When is an abortion covered by medical insurance?


Abortion rights advocates display outside of the US Supreme Court a day after the Supreme Courts overturning of Roe v. Wade in Washington, DC on June 25, 2022.Craig Hudson for The Washington Post via Getty Images

  • Whether or not abortions are covered by medical insurance depends upon your plan type and state laws.

  • Many businesses have said they may cover travel costs for staff searching for out-of-state medical care.

  • Here’s how one can determine in case your insurance plan covers abortion now that Roe v. Wade is overturned.

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 to be able 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 insurance can cover some or all the bill.

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

Which kinds of insurance coverage cover abortion? 

State policies on abortion health insurance coverage.

State policies on abortion medical insurance coverage.

State policies on abortion medical insurance coverage.KFF

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

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

By comparison, firms with self-insured plans pay for workers’ medical bills directly. Roughly 64% of US staff were covered by self-funded medical insurance plans in 2021, in response to Statista.

State laws — including people who outlaw insurance providers from covering abortions — can only regulate fully-insured plans. Firms 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 lady can have to travel and [the provider] would need to clarify that that they will allow you to exit of network for the care,” she said. “But they might definitely cover it.”

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Currently, only eleven US states have laws that prohibit abortion coverage from being included in fully-funded private insurance policies, in response to 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.

On the subject of federally-funded medical insurance, coverage is simply offered in very specific cases. As a result 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 firms need to contemplate to be able to ensure their employees have access to out-of-state care, Sobel told Insider.

“It is vital to take 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 just isn’t in-network, the deductible might be costlier than the procedure itself, she explained.

“Even employers who’ve the very best of intentions and try to cover this, it should be difficult simply to make it actually work in a way that the person doesn’t need to pay out of pocket,” Sobel added. “For a lot of staff, paying out of pocket won’t be financially feasible.”

Listed here are five questions Sobel recommends asking your employer or insurance provider to be able 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?

Read the unique article on Business Insider


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