The Supreme Court’s Roe v. Wade decision could affect health insurance coverage

Abortion rights demonstrators protest 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, U.S., June 24, 2022.

Jim Bourg | Reuters

Even when Roe v. Wade was in effect and women had the legal right to an abortion regardless of where they lived in the US, health insurance coverage of the procedure was limited.

Many states limit what plans can cover them, and a decades-old national law prohibits the use of federal funds for abortions, meaning women on Medicaid and Medicare were often not covered when it came to terminations.

With abortion now set to be banned in at least half of the states after a landmark ruling protecting women’s right to an abortion was overturned by the Supreme Court last week, coverage will become rarer, experts say.

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“State-regulated insurers in states where abortion is prohibited will have to drop coverage of abortions to stay in compliance with the state’s criminal law,” said Caitlin Donovan, a spokeswoman for the National Patient Advocate Foundation.

However, women seeking abortion coverage may have options available to them. Although the landscape is changing quickly, here’s what we know now.

How much does an abortion cost?

Medication abortions, which account for over half of all abortions and involve a two-drug regimen of mifepristone and misoprostol, can be safely used within the first 10 weeks of pregnancy and can cost up to $750 without insurance, according to Planned Parenthood.

A surgical abortion, meanwhile, can cost more than $2,000 out of pocket.

How did abortion coverage work before?

Before the Supreme Court’s decision last week, abortion coverage still depended heavily on where you lived and what kind of plan you had, Donovan said. “Most states impose limits on coverage to varying degrees.”

Eleven states limit abortion coverage to all private health insurance plans written in the state, according to the Guttmacher Institute, an abortion rights research organization. They are Idaho, Indiana, Kansas, Kentucky, Michigan, Missouri, Nebraska, North Dakota, Oklahoma, Texas and Utah.

Meanwhile, only six states — California, Illinois, Maine, New York, Oregon and Washington — require abortion coverage, with some stipulations, in private plans.

The Hyde Amendment, passed in 1976, blocked 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 budgets to supplement 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 seeking abortion services each year are left without coverage,” according to a 2019 report by the Kaiser Family Foundation.

How will coverage change now?

It will simply be limited, experts say.

If you live in a state like Louisiana or South Dakota, where abortion is now illegal, “you probably don’t have insurance coverage for it at all, unless it’s rape, incest, or a threat to the mother’s life.” Donovan said.

“Some states may not even allow those exemptions,” Donovan added.

However, employers who self-fund their health insurance policy, meaning they shoulder most of the costs of benefit claims, may be able to maintain their abortion coverage, said Joelle Abramowitz, an assistant research scientist at the University of Michigan. Such plans tend to be subject to fewer rules, giving the company more flexibility in the benefits offered.

Donovan recommends calling your plan provider and asking about its abortion coverage. Of course, if abortions are banned in your state, even if you’re covered, you’ll likely have to travel to another state to get one.

Some companies are even covering travel expenses for employees who must leave the state for an abortion.

What about leaving my state for an abortion?

If you have abortion coverage, you may need to go “out-of-network” in your health insurance plan to see a doctor in another state, experts say.

Out-of-network coverage is usually 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 have out-of-network benefits and how they work.

In some cases, people may find it cheaper to pay a provider out of pocket than switch to 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 any in-network abortion providers in another state. There could be one right over 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 medication abortion. In these cases, your medication may be mailed to you or you will be asked to pick it up somewhere.

However, 19 states have already made it illegal to take prescribed medications during a telehealth visit.

How can I get financial aid?

A growing number of resources are available to help people with the financial costs of an abortion.

Information about these options can be found at There is also a national network of abortion funds.

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