Abortion rights demonstrators protest outside the United States Supreme Court as the court rules in the Dobbs v Women's Health Organization abortion case, overturning the landmark Roe v Wade abortion decision in Washington, U.S., June 24, 2022.
Jim Bourg | Reuters
Even when Roe v. Wade was in effect and women had the legal right to an abortion no matter where they lived in the U.S., health insurance coverage of the procedure was limited.
Many states restrict what plans can cover, and a decadeslong national law bans the use of federal funds for abortions, meaning that women on Medicaid and Medicare were often not covered when it came to pregnancy terminations.
With abortion now expected to be prohibited in at least half the states after the landmark decision protecting women's right to an abortion was overturned by the Supreme Court last week, coverage will only become rarer, experts say.
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"State-regulated insurers in states where abortion is banned will have to drop coverage of abortions to stay in compliance with state criminal law," said Caitlin Donovan, a spokeswoman for the National Patient Advocate Foundation.
Still, women seeking coverage for abortion may have options available to them. Although the landscape is quickly changing, here's what we know as of now.
Medication abortions, which account for over half of all abortions, and include a two-drug regimen of mifepristone and misoprostol, can be safely used within the first 10 weeks of pregnancy, and can cost up to $750 without insurance, according to Planned Parenthood.
A surgical abortion, meanwhile, can run more than $2,000 out of pocket.
Prior to the Supreme Court's decision last week, abortion coverage was still highly dependent on where you lived and what type of plan you had, Donovan said. "Most states impose restrictions on coverage in varying degrees."
Eleven states limit the coverage of abortion in all private health insurance plans written in the state, according to The Guttmacher Institute, a pro-abortion rights research organization. They are Idaho, Indiana, Kansas, Kentucky, Michigan, Missouri, Nebraska, North Dakota, Oklahoma, Texas and Utah.
The Hyde Amendment, passed in 1976, blocked federal funding for services such as Medicaid from being used for abortions, except in limited cases including rape and incest. States can choose to use their own budgets to supplement their Medicaid coverage and extend their abortion policies, but more than 30 states have not done so, Donovan said.
As a result, "in many states, hundreds of thousands of women seeking abortion services annually are left without coverage options," according to a 2019 report by the Kaiser Family Foundation.
If you live in a state such as Louisiana or South Dakota, where abortion is now banned, "you probably don't have any insurance coverage for it at all except in the case of rape, incest or a threat to the mother's life," Donovan said.
"Some states may not even allow those exceptions," Donovan added.
However, employers that self-fund for their health insurance policy, meaning they take on most of the costs of benefit claims, may be able to maintain their abortion coverage, said Joelle Abramowitz, an assistant research scientist at the University of Michigan. Such plans tend to be subject to less regulation, giving the company more flexibility on benefits offered.
Donovan recommends calling your plan provider and asking about its abortion coverage. Of course, if abortions are banned in your state, even if you're covered, you'll likely have to travel to another state to get one.
Some companies are also covering travel expenses for employees who need to leave the state for an abortion.
Out-of-network coverage is typically less robust, and some health plans, including HMO plans, don't offer it at all. Abramowitz suggests calling your insurance plan and asking whether you have out-of-network benefits and how they work.
In some cases, people may find it's cheaper to pay a provider out of pocket than to go through their out-of-network insurance option, Abramowitz said. Many abortion providers work on a sliding scale, she added.
It's also worth asking your insurance plan if there are any in-network abortion providers in another state. There could be one right over the state line, for example, Abramowitz said.
You also may be able to see a provider in another state virtually through a telehealth visit to get a medication abortion. In these cases, your medication can be mailed to you or you'll be asked to pick it up somewhere.
However, 19 states have already made it illegal to receive medication prescribed during a telehealth visit.
After the fall of Roe v. Wade, many companies across the US announced they would cover travel costs for employees seeking out-of-state medical care.
Employer health insurance falls into two categories: fully-insured plans and self-insured plans. A fully-insured plan is when an employer purchases health coverage from a state-regulated insurance company.
By comparison, companies with self-insured plans pay for employees' medical bills directly. Approximately 64% of US workers were covered by self-funded health insurance plans in 2021, according to Statista.
State laws — including those that outlaw insurance providers from covering abortions — can only regulate fully-insured plans. Companies with self-insured plans are "free to make whatever coverage decisions they want," 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 woman may have to travel and [the provider] would have to make clear that that they'll let you go out of network for the care," she said. "But they could certainly cover it."
Currently, only eleven US states have laws that prohibit abortion coverage from being included in fully-funded private insurance policies, according to health policy nonprofit KFF.
"So there are some states that will ban abortion, but that 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.
When it comes to federally-funded health insurance, coverage is only offered in very specific cases. Due to the Hyde amendment, federal funds can't be used to pay for abortions. That means Medicaid is unable to cover abortions unless the pregnancy is life-threatening or resulted from rape or incest.
Questions to ask your employer or insurance provider in the post-Roe era
While employers have largely focused on travel costs in their corporate responses to the fall of Roe v Wade, there are other logistical hurdles companies need to consider in order to ensure their employees have access to out-of-state care, Sobel told Insider.
"It's important to look at the structure of the plan. So what is the deductible? What is the copay? What is the network?" she said. "If abortion is now illegal in the state that you reside in, then there needs to be some contract with the clinic out of state."
If the out-of-state abortion provider is not in-network, the deductible could be more expensive than the procedure itself, she explained.
"Even employers who have the best of intentions and are trying to cover this, it will be challenging just to make it actually work in a way that the person doesn't have to pay out of pocket," Sobel added. "For many workers, paying out of pocket won't be financially feasible."
Here are five questions Sobel recommends asking your employer or insurance provider in order 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?
Governor Tom Wolf is urging Congress to take action to preserve Affordable Care Act (ACA) subsidies to ensure that individuals and families who were eligible for this important subsidy may continue to obtain health care.
In a joint letter, Gov. Wolf and 13 other governors urged Congress to take action and ensure funding is in place to preserve ACA subsidies known as advanced premium tax credits (APTCs), which were expanded through the American Rescue Plan Act of 2021. The ARPA-expanded subsidy eligibility is set to expire at the end of the current plan year, leaving consumers exposed to dramatic premium increases.
“Tens of thousands of Pennsylvanians will be impacted if this subsidy expansion expires in December, which will mean their insurance premiums will increase, putting individuals in a health and financial risk. It’s critical that we continue to make affordable coverage as accessible as possible to as many as possible, and I applaud President Joe Biden for his leadership to not only expand coverage as part of ARPA, but also to make it permanent,” Gov. Wolf said. “I urge Congress to make these subsidies permanent so that Pennsylvanians can continue to have a better quality of life through affordable comprehensive ACA coverage.”
Governor Wolf has made access to affordable health coverage a priority throughout his administration.
In July 2019, Governor Wolf signed legislation establishing Pennie, the state-based ACA marketplace. Pennie replaces healthcare.gov as Pennsylvania’s official destination for shopping for quality health insurance plans and the only source of financial assistance to help with the cost of coverage and care. Currently there are nearly 360,000 Pennie customers throughout the commonwealth.
In addition to Pennie, Governor Wolf expanded Medicaid in 2015 — one of his first acts as governor — ensuring more Pennsylvanians have access to Medical Assistance in Pennsylvania. Today, more than 3.3 million Pennsylvanians are covered by Medical Assistance including almost 1 million people through the expansion. By expanding access to health care, the commonwealth realized the lowest uninsured rate in Pennsylvania history during the Wolf Administration and insurance rates are now the most stable year over year than they’ve ever been.
View a copy of the letter:
As governors, we are working to expand access to quality, affordable healthcare for the people of our states. Since the beginning of the pandemic, we have seen the tragic impact of disease and illness among the uninsured and underinsured, particularly in communities of color and other underserved populations. As we have experienced during the COVID-19 pandemic, access to affordable health insurance can sometimes mean the difference between life or death. At a time when governments at all levels are struggling to find ways to reduce costs for the American people, we cannot allow the looming specter of rising health costs to cause more uncertainty and stress for American families. Therefore, we urge you to take action and ensure funding is in place to preserve Affordable Care Act (ACA) subsidies known as advanced premium tax credits (APTCs).
We applaud Congress for the passage of the American Rescue Plan Act of 2021 (ARP), which expanded and enhanced ACA APTCs. The ARP’s expansion of subsidies, along with the Biden Administration’s investment in marketing and enrollment support, led to a record high 14.5 million people signing up for ACA coverage during the most recent open enrollment period, a 21 percent increase from the prior year.
Health insurance coverage is critical to ensure consumers have access to healthcare and the best way to increase enrollment is to make coverage more affordable. The ARP has lowered costs for consumers: families saved an average of $200 a month in premiums, with four out of five consumers eligible to obtain a plan for $10 or less. The ARP expanded access to financial assistance and increased the number of consumers eligible for subsidies by 2.8 million in 2022 compared to the prior year.3 With the Biden Administration’s reinvestment in the ACA and the proposed rulemaking to fix the “Family Glitch,” we have a historic opportunity to build upon these enrollment gains and affordability improvements next year and in years to come.
Unfortunately, the ARP-expanded subsidy eligibility is set to expire at the end of the current plan year, leaving consumers exposed to dramatic premium increases, and threatening the progress we have made. As inflation continues to put a strain on consumers’ budgets, we are concerned that many people will choose to reduce health insurance coverage or even go without coverage if Congress fails to act. The Biden Administration estimates that approximately 3.4 million consumers currently enrolled could lose coverage if the ARP subsidy expansions expire at the end of 2022. The expiration of the enhanced subsidies would also lead to a decrease in enrollment and an increase in premiums, destabilizing health insurance markets, and impacting affordability for the broader population. Additionally, as the Public Health Emergency is expected to end in the coming months, some consumers will no longer be eligible for Medicaid but may become eligible for ACA subsidies. Without the enhanced subsidies to ensure there are affordable marketplace options, those consumers are likely to become uninsured.
Healthcare is a right—not a privilege. The ARP greatly improved health insurance affordability to ensure lifesaving healthcare is accessible to all Americans. We urge you to take action immediately to make the ARP expanded subsidies permanent to prevent a disastrous erosion of health insurance coverage.