abortion by viewing your plan documents (available through your online portal) or by calling your insurer and asking directly. If you have health insurance throughout your job and you feel okay asking your HR department about coverage, they could probably also answer the question or direct you to someone who can.
Even if your insurer covers abortion services, you will need to find a provider that accepts your insurance and is in-network for your plan. In 2020, about 80% of abortion providers accepted insurance, up from 89% in 2017, according to a Health Affairs study.
Your company won’t know if you had an abortion from your medical bills or medical records.
Even self-insured employers usually have a different entity that handles health benefits. “They get aggregate-level reports on the types of procedures funded, but they wouldn’t identify the person who used them,” says Joelle Abramowitz, PhD, health policy economist at the Institute for Social Research. University of Michigan. “This information is protected by HIPAA.”
HIPAAor Health Insurance Portability and Accountability Act, is a law that protects the privacy of your health records.
Does insurance treat mifepristone (RU-486), the so-called abortion pill, differently than abortion procedures?
A medical abortion at a provider would likely fall under the same rules as the medical procedure. But this is not always the case if it is done by telehealth.
If you have coverage, is it protected by law or does it vary by state?
It varies greatly by state. Eleven states have limits on whether private insurers can cover abortion, and seven states require insurance plans to cover abortion.
That said, state laws only apply to fully insured employers, meaning those where the employer pays an insurer to provide policies to workers on their behalf. Only about a third of workers participate in these types of plans.
Most large employers are self-insured, which means they take on all financial responsibility for the people in the plan.
“Even in states where the law says you’re not allowed to cover an abortion, a self-insured plan wouldn’t be bound by those kinds of laws,” Abramowitz says.
The rules also vary for those who are not covered by employer-provided plans.
Analysis by the Kaiser Family Foundation finds that 34 states and Washington, DC, limit Medical help abortion coverage only for cases of rape, incest, or to save the life of the mother, while about half of states have limits on plans available through public health insurance Market. You can check the rules for your state here.
If your plan covers abortion, but you’re in a state that doesn’t provide what you need, are you covered if you have to travel to get one?
It’s unclear. Health insurance plans may cover out-of-state abortions (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 promised to help cover the costs of employees who have to travel for abortions. But legal experts say companies’ ability to do so will depend on the rules in place in their state.
In Texas, for example, anyone who helps someone cross state lines for an abortion could face civil penalties for “aiding and abetting them,” and employers and insurers may have to hold account of their potential liability for this.
Flexible Spending Accounts (FSA) can be a way to cover some of the travel costs. “Even if the travel costs are not covered by the insurance plan, they could be reimbursed through accounts like FSAs,” says Abramowitz.
If your plan changes during the year, do they have to let you know?
Yes, although it is rare for insurers to make such changes.
“They might change abortion coverage before a new year, so when people look at their plans during open enrollment, that might be something to think about or inquire about at that point,” Abramowitz says.
If the pregnant woman has a potentially life-threatening medical condition, does this affect coverage?
Yes. Even in some states that now ban abortion, there is often an exception to save the mother’s life. In most cases, if providers perform the abortion as part of a life-saving medical procedure, insurance will cover it.
“Any type of emergency procedure is medically necessary, so there should be no questions about coverage,” says Keith. “If someone is in the emergency room and needs care because they have a ectopic pregnancy or something else, which should be covered.