The Supreme Court decision Roe v. Wade could affect health insurance coverage
Abortion rights protesters demonstrate outside the United States Supreme Court as the court rules in the abortion case Dobbs v Women’s Health Organization, overturning the landmark Roe v Wade abortion decision in Washington, USA States, June 24, 2022.
Jim Bourg | Reuters
Even when Roe v. Wade was in effect and that women had the legal right to an abortion no matter where they lived in the United States, health insurance coverage for the procedure was limited.
Many states restrict what plans can cover, and a decades-old state law prohibits the use of federal funds for abortions, which meant women on Medicaid and Medicare were often not covered for terminations. of pregnancy.
With abortion now set to be banned in at least half of states after the landmark ruling protecting women’s right to abortion was overturned by the Supreme Court last week, coverage will only wane, experts say .
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“State-regulated insurers in states where abortion is prohibited will need to drop coverage for abortions to remain compliant with state criminal law,” said Caitlin Donovanspokesperson for the National Patient Advocate Foundation.
Still, women seeking abortion coverage may have options available to them. Although the landscape is changing rapidly, here’s what we know so far.
Medication abortions, which account for more than half of all abortions and include a two-drug regimen of mifepristone and misoprostol, can be used safely within the first 10 weeks of pregnancy and can cost up to $750 without insurance , according to family planning.
A surgical abortion, on the other hand, can last more than $2,000 in the pocket.
Prior to the Supreme Court ruling last week, abortion coverage was still very dependent on where you lived and what kind of plan you had, Donovan said. “Most states impose coverage restrictions to varying degrees.”
eleven states limit abortion coverage in all underwritten private health insurance plans 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, only six the states – California, Illinois, Maine, New York, Oregon and Washington – require abortion coverage, with certain stipulations, in private plans.
The Hyde Amendment, passed in 1976, prevented 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 top up their Medicaid coverage and expand 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 who seek abortion services each year are left without coverage options,” according to a 2019 study. report by the Kaiser Family Foundation.
It will just become more limited, experts say.
If you live in a state like Louisiana or South Dakota, where abortion is now banned, “you probably don’t have any insurance coverage except for rape, incest, or threat to the life of the mother”. Donovan said.
“Some states may not even allow these exceptions,” Donovan added.
However, employers who fund their health insurance policies themselves, meaning they pay most of the costs of claims, may be able to maintain abortion coverage, said Joelle Abramowitz, research assistant at the University of Michigan. Such projects tend to be less regulatedgiving the company more flexibility on the benefits offered.
Donovan recommends calling your plan provider and asking about their abortion coverage. Of course, if abortions are banned in your state, even if you’re covered, you’ll probably have to travel to another state to get one.
Some companies also cover travel expenses for employees who need to leave the state to have an abortion.
If you have abortion coverage, you may need to go”off grid“on your health insurance plan to see a doctor in another state, experts say.
Off-grid coverage is generally less robust, and some health plans, including HMO plans, don’t offer it at all. Abramowitz suggests calling your insurance plan and asking if you get any 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 in-network abortion providers in another state. There could be one just above the state line, for example, Abramowitz said.
You may also be able to see a provider in another state virtually through a telehealth visit to get a medical abortion. In these cases, your medications may be mailed to you or you may be asked to pick them up somewhere.
However, 19 states have previously been prohibited from receiving prescribed medication during a telehealth visit.