When does health insurance cover abortions?
Following the Supreme Court’s overturning of Roe v. Wade last week, Americans who live in areas that ban abortion must now travel out of state in order to receive the medical care they seek.
In addition to the financial burden created by travel alone, abortions can cost anywhere from $350 to over $1,500. But depending on the state you live in and your insurer, health insurance may cover part or all of the bill.
Insider spoke with two health policy experts to find out which insurance plans cover abortion and questions to ask your provider in the post-Roe era.
What types of insurance plans cover abortion?
After the fall of Roe c. Wade, many companies across the United States have announced that they will cover travel expenses 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.
In comparison, companies with self-insured plans pay employees’ medical bills directly. About 64% of American workers were covered by self-funded health insurance plans in 2021, according to Statista.
State laws, including those that prohibit insurers 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 JD, a professor and founding chair of health law and policy at the school of health, told Insider. public at George Washington University.
“The woman may have to travel and [the provider] will have to specify that they will let you out of the network for care,” she said. “But they could definitely cover it.
Currently, only eleven US states have laws that prohibit the inclusion of abortion coverage in fully funded private insurance policies, according to health policy nonprofit KFF.
“So there are states that will ban abortion, but haven’t banned coverage,” Laurie Sobel, associate director of women’s health policy at KFF, told Insider, adding that it’s ” probably a matter of time” before those states ban insurance. cover as well.
With respect to federally funded health insurance, coverage is only offered in very specific cases. Due to the Hyde Amendment, federal funds cannot be used to pay for abortions. This means that Medicaid is unable to cover abortions unless the pregnancy is life-threatening or results from rape or incest.
Questions to Ask Your Employer or Insurer 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’s the deductible? What’s the copayment? What’s the network?” she says. “If abortion is now illegal in the state where you reside, then there must be a contract with the out-of-state clinic.”
If the out-of-state abortion provider isn’t part of the network, the franchise could be more expensive than the procedure itself, she explained.
“Even employers who have the best intentions and try to cover this up, it will be difficult to make it work in a way that the person doesn’t have to pay out of pocket,” Sobel added. “For many workers, paying out of pocket will not be financially feasible.”
Here are five questions Sobel recommends asking your employer or insurer 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 the network?