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Even when Roe v. Wade was in effect and women had the legal right to an abortion no matter where they lived in the US, 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 banned 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 rapidly changing, here’s what we know as of now.
How much does an abortion cost?
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.
How did coverage of abortions work before?
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.
Meanwhile, just six states – California, Illinois, Maine, New York, Oregon and Washington – require abortion coverage, with some stipulations, on private plans.
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.
How will coverage now change?
It will just get more limited, experts say.
If you live in a state such as Louisiana or South Dakota, where abortion is now banned, “you probably do not 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.
What about leaving my state for an abortion?
If you have abortion coverage, you may need to go “out of network” on your health insurance plan to see a doctor in another state, experts say.
Out-of-network coverage is typically less robust, and some health plans, including HMO plans, do not 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 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.
How can I get financial help?
A growing number of resources are available to help people with the financial costs of an abortion.
Information about those options can be found at AbortionFinder.org. There’s also a national network of abortion funds.