Does Health Insurance Cover Abortion?

Editor’s Note: We receive a commission from affiliate links on Forbes Advisor. Commissions do not influence the opinions or evaluations of our editors.

In a recent landmark decision, the United States Supreme Court voted that Roe v. Wade should remove abortion rights from the state. As a result of the Supreme Court’s decision, abortion will be illegal in 26 countries, including countries that previously had age restrictions.

Even in countries where women’s abortion rights have not been changed, health insurance does not always cover the procedure. Whether or not an abortion is covered by health insurance depends on the state, the type of plan and the woman’s circumstances.

Will an Employer’s Health Insurance Plan Cover Abortion?

Whether or not an employer’s health plan covers abortion depends on where you live and what type of health insurance you have.

Some employer-sponsored health insurance plans offer abortion coverage. If you live in a state where abortion coverage is legally required for full coverage, employer-sponsored health insurance will cover the abortion.

But employers who offer self-employment plans are not required to comply with state insurance laws. Self-funded plans, also called self-insurance, are a type of plan in which the employer is responsible for all or most of the benefits. These employers may choose not to provide abortion services or limit the exposure to certain situations, such as rape or endangering the life of a pregnant woman.

Data show that self-funded plans, which do not require coverage for abortions, are more common than plans with insurance. According to the Kaiser Family Foundation (KFF), about 60% of private sector workers have a self-funded plan. This means that many women do not have abortion coverage under their group insurance.

Research also shows that small companies are more likely to provide abortion care under the employer’s health insurance policy than large companies. KFF found that about 17% of large companies with 5,000 or more employees offer a health plan that prohibits coverage of abortions, compared to only 3% of small companies with fewer than 199 employees.

Will ACA Plans Through the Federal Government or State Exchanges Cover Abortions?

Whether the Affordable Care Act (ACA) covers abortion depends on where you live.
There are 25 states that currently prohibit abortion coverage for ACA health insurance plans purchased through federal or state exchanges. Of these countries, most allow abortion coverage only in special circumstances.

For example, seven countries limit the coverage of abortion to cases of danger to the life of the woman and nine countries limit the risk to life, rape and sexual intercourse. Only two states — Louisiana and Tennessee — ban abortions entirely under ACA plans.

The only states that require ACA insurance plans to cover abortions are:

  • California
  • Illinois
  • Maine
  • Maryland
  • new York
  • Oregon
  • Washington

A few states have no restrictions or prohibitions against abortion but do not require state reforms to provide abortion services.

Is There Cost Sharing Even If My Health Insurance Covers Abortion Services?

Some health insurance plans cover abortion and do not mandate co-payments, but this depends on your state. California, Illinois, Maryland, New York and Oregon have laws prohibiting cost-sharing for state-run health plans that cover abortion.

If you live in one of these states and your health insurance covers abortion services, there is no deductible, reimbursement or coinsurance for abortion. However, 45 other states do not have laws against cost-sharing for abortions, even if your health insurance plan covers the policy.

How Much Does Health Insurance Cost for Abortion?

The average cost of an abortion is $560, according to Health Affairs, a peer-reviewed medical journal. This can be used for the first 10 weeks of pregnancy. The average cost of a first trimester abortion is $575 and the average cost of a second trimester abortion is $895.
The actual cost of an abortion with health insurance depends on a number of factors, including your state, health insurance plan, location and type of abortion.

Depending on your health insurance policy, the cost of an abortion with insurance can be as low as $0, especially in countries that prohibit co-payments for abortion services. If your health insurance plan pays less, however, you may pay higher out-of-pocket costs.

What Is the Hyde Amendment and How Does It Affect Health Insurance?

The Hyde’s transformationpassed by Congress in 1973, it prohibits federal funds from being used for elective abortions, unless they involve rape, sexual intercourse or endangerment of life.

As a result, the Hyde Amendment reduced state funding for abortion through federal programs such as Medicaid, the Children’s Health Insurance Program (CHIP) and the Indian Health Service.

Women who receive Medicaid health insurance are directly affected by the Hyde Amendment because Medicaid is funded by federal funds. Most states follow the Hyde Amendment, which means that abortion is not covered by Medicaid.

There are 16 states that pay for abortions under Medicaid, using federal funds:

  • Alaska
  • California
  • Connecticut
  • Hawaii
  • Illinois
  • Maryland
  • Maine
  • Massachusetts
  • Minnesota
  • New Jersey
  • new York
  • Montana
  • New Mexico
  • Oregon
  • Washington
  • Vermont

Can Health Plans Require Referrals for Abortion Services?

You don’t need to be referred for an abortion, regardless of your health insurance plan, in most cases. Most women can make an appointment with a gynecologist or an abortion clinic, such as Planned Parenthood, without a referral from their primary care physician. If you are looking for abortion referrals, your doctor can provide you with a list of providers in your area.

Does Health Insurance Cover Abortion Pills?

The plan will pay for abortion pills if your health insurance plan pays for abortion services and your condition is covered. Your health insurance company will pay some or all of the cost of the medication, but you may be responsible for paying out-of-pocket costs, including co-pays.

However, if your health insurance plan does not cover abortion, your plan will not cover the cost of abortion pills. In that case, you have to pay the full amount out of pocket, if you live in an area where abortion is legal.