When Does Health Insurance Cover Abortions?

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Following the Supreme Court’s overturning of Roe v. Wade last week, Americans who live in areas that ban abortion now must travel out-of-state with a view to receive the medical care they’re searching for.

On top of the financial burden created by travel alone, abortions can cost anywhere from $350 to over $1,500. But depending on the state you reside in and your insurance provider, medical health insurance can cover some or the entire bill. 

Insider spoke with two health policy experts about which insurance policy cover abortion, and inquiries to ask your provider within the post-Roe era. 

Which forms of insurance policy cover abortion? 

State policies on abortion health insurance coverage.

State policies on abortion medical health insurance coverage.

KFF


After the autumn of Roe v. Wade, many corporations across the US announced they’d cover travel costs for workers searching for out-of-state medical care. 

Employer medical health insurance falls into two categories: fully-insured plans and self-insured plans. A completely-insured plan is when an employer purchases health coverage from a state-regulated insurance company.

By comparison, corporations with self-insured plans pay for workers’ medical bills directly. Roughly 64% of US employees were covered by self-funded medical health insurance plans in 2021, in line with Statista.

State laws — including those who outlaw insurance providers from covering abortions — can only regulate fully-insured plans. Corporations with self-insured plans are “free to make whatever coverage decisions they need,” Sara Rosenbaum J.D., a professor and founding chair of health law and policy at George Washington University’s school of public health, told Insider.

“The girl could have to travel and [the provider] would must clarify that that they will allow you to exit of network for the care,” she said. “But they might actually cover it.”

Currently, only eleven US states have laws that prohibit abortion coverage from being included in fully-funded private insurance policies, in line with health policy nonprofit KFF. 

“So there are some states that can ban abortion, but which have not banned coverage,” Laurie Sobel, the Associate Director for Women’s Health Policy at KFF, told Insider, adding that it’s “probably a matter of time” before those states ban insurance coverage as well. 

In terms of federally-funded medical health insurance, coverage is just offered in very specific cases. As a consequence of the Hyde amendment, federal funds cannot be used to pay for abortions. Meaning Medicaid is unable to cover abortions unless the pregnancy is life-threatening or resulted from rape or incest. 

Inquiries to ask your employer or insurance provider within the post-Roe era

While employers have largely focused on travel costs of their corporate responses to the autumn of Roe v Wade, there are other logistical hurdles corporations need to think about with a view to ensure their employees have access to out-of-state care, Sobel told Insider. 

“It is important to have a look at the structure of the plan. So what’s the deductible? What’s the copay? What’s the network?” she said. “If abortion is now illegal within the state that you simply reside in, then there must be some contract with the clinic out of state.”

If the out-of-state abortion provider will not be in-network, the deductible could possibly be dearer than the procedure itself, she explained.

“Even employers who’ve the most effective of intentions and are attempting to cover this, it should be difficult simply to make it actually work in a way that the person doesn’t must pay out of pocket,” Sobel added. “For a lot of employees, paying out of pocket won’t be financially feasible.”

Listed below are five questions Sobel recommends asking your employer or insurance provider with a view to determine the extent of your plan’s abortion coverage: 

1. Is abortion covered?

2. Are there any restrictions?

3. Does the deductible apply?

4. Is there cost sharing?

5. Are there out-of-state abortion providers in network? 

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