Will your health plan pay for an abortion now that the Supreme Court has changed it? Roe v. Wade?
Even before the June 24 decision, abortion insurance was very different. Now the issue is even more complicated as countries adopt different laws – about half are expected to limit or ban abortion almost always.
Abortion is legal in Pennsylvania up to 24 weeks of pregnancy. New Jersey has legalized abortion rights and in June passed legislation establishing the state as a “safe haven” for abortion patients.
To be clear, the question of whether an insurance policy covers abortion is not the same as whether abortion is legal in the state. Monitoring issues are complex and driven by a variety of factors, including the number of abortions a state allows.
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How dense is the forest? Abortion can be covered by the health system, but if there are no providers, patients are out of luck. People with insurance that doesn’t cover abortion can still get one if it’s available in their state or they can afford to travel and pay out of pocket. It is also unclear whether states that ban abortion will have the ability to mandate abortion in employer plans.
These issues can be in the courts for years.
“Governments will make laws, there will be disputes, and then it will go to the courts,” he said Erin Fuse Brown, director of the Center for Law, Health & Society at Georgia State University College of Law. “It might be a while.”
In the meantime, here are the answers to three questions that many people ask.
The simple answer is “no.”
Whether he does is very difficult.
Some employer-based health plans cover elective abortions. Patients can check their plan documents or call their insurers directly to check.
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The need also exists in self-insured employer-provided plans because federal pension law generally prohibits government control over health plans. Self-employed workers, who tend to be seniors, pay for medical expenses.
However, millions of Americans work for small employers, who prefer to buy plans directly from health insurers, who pay for medical expenses. Those plans, known as “universal insurance,” are governed by state laws, whose abortion policies have varied.
Eleven countries cancel their privacy plans Abortions are common, according to the Kaiser Family Foundation, although some states allow consumers to purchase insurance that will cover the cost of an abortion.
If you are not sure which health plan you have, ask the administrator.
“There’s no way to tell on the face of your insurance card whether you have insurance or coverage,” said Fuse Brown.
For the more than 14 million Americans who buy their products through the Affordable Care Act’s marketplaces, where they live matters.
Twenty-six states, including Pennsylvania, prohibit it Abortion in ACA plans, where seven countries need it as a benefit plan, according to KFF. New Jersey is among a dozen states that do not prohibit abortion coverage in ACA plans, and has one plan to provide such coverage.
Medicaid laws, a federal-state health care program for low-income people, it also varies. Thirty-four states, including Pennsylvania, and the District of Columbia adhere to the so-called Hyde Amendment, which prohibits federal funds from paying for abortions, except for rape or sex with a family member or to save the life of the woman. New Jersey is among the few states where Medicaid pays for all or medically necessary abortions, according to KFF.
Insurance policies should cover essential health care, including essential medical care during pregnancy and abortion by carrying the pregnancy to term can endanger the patient’s life.
Under the Pregnancy Discrimination Act of 1978 and other laws, Fuse Brown said, “pregnancy care, including pregnancy, and special care must be paid.”
In an ectopic pregnancy – when the fertilized egg goes outside the uterus – the fetus cannot function, and the condition is often life-threatening for the mother without medical treatment.
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Although all current state laws prohibiting abortion include the termination of a woman’s life, the risks to life are not always known. This means that doctors in countries that prohibit abortion may have to weigh the medical risk of the pregnant woman against the legal consequences.
“This is less of a question and a bigger question of whether providers in states that prohibit abortion will provide care,” he said. Katie Keithmember of the research team at the Center on Health Insurance Reforms at Georgetown University.
In recent weeks, many employers — including Microsoft, Bank of America, Disney, and Netflix — have said they will help pay for travel expenses so workers or other beneficiaries in states with restrictions can get abortions elsewhere.
But it’s not as straightforward as it sounds. Employers need to know if employees do get this benefit through a health plan or other reimbursement method. Privacy protection, too, can be a problem. Some advisers suggested that employers need to consider whether their return policy is inconsistent with other laws.
For example, if an employer pays for abortion visits but not for an eating disorder clinic, does that violate the abortion law? Mental Health Parity and Addiction Equity Act? If a plan does not have providers willing or able to perform abortions, does it violate any state or federal network adequacy laws?
Lawmakers need to consider these conflicts, said Jessica Waltman, vice president of employee benefits at MZQ Consulting. “They could be putting all the employer group plans in their state in serious jeopardy if the state law prevents them from complying with the state law,” he said, especially if it restricts access to benefits required by the Regency Discrimination Act.
There are some potential conflicts if the employer is in a state that allows abortion but the employee is in a state that prohibits it, he said. Renee Thorneprincipal at Jackson Lewis, where he handles litigation involving insurance companies.
It is also unclear whether federal laws will target insurers, employers, or others who provide benefits, including travel or television, for abortion services.
Laws that prohibit abortion, Thorne wrote in a white paper for customers, usually work for medical professionals and sometimes those who “support or facilitate” abortion. Some states, including Texas, allow private citizens to sue for up to $10,000 against anyone who provides an illegal abortion or assists in an abortion.
Non-member health plans, their employers, and plan administrators have been in a position to face lawsuits over the benefits of the plans, he said. Seth Perrettaprincipal of Groom Law Group, which advises employers.
He said: “We are in an area where we have never preached before.
Kaiser Health News is a national news outlet that covers health issues.