Even before the Supreme Court overturned the Roe v. Wade decision on June 24, the ability to use health insurance to pay for an abortion depended on many things, including the insured woman’s state, the type of insurance involved, and where the procedure took place.
Lack of coverage means that most Americans who get an abortion pay out of pocket for it, says Katie Keith, JD, a research faculty member at Georgetown University’s Center on Health Insurance Reforms.
“That’s not to say you shouldn’t try to use insurance if you have it,” she says. “The average cost for abortion is above $500, and if you add in travel and everything else, the cost can be a huge barrier.”
Here are answers to common questions about whether health insurance covers abortion:
How do you know whether your plan covers abortion?
As with any medical procedure or medication, you can find out whether your plan covers abortion by looking at your plan documents (available through your online portal) or by calling your insurer and asking directly. If you have health insurance through your job and you feel OK asking your HR department about coverage, they likely could also answer the question or direct you to someone who can.
Even if your insurer covers abortion services, you’ll need to find a provider who accepts your insurance and is in network for your plan. In 2020, about 80% of abortion providers accepted insurance, down from 89% in 2017, according to a Health Affairs study.
Your company will not know if you have an abortion from your medical bills or health records.
Even self-insured employers usually have a different entity handling the health benefits. “They get reports on the aggregate level about the types of procedures funded, but they wouldn’t identify the individual who used them,” says Joelle Abramowitz, PhD, a health policy economist at the University of Michigan’s Institute for Social Research. “That information is protected by HIPAA.”
HIPAA, or the Health Insurance Portability and Accountability Act, is a law that protects the privacy of your health records.
Does insurance treat mifepristone (RU-486), the so-called abortion pill, differently from abortion procedures?
A medication abortion from a provider would likely fall under the same rules as the medical procedure. But that’s not always the case if it’s done through telehealth.
If you do have coverage, is it protected by law, or does that vary by state?
It varies widely by state. Eleven states have limits on whether private insurers can cover abortion, and seven states require that insurance plans cover abortion.
That said, state laws only apply to fully insured employers, meaning those in which the employer pays an insurer to provide policies to workers on its behalf. Only about one-third of workers are in these types of plans.
Most large employers are self-insured, which means that they assume all the financial liability for people in the plan.
“Even in states where the law says you’re not allowed to cover an abortion, a self-insured plan would not be bound by those types of laws,” Abramowitz says.
The rules also vary for those who do not get their insurance from employer-provided plans.
An analysis by the Kaiser Family Foundation finds that 34 states and Washington, DC, limit Medicaid coverage of abortion to only cases of rape, incest, or to save the life of the mother, while about half of states have limits on plans available through the state health insurance Marketplace. You can check out the rules in your state here.
If your plan covers abortion, but you are in a state that doesn’t offer what you need, are you covered if you must travel to get one?
It’s unclear. Health insurance plans may cover abortions performed out of state (most likely at out-of-network rates), but they may not cover the travel expenses – or they could cover both. Check your plan’s details or contact your health insurance company.
Some employers have promised to help cover the costs of employees who need to travel to get an abortion. But legal experts say that companies’ ability to do so will depend on the rules in their state.
In Texas, for example, anyone who helps someone travel across state lines for an abortion could face civil penalties for “aiding and abetting” them, and employers and insurers may need to consider their potential liability for doing so.
Flexible spending accounts (FSAs) may be a way to cover some of the travel costs. “Even if the travel expenses are not covered by the insurance plan, they could be reimbursable through accounts like FSAs,” Abramowitz says.
If your plan changes mid-year, do they have to notify you?
Yes, although it’s rare that insurers would make such changes.
“They could change coverage for abortion before a new year, so when people are looking at their plans during open enrollment, that might be something to think about or inquire about at that point,” Abramowitz says.
If the pregnant woman has a medical condition that could be life-threatening, does that affect coverage?
Yes. Even in some states that now prohibit abortion, there is often an exception to save the life of the mother. In most cases, if providers perform the abortion as part of a live-saving medical intervention, insurance will cover it.
“Any kind of emergency procedure is medically necessary, so there shouldn’t be any questions about coverage,” Keith says. “If someone is in the emergency room and needs care because they have an ectopic pregnancy or something else, that should be covered.”
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