Potential Roe v. Wade decision reveals major differences in abortion health insurance rules – InsuranceNewsNet
Regardless of a
Insurance coverage for abortions was not required or prohibited by the Affordable Care Act. However, states have created their own rules and regulations regarding abortion insurance — and those rules vary widely.
“States took their own steps to regulate health insurance coverage for abortions long before the current Roe v. Wade could fall,” Norris said. “States that are most likely to ban abortion are already banning abortion coverage from ACA-compliant health plans.”
Here is the breakdown of government approaches:
- 25 states prohibit or limit abortion coverage by health plans offered through ACA health insurance exchanges. Of these states, all but two (
Louisianaand Tennessee) have an exception that allows insurance cover in the event of danger to life. Many states also have exceptions that allow coverage for abortion services in cases of rape and incest or other special circumstances.
- As of last year, however, there were 26 states with restrictions on health insurance for abortions
Virginiaenacted legislation to lift the ban in 2021.
- In most of the other 25 states, insurance carriers determine whether their plans include abortion insurance.
- Six States –
Oregon, new York, California, Washington, Illinoisand Maine– all state-regulated health insurance companies are obliged to cover abortions. In three of these states – Oregon, new Yorkand Illinois– The health insurance company must fully cover the costs, while the health insurance companies in the other three states may require the member to pay their normal deductible, co-payments and co-insurances.
As the ACA increased access to affordable, long-acting contraception, abortion rates fell.
Under the ACA, women (and their partners) have access to contraception at no additional cost. These include birth control methods such as IUDs (intrauterine devices), implants and tubal ligations, which are highly effective but would have prohibitively high upfront costs if not covered by insurance.
Studies in Michigan and
Unlike abortion insurance, the ACA mandates health insurance coverage for birth control; As a result, this coverage is more consistent from state to state. The ACA and subsequent regulations require non-grandfathered health plans to cover a wide range of preventive services for women, including FDA-approved birth control and sterilization procedures.
“That doesn’t mean every female birth control option is offered for free,” Norris said. “Rather, it means that at least one version of each type of contraceptive is covered at no additional cost to the patient.”
There are some exceptions. A 2014
“The landscape for women’s health insurance coverage has changed drastically since the inception of the ACA, and it’s changing all the time,” Norris said. “Understanding what insurance benefits you can use is something you have to think about every year you buy health insurance. People often don’t know what their insurance covers until they are considering a specific healthcare service or drug.”
Consumers curious about the impact of abortion on health insurance can visit healthinsurance.org for details on insurance regulations in their state. The site, a collection of articles on individual health insurance, contains a collection of articles explaining how reproductive health is covered by different types of health insurance and a country-specific overview of coverage limitations.
Health Insurance.org provides free online resources for consumers, including information about individual health plans, major health plans, and affordable health plans.
healthinsurance.org [email protected]