Will health insurers continue to cover abortion now that Roe has been overturned?
But whether a person can use their insurance out of state depends on whether a clinic or doctor is willing to accept it. Even then, unless that clinic is in-network, patients can face high deductibles and out-of-network fees that make their coverage prohibitively expensive.
It leaves abortion clinics and health experts grappling with how insurance coverage for abortion will work in a post-roe world.
“It’s an unknown at this point,” said Laurie Sobel, associate director for women’s health policy at the Kaiser Family Foundation.
Take the Red River Women’s Clinic in Fargo, ND, which has plans to move five minutes across the river to Moorhead, Minnesota, where abortion will remain legal. The clinic plans to continue billing North Dakota Medicaid for abortions due to rape, as allowed under the federal Hyde amendment, but isn’t sure if the state will pay.
“We’re going to bill them, and we’ll just have to wait and see,” said Tammi Kromenaker, the clinic’s director. ‘We do not know. That is the unknown.”
South Dakota does not cover abortions in cases of rape or incest in violation of federal law, according to: a report from 2019 of the Accountability Office of the National Government. The report found that although CMS notified the state nearly three decades ago that its policies were inconsistent with federal law, “the agency has since taken no action to ensure South Dakota’s compliance, and also has no plans to do so.”
The uncertainty surrounding abortion insurance coverage means it will increasingly be up to patients and abortion funds to foot the bill. A procedural abortion in the first trimester costs about $575, a procedural abortion in the second trimester costs about $895, and drug abortion, approved by the FDA for use up to 10 weeks gestation, costs about $560, according to a recent study from researchers at the University of California, San Francisco.
Here are some other scenarios based on an analysis of state and federal law by: the Kaiser Family Foundation†
I am covered under…
An individual, small group, or large group health plan regulated by the state
Whether an insurer will cover abortion is generally up to each company, although there is no recent data on the number of private plans that offer such coverage, according to the Kaiser Family Foundation. However, several states have passed laws limiting or requiring abortion coverage for the health insurance plans they oversee, called fully insured plans.
Eleven states restrict abortion coverage in state-regulated private health insurance plans: Idaho, Indiana, Kansas, Kentucky, Michigan, Missouri, Nebraska, North Dakota, Oklahoma, Texas, and Utah. Some of those states prohibit private plans to cover abortion in all cases except to save the life of the pregnant person, while others also include exceptions for rape and incest or fatal fetal abnormalities.
Abortion is now illegal or will soon be illegal in many of those states. The exceptions are Indiana, where lawmakers are likely to pass abortion restrictions soon; Kansas, where a court order protects abortion rights for the time being; Michigan, where the state pre-roe the law is temporarily blocked; and Nebraska, where abortion will remain legal.
Seven states — California, Illinois, Maine, Maryland, New York, Oregon and Washington — require state-regulated plans to cover abortions. The procedure is still legal in all those states.
Nine states haven’t blocked private insurance plans from providing abortion coverage, though they do have laws on the books that would make abortion illegal — or potentially illegal — after the fall of roe† They are Alabama, Arkansas, Louisiana, Mississippi, South Dakota, Tennessee, West Virginia, Wisconsin, and Wyoming.
A confident health plan regulated by ERISA
Other private insurance plans, also known as self-insured plans, are regulated by the federal government — not the states. Those plans can choose whether to cover abortion regardless of state law, but finding in-network coverage if an individual needs an outside provider can be challenging.
Bought an exchange plan through the marketplace
Exchange plans are not required to provide abortion coverage under the Affordable Care Act.
More than half of the states ban abortion plans sold on the market. They are Alabama, Arizona, Arkansas, Florida, Georgia, Idaho, Indiana, Kansas, Kentucky, Louisiana, Montana, Michigan, Mississippi, Missouri, Nebraska, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah and Wisconsin.
While abortion is now illegal or will soon be illegal in many of those states after the fall of roethe procedure remains legal in some of those states, including Montana, North Carolina and Pennsylvania.
In most states, Medicaid only covers abortions in pregnancies that endanger the life of the pregnant person or are the result of rape or incest.
However, there are eight states with trigger laws that prohibit abortions, even in cases of rape or incest, although Medicaid is technically required to still cover those abortions.
“It is not yet known exactly how that will play out,” Sobel said.
South Dakota Medicaid currently only covers abortions if the pregnant person’s life is at risk, a conflict with the Hyde amendment CMS has yet to be resolved, Sobel added.
“I think this is going to be a bigger problem because if abortion is illegal in the state, except in the case of life-threatening situations, and rape or incest isn’t included as exceptions to that law, that’s going to be tricky,” Sobel said. †
Sixteen states use their own money to pay for all or most medically necessary abortions through Medicaid — mostly, meaning they’re necessary to protect the pregnant person’s physical or mental health. They are Alaska, California, Connecticut, Hawaii, Illinois, Maine, Maryland, Massachusetts, Minnesota, Montana, New Jersey, New Mexico, New York, Oregon, Vermont, and Washington. In all those states, abortion is still legal.
Medicare only covers abortions in pregnancies that endanger the life of the pregnant person or are the result of rape or incest under the federal Hyde amendment. In addition to covering people 65 and older, Medicare covers certain younger people with disabilities.
TRICARE, which serves the military, only covers abortions in pregnancies that endanger the life of the pregnant person or are the result of rape or incest under the federal Hyde amendment.
Physicians must note in the patient’s medical record that they believe “in good faith” that the pregnancy was the result of rape or incest or that the pregnant person’s life would have been in danger if the pregnancy went to full term.