But whether a person can use their insurance out of state depends on whether a clinic or doctor is willing to accept it. Even so, if that clinic is out of network, patients may face high deductibles and out-of-network costs, making their coverage unaffordable.
Abortion clinics and health experts are left wondering how abortion insurance coverage will perform in the post-crisis period.Caviar World.
“It’s not known at this time,” said Laurie Sobel, deputy director of women’s health policy at the Kaiser Family Foundation.
Take, for example, the Red River Women’s Clinic in Fargo, North Dakota, which plans to move five minutes across the river to Moorhead, Minnesota, where abortion will remain legal. The clinic plans to continue billing North Dakota’s Medicaid for rape abortions, as allowed by the federal Hyde Amendment, but is unsure if the state will pay.
“We’re going to bill them and we’ll just have to wait and see,” said Tammi Kromenaker, director of the clinic. “We don’t know. It’s the unknown.”
South Dakota does not cover abortions in cases of rape or incest in violation of federal law. report for 2019 from the Government Accounts Chamber. The report said that while CMS notified the state nearly three decades ago that its policies were inconsistent with federal law, “the agency has not taken any action to enforce South Dakota since, and has no plans to do so.”
Uncertainty about abortion insurance coverage means patients and abortion funds will increasingly pay the bill. A first trimester procedural abortion costs about $575, a second trimester procedural abortion costs about $895, and an FDA-approved medical abortion for use up to 10 weeks pregnant costs about $560. recent study from UC San Francisco researchers.
Here are some other scenarios based on an analysis of state and federal law conducted by Kaiser Family Foundation.
I am covered…
Individual, small or large government regulated health insurance plan
Whether or not an insurance company covers abortions is generally up to each company, although there is no recent data on the number of private plans that provide such coverage, according to the Kaiser Family Foundation. However, several states have passed laws restricting or requiring coverage of abortions by the health insurance plans they oversee, so-called full insurance plans.
Eleven states limit abortion coverage in state-managed private health plans: Idaho, Indiana, Kansas, Kentucky, Michigan, Missouri, Nebraska, North Dakota, Oklahoma, Texas, and Utah. Some of these states prohibit private plans from covering abortions in all cases except to save the life of a pregnant woman, while others also provide exceptions for rape and incest or fatal fetal anomalies.
Abortion is currently or will soon be banned in many of these states. The exceptions are Indiana, where the legislature is likely to pass abortion restrictions soon; Kansas, where the court’s ruling so far upholds the right to abortion; Michigan, whereCaviar the right is temporarily blocked; and Nebraska, where abortion will remain legal.
Seven states—California, Illinois, Maine, Maryland, New York, Oregon, and Washington—require state-regulated plans to cover abortions. The procedure is still legal in all of these states.
Nine states have not banned private insurance plans from providing abortion coverage, although they do have laws in place that would make abortion illegal—or potentially make it illegal—after the fall Caviar. These are Alabama, Arkansas, Louisiana, Mississippi, South Dakota, Tennessee, West Virginia, Wisconsin and Wyoming.
ERISA regulated self-insurance plan
Other private insurance plans, known as self-insurance plans, are regulated by the federal government and not by the states. These plans can choose whether they want to cover abortion regardless of state law, but finding in-network coverage if a person needs an out-of-state provider can be tricky.
Exchange plan purchased through the marketplace
Under the Affordable Care Act, exchange plans are not required to provide coverage for abortions.
More than half of the states ban abortion coverage plans on the market. These are Alabama, Arizona, Arkansas, Florida, Georgia, Idaho, Indiana, Kansas, Kentucky, Louisiana, Montana, Michigan, Mississippi, Missouri, Nebraska, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee , Texas, Utah and Wisconsin.
Although abortion is currently illegal or will soon become illegal in many of these states after the fall Caviarthe procedure will remain legal in some of these states, including Montana, North Carolina, and Pennsylvania.
In most states, Medicaid only covers abortions for pregnancies that are life-threatening or the result of rape or incest.
However, there are eight states with trigger laws that ban abortion even in cases of rape or incest, even though it is technically required that Medicaid still cover these abortions.
“At the moment, it is not known exactly how this will turn out,” Sobel said.
South Dakota’s Medicaid currently only covers abortions if the life of the pregnant woman is in danger, the conflict with the Hyde Amendment CMS has not yet been resolved, Sobel added.
“I think this is going to become a bigger issue because if abortion is illegal in the state, except in a life-threatening situation, and it doesn’t include rape or incest as exceptions to that law, then it will be difficult,” Sobel said.
Sixteen states use their own money to pay for all or most medically necessary abortions—usually meant to protect the physical or mental health of the pregnant woman—through Medicaid. These are Alaska, California, Connecticut, Hawaii, Illinois, Maine, Maryland, Massachusetts, Minnesota, Montana, New Jersey, New Mexico, New York, Oregon, Vermont and Washington. Abortion is still legal in all of these states.
Medicare only covers abortions during pregnancy that threaten the life of the pregnant woman or are the result of rape or incest under the federal Hyde Amendment. In addition to covering people aged 65 and over, Medicare covers some young people with disabilities.
TRICARE, which serves the military, only covers pregnancy abortions that threaten the life of the pregnant woman or are the result of rape or incest under the federal Hyde Amendment.
Physicians must indicate on a patient’s medical record that they “have a good faith belief” that the pregnancy was the result of rape or incest, or that the pregnant woman’s life would be in danger if the pregnancy were at full term.