Does Private Insurance Cover Abortion?

Zöe Colòn

11/6/2024

It’s hard to find a straightforward answer on how much abortion costs. Health care is complicated but to make matters worse most online sources are more concerned with dragging you into the politics of abortion than giving you honest, practical information.

Here is the simple answer. Private insurance coverage of abortion is dependent upon two things:

1. State Laws
2. Your Insurance Company Policy

Even in states where there are no restrictions on private coverage of abortion, not all health insurance policies choose to cover it. Health insurance plans that you can purchase through your university if you are a college or graduate student may or may not cover abortion as well.

Without insurance, the average cost of medical abortions (abortions initiated by prescribed medication taken up to 10 weeks of pregnancy) is between $300-$500. A surgical abortion (an in-office procedure that may require anesthesia) can cost $1500-$3000 or more depending on the stage of pregnancy. Check out She Might’s articles on the different types of abortion and their associated costs so you know what to expect as you explore your pregnancy options.

This article will help you figure out whether your insurance plan covers abortion, and if it does, what costs to generally expect.

What are the laws on insurance coverage for abortion in my state?

Certain states require all private insurance plans to offer insurance coverage for abortion.

Most states have no restrictions on what private health plans can provide for abortion coverage. However, some states restrict private insurance to only cover abortion in specific circumstances, such as rape, incest, fetal impairment, or to protect the life of the mother. These states include Idaho, Indiana, Kansas, Kentucky, Missouri, Nebraska, North Dakota, Oklahoma, Texas, and Utah. For more information check out this 

interactive table from the Kaiser Family Foundation that illustrates the states policies on abortion coverage including Medicaid, Private Insurance and AC Marketplace. 

Even in states where private insurance is banned from covering abortion, the majority do allow individuals to purchase supplementary coverage for abortion, known as an “abortion rider”. However, these riders are few and far between.

Insurance restrictions based on gestational limits

State laws also govern restrictions on the gestational limits for abortion procedures to take place, which will consequently affect your insurance coverage and costs. If you are trying to have an abortion past your state’s limit, you may have to look for care outside your state, which will increase travel costs and may make it harder to find a preferred, in-network doctor.

Most states ban abortions that would take place after a woman is 22-24 weeks pregnant, or at the stage of “fetal viability.” A few states, such as Texas, Arkansas, and Mississippi, have passed or have legislation that limits abortions to those that take place before pregnancy at 6-12 weeks. This table from the Kaiser Family Foundation can give you the specifics for your state.

If you live where you no longer qualify for an abortion due to gestational limits, we understand that the path in front of you is not an easy one. She Might desires to support you as you make important pregnancy choices.

My state allows insurance coverage for abortion. Now what?

If your state permits private insurance coverage for abortion, the next step is to find out if your specific policy offers abortion coverage. If you’re in Illinois, New York, Oregon, California, Maine, or Washington, you are virtually guaranteed that your insurance policy will cover abortion.

If you are in a state where there are no restrictions on private insurance coverage for abortion, you will have to look up your healthcare policy online. Look through the policy documents you received when you enrolled in your plan, or call your insurance company using the phone number on the back of your insurance ID card to find out if your insurance offers coverage. This may sound daunting, but it will be the fastest and easiest way to find out if your plan offers abortion coverage.

This chart offers state-by-state information on whether insurance providers in that state will cover abortion. This does not necessarily mean that your policy will cover abortion, even if you get your coverage from one of the listed companies. Check directly with your company regarding your plan to get the most accurate information on coverage.

I’m on a family plan. Now what?

Typically when you use an insurance plan to cover any kind of healthcare, an Explanation of Benefits (EOB) will be sent to the insurance plan’s primary enrollee or cardholder. The EOB provides details about what service the plan was used to cover, how much of the service was covered, and the remaining financial responsibility of the enrollee.

If you have confirmed that your insurance policy covers elective abortion, you may have privacy concerns about using the insurance if it comes from a health plan you share with your parents or spouse.

There are ways that you can keep your medical choices private, even if you use your family’s insurance. First, when you call your insurance company to verify abortion coverage, ask them how they keep your medical information private on the EOB. Often, these documents will not detail what exact services you received, or even the facility you visited.

Sadly, the stigma surrounding unexpected pregnancies, no matter how you decide to respond, makes it incredibly difficult for many women to tell their families or a partner when it happens to them. Toxic family dynamics may make sharing this news potentially harmful. But keeping your pregnancy a secret will deprive you of the support system you deserve, and it may also hurt you if the secrecy causes you to avoid getting healthcare when you need it. Check out these articles to help you break the news to your parents or a partner.

My insurance does not cover abortion. What are my options?

If your insurance does not cover the cost of an abortion, you have a few options to pay for it. Many women ask for help from a trusted person to pay for their abortion, whether that be a boyfriend, husband, parent, or close friend. While it can be really uncomfortable to tell someone you’re close to that you have an unexpected pregnancy and wish to terminate it, picking the right person to confide in may allow you to gain much-needed emotional and financial support .

Check out She Might’s article on what to do with an unplanned pregnancy for advice on how to choose the right support person for your situation.

If you don’t have anyone that you can ask for money to help cover the abortion, or the money you do have doesn’t cover the entire cost of the procedure, there are other ways you can get funding. Ask the clinic where you are considering having an abortion if they offer discounts based on income. This is usually referred to as a sliding scale for payment. The clinic might also be able to help you access abortion funds.

Conclusion

As with most medical procedures, it can be overwhelming to navigate the health insurance system, whether you have public or private insurance. Remember that unexpected pregnancies happen to women from all walks of life, whether you’re a medical student, a mom, or unsure where your path leads. She Might is here to provide you with community while you face the unexpected.