How do health insurance plans cover abortion?

How does employer-sponsored health insurance cover abortion?

Whether and how employer-sponsored health plans cover abortion will vary from one employer’s plan to another. The availability of abortion coverage depends in part on where the business is located, whether the employer wants to offer abortion coverage, and whether the employer buys coverage from an insurance company or self-insures. If the health plan provides abortion coverage, the amount that a plan member will pay for an abortion will depend on the plan specifics, such as deductible and out-of-pocket costs.

How do individual and family health plans cover abortion?

This also varies considerably from one state to another and from one health plan to another. Half of the states have banned non-Hyde abortion coverage for health plans sold in the exchange/marketplace, and some of those states even restrict coverage for abortions that result from rape or incest or would endanger the mother’s life.

But ten states (growing to 11 by mid-2025) require marketplace health plans to cover abortion, and some of those states require the plans to cover abortion without any out-of-pocket costs for enrollees. In the rest of the states, abortion coverage is offered at the discretion of each insurance company. In some states, there are no plans available with abortion coverage, even though the state does not forbid such coverage.

If non-Hyde abortion coverage is offered on a plan sold in the exchange, premium tax credits (subsidies) cannot be used to cover the cost of that coverage. So insurers that provide non-Hyde abortion coverage are required to collect at least $1/month from enrollees on these plans and keep it segregated from the rest of the premiums they collect, using only these proceeds to pay for abortion services.

This means that even if the health plan costs less than the person’s allowable premium subsidy and would otherwise be premium-free, the enrollee must pay at least $1/month for the coverage. States can choose to offset this with state funds; California is an example of a state that has done this.

(Note that federal legislation under consideration since 2023 would repeal Section 1303 of the ACA, which pertains to abortion coverage offered by private plans in the exchange/marketplace. But the legislation had not yet advanced out of committee, more than a year after its introduction.)

In most states where abortion coverage is available on self-purchased health plans, the specific benefits will vary widely from one plan to another — just like coverage for all other types of medical care. One plan might have a low (or no) deductible and/or cover most of the cost of an abortion, while another plan might count the abortion toward a deductible that could be several thousand dollars, meaning that the patient would pay the full cost of the abortion (after the health plan’s network negotiated discount) if they hadn’t already met their deductible earlier in the year.

How does Medicaid cover abortions?

In most states, Medicaid only covers abortions in cases of rape, incest, or to save the mother’s life). But there are 17 states where the Medicaid program also covers non-Hyde abortions. In most cases, Medicaid in these states will cover abortion without any out-of-pocket costs. The most recent addition to this list was Rhode Island, where legislation(H.5006/S.32) was enacted in 2023 that added abortion coverage to the state’s Medicaid program, using state funds.²

Although most Medicaid costs are jointly covered by the state and federal government, the Hyde amendment prohibits the use of federal funds to pay for non-Hyde abortions. So those 17 states must use only state funds to pay for non-Hyde abortions for Medicaid enrollees. One of those states — Montana — enacted legislation (H.B.544) in 2023 that was designed to reduce Medicaid abortion coverage in the state, as the new law implemented significant restrictions.³)

Abortions that meet the Hyde Act’s exceptions account for a very small fraction of all abortions. In states where Medicaid programs only cover abortions in cases of life endangerment, rape, or incest, just 1.5% of abortions were covered by Medicaid as of 2014, versus 52% in states where state funds are used to provide comprehensive abortion coverage.

Legislation under consideration in Congress since 2023 would add abortion coverage to all federal government health programs, including Medicaid. But it’s unlikely to pass in a divided Congress.

How does Medicare cover abortions?

Medicare is funded by the federal government, and states do not contribute to the funding. So non-Hyde abortions are not covered by Medicare in any state, since federal funds cannot be used to pay for non-Hyde abortions. The legislation under consideration since 2023 would add abortion coverage to Medicare, but it’s unlikely to be approved in the House.

Most Medicare beneficiaries are 65 or older, and thus well past reproductive age. However, more than 7 million people — accounting for more than 10% of all Medicare beneficiaries nationwide – are under 65 and are enrolled in Medicare due to a long-term disability.⁴But since non-Hyde abortions account for the vast majority of all abortions, Medicare beneficiaries generally do not have coverage for abortion.