QUESTION

Does my health insurance plan cover abortion care?

Individuals with coverage | Post enrollment issues | Individual and Marketplace Health Coverage | Individual Health Insurance | Employer-Sponsored Coverage |
ANSWER

Most health insurance plans do not have to cover abortion care, and some are prohibited from covering these services. However, protections and limitations vary across states and health coverage programs:

Medicaid: Due to federal funding restrictions, state Medicaid programs generally only cover abortion in the case of rape, incest, or life endangerment, and some states have imposed further restrictions on coverage and/or delivery of abortion services within the state. A number of states also use state funds to cover “medically necessary” abortions for Medicaid enrollees.

Marketplace plans: Many states restrict coverage of abortion care in Marketplace plans, ranging from limiting coverage to certain scenarios, such as life endangerment, to outright coverage bans. However, several states require Marketplace plans to cover abortion care. Absent a requirement or ban, the insurer can choose whether or not to cover abortion services. Check your plan’s Summary of Benefits and Coverage to find out if abortion services are covered beyond cases of rape, incest, and life endangerment. (42 U.S.C. § 18023(b)(3).)

Other private plans: Non-Marketplace private plans may also be subject to state restrictions or mandates related to abortion coverage. If your plan is not subject to such state requirements, the insurer (or your employer) can decide whether or not to cover abortion services. Reach out to your insurer (or, if you are enrolled in your employer’s health plan, your plan administrator) to find out what services are covered. If you need access to abortion care and your health insurance plan does not cover these services, check to see if there are local or national organizations offering financial assistance. Some clinics also charge for services on a sliding scale, or may have discounts if you are uninsured, a Medicaid enrollee, or otherwise cannot afford the full cost of the procedure.

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