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HEALTH Insurance
HEALTH INSURANCE INSIGHTS

Whether your health insurance covers an abortion procedure depends on the state laws and type of plan.

If you or someone you love has an unwanted pregnancy, you may be considering an abortion procedure. This can be expensive if you have to pay out-of-pocket, which begs the question: Does health insurance cover abortions?

Some health insurance plans cover abortions. However, it depends on state laws and the type of insurance plan, including Medicaid, an Affordable Care Act (ACA) marketplace (Obamacare) plan or private insurance.

The regulations and limits vary by state. Learn more about your options, which insurance companies cover abortion and how much and abortion is with insurance.

KEY TAKEAWAYS
  • Abortion regulations vary by state and health plan.
  • Half of U.S. states ban abortion coverage in at least some private insurance plans. 
  • Only six states require coverage in all private plans: California, Illinois, Maine, New York, Oregon, and Washington.
  • Twenty states limit abortion coverage to cases that involve exceptions such issues as life endangerment, rape, incest and fetal abnormality.

Does health insurance cover abortions?

An abortion procedure, including a medication abortion (the abortion pill) and a surgical abortion, may or may not be covered by your health insurance plan. The answer depends on your state's reproductive health care laws and restrictions, the type of health insurance, insurance company policies and the timeframe of the pregnancy. Some states restrict abortion, while others allow women to have access to abortion procedures depending on the situation.

"Regulations governing health insurance coverage for abortions vary by state. In some states, insurance coverage for abortion -- including Medicaid coverage -- is quite limited, allowing coverage only in situations where the mother's life is in danger. In other states, coverage is less restrictive," says Brian Martucci, the Minneapolis-based finance editor for Money Crashers.

According to the Guttmacher Institute:

  • Half of all states currently ban abortion coverage in at least some private insurance health plans. Only six states require coverage in all private insurance policies: California, Illinois, Maine, New York, Oregon, and Washington.
  • 25 states ban abortion coverage and plans offered through health insurance exchanges.
  • 20 states limit coverage to cases involving only one or more of the following exceptions: life endangerment, threat to the pregnant person's health, rape, incest, fetal abnormality, and "substantial and irreversible impairment of a major bodily function."
  • 22 states restrict insurance coverage of abortion for public employees in health insurance plans.

ACA marketplace plans may or may not cover abortion services. In more than half the states, health insurance plans sold in the exchange aren’t allowed to cover abortions except for circumstances involving rape, incest, or the mother's life being in danger.

The Guttmacher Institute says Medicaid only provides insurance coverage of abortion within 33 states and the District of Columbia in instances of rape, incest, or life endangerment. South Dakota restricts public abortion coverage to cases of life endangerment. The other states utilize their own Medicaid funds to offer coverage that applies to most or all medically necessary abortions.

Find out the specifics of your state’s abortion restrictions and laws.

Also, on the federal government level, the Hyde Amendment is a Congressional provision that bars using federal funds to pay for abortions except to save the life of the mother or if the pregnancy was the result of rape or incest.

How much is an abortion with insurance?

If you have insurance that covers an abortion procedure, you can count on paying anywhere from nothing to a few hundred dollars out of pocket, depending on the type of procedure and your policy's copay or coinsurance requirements, explains Martucci.

"Patients without insurance coverage can expect to pay upwards of $1,000 -- perhaps significantly more -- for a surgical abortion later in pregnancy, or a few hundred dollars for a medical or surgical abortion earlier in pregnancy. These costs will vary by provider, state, and other factors," he adds.

Without insurance, a medical abortion (effective only within a pregnancy's first 10 weeks) can likely cost between $300 and $700, and a surgical abortion (after the first 10 weeks) can cost more than $3,000.

The Kaiser Family Foundation reports that the median cost of an abortion is $500 at 10 weeks gestation versus $1,195 at 20 weeks of pregnancy.

Organizations like Planned Parenthood also offer services at no to low cost if you qualify. Contact Planned Parenthood health centers for more information about those options.

Health insurance companies that provide abortion coverage

Many health insurance companies provide coverage for abortion services if state laws allow it and if the insurer chooses to cover these services.

Top carriers that may offer abortion services (depending on the reason for the procedure, your location, the type of plan/policy, and other factors) include Blue Cross Blue Shield, Cigna, and UnitedHealthcare.

"If you are currently insured, refer to your policy's plan documents for more details about what it will and won't cover. And if you are shopping for health insurance on the marketplace or elsewhere, scrutinize plans and insurance companies for information about abortion coverage they offer," recommends Martucci.

How are abortions paid for?

If you have health insurance that covers abortion services and live in a state that allows for this coverage and the services, you can have an abortion procedure done and submit a claim for the costs through your insurance company.

"The process for submitting abortion procedure claims is broadly similar to insurance claim submissions for other types of procedures," notes Martucci. "What happens next -- the extent to which the insurer will review, verify, and reimburse your claim -- will vary significantly based on the company, the provider, and your plan."

Frequently Asked Questions

Can you get an abortion without insurance?

Yes, you can have an abortion procedure done if you lack health insurance coverage and your state allows it. But be prepared to pay out-of-pocket costs that can be a lot more expensive than if you had insurance coverage for these services.

Does Medicaid pay for abortions?

Medicaid covers most or all medically necessary abortions in 16 states. However, in 33 states and the District of Columbia, Medicaid will only provide abortion coverage in instances of rape, incest, or life endangerment. South Dakota restricts public abortion coverage to cases of life endangerment.

Does Blue Cross Blue Shield PPO cover abortion?

Blue Cross Blue Shield PPO will cover some abortion services in certain states, depending on the plan and reason for the procedure.

Does Cigna insurance cover abortion?

Cigna will cover some abortion services in certain states, depending on the plan and reason for the procedure.

Does UnitedHealthcare cover abortion?

UnitedHealthcare will cover some abortion services in certain states, depending on the plan and reason for the procedure.

Does Medicaid cover abortions in Texas?

No. Texas will not pay for abortions via its Medicaid program, except in limited circumstances such as incest or rape.

Will an abortion show up on insurance?

If you have an abortion procedure done and submit an allowable claim through your insurance company, that claim should be reviewed, verified, and reimbursed to the extent indicated in your policy.

Does insurance cover the abortion pill?

Depending on your plan, the state you live in, the reason for the procedure, and how far along the pregnancy is, your health care insurance may cover the abortion pill (also called a medical abortion).

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