Does Medical Insurance Cover Abortion

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Does Medical Insurance Cover Abortion – Three Things to Know About Abortion Insurance Coverage: Shots – Health News US Supreme Court Roe v. Wade, or a health care plan that pays for abortions, was very different. Now it has become even more complicated, with disputes and court challenges.

Abortion rights supporters rally at the Minnesota State Capitol in downtown St. Paul after the U.S. Supreme Court overturned the ruling.

Does Medical Insurance Cover Abortion

Even before the June 24 decision, abortion insurance coverage varied greatly. The issue is even more complicated now that states have enacted different rules — from about half to almost all circumstances ban or are expected to ban abortion.

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However, to be clear, whether an insurance plan covers abortion is not the same as whether abortion is allowed in a state. Coverage issues are more complex and determined by various factors, including state abortion access.

How thick is this bush? Abortion may be covered by the health plan, but if providers are not available, patients do not have access. However, people with insurance that doesn’t cover abortion can still get it, but only if it’s available in their state or they can afford to travel and pay out of pocket. There are also many unanswered questions about whether states that restrict abortion will have the legal authority to mandate coverage in employer plans.

“States will pass laws, there will be some conflicts, and then it will end up in the courts,” said Erin Foos Brown, director of the Center for Law, Health and Society at Georgia State University’s College of Law. – This may take some time.

“There’s no law that requires a health plan to cover elective abortion, whether it’s employer-based or whatever,” Foos Brown said.

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Some work-related health plans cover elective abortions. Patients can view their plan documents or call their insurer directly to check.

Coverage is likely to be in self-insured plans offered by employers, as these plans are generally not covered by state law. Self-funded employers, usually the largest, pay their employees’ medical bills out of pocket, although they typically hire third parties, sometimes health insurers, to handle claims and administrative work. .

However, millions of Americans work for small employers that buy plans directly from health insurers, which then pay the medical bills. Known as “fully insured,” these plans are subject to state laws that have changed over time regarding abortion coverage.

According to the Kaiser Family Foundation, eleven states prevent these private plans from covering abortion in most cases, although some states allow people to purchase an insurance rider to cover the cost.

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“You can’t tell from the front of your insurance card whether you’re fully insured or self-funded,” Foos Brown said.

For the more than 14 million Americans who buy coverage through the Affordable Care Act’s marketplaces, where they live matters.

According to KFF, 26 states limit abortion coverage in ACA plans, while seven states require it. These states are California, Illinois, Maine, Maryland, New York, Oregon and Washington.

The rules for Medicaid, the federal health program for low-income people, are also different. Thirty-four states and the District of Columbia adhere to the Hyde Amendment, which prohibits federal funds from paying for abortions except in cases of rape or obscenity or to save the life of the mother, although some other states do so for medically necessary abortions. Allow coverage.

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For all these reasons, it’s not surprising that research published in April in the journal Health Affairs noted that patients perform most abortions (69% in one study) out of pocket. Researchers found that the average price of medicine. Abortions were $560, and abortion procedures averaged $575 in the first trimester to $895 in the second trimester.

Insurance policies must cover essential health services, including medically necessary prenatal care and abortion if carrying the pregnancy to term would threaten the patient’s life.

Under the Pregnancy Discrimination Act of 1978 and other provisions, Foos Brown said, “pregnancy and prenatal care, including high-risk pregnancies, as well as maternity care in general. “

In an ectopic pregnancy, when a fertilized egg implants outside the uterus, the fetus is not viable, and the condition is usually life-threatening for the mother without medical attention. Many other scenarios can be used, such as when a woman has a miscarriage but not all of the tissue is removed, which can lead to a dangerous infection.

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While all state laws currently banning abortion include an exception to save the life of the mother, it is not always clear what constitutes a life-threatening scenario. This means that doctors in abortion-regulating countries may need to assess the mother’s medical risk and potential legal consequences.

“It’s less about coverage and more about whether providers in states that ban abortion will provide care,” said Kathy Keith, a researcher at Georgetown University’s Center for Health Insurance Reform. “All of these laws are designed to facilitate the behavior, to make it so attractive or scary to providers that they don’t do it at all.”

Can residents of states where abortion is illegal get coverage or help with travel costs in other states?

In recent weeks, a number of large employers, including Microsoft, Bank of America, Disney and Netflix, have announced that they will cover travel expenses for employees or other beneficiaries to legally access abortion services in the states they are in. Will create programs to help where it is legal.

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But it’s not as simple as it sounds. Employers will need to determine whether employees will be covered under a health plan or otherwise. Privacy protection can also be an issue. Some consultants also said that employers would need to consider other conflicts as well. If an employer covers travel for abortion procedures, for example, but not to an eating disorder clinic, does that violate the Mental Health Equity and Addiction Justice Act? If a plan does not have providers willing or able to perform abortions, does it violate any state or federal regulations requiring reasonable access to in-network doctors and health care services?

Lawmakers need to think about these conflicts, said Jessica Waltman, vice president of compliance at employee benefits firm MZQ Consulting. “They can put all employer group plans in their state in a very precarious position if these state laws prevent them from complying with federal law,” she said, especially if they are pregnant. Limits access to benefits under the Discrimination Act.

Other potential conflicts are if the employer is in a position that allows abortion and the employee is in a position that prohibits it. “If I’m an Oregon company, my insurance plan should have abortion coverage, but what do I do with an Oklahoma employee? I don’t know the answer to that,” said Renee Thorne, director of the Jackson Lewis law firm. , where she oversees litigation involving self-insurance companies.

It’s also unclear whether the state law would target insurers, employers or others who cover abortion services, including travel or televised appointments.

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Laws banning abortion, Thorne wrote on his company’s website, generally apply to medical providers and sometimes to those who “aid or facilitate” an abortion. Some states, including Texas, allow individuals to sue for $10,000 for causing or assisting someone in obtaining an illegal abortion.

“We’re in uncharted territory here because we’ve never before been in a situation where plans, as well as their owner sponsors and those who administer the plans, can face criminal liability related to plan benefits,” Seth Peretta said. , said the principal. Groom Law Group, which advises employers.

(Kaiser Health News) is a national newsroom producing in-depth journalism on health issues. It is an editorially independent program of state and federal action to address problems related to insurance and Medicaid coverage of abortion services that began shortly after the 1973 Supreme Court hearings.

The decision on the legalization of abortion is still in force today. Beginning in 1977, the Hyde Amendment prohibited all federal funds from being used for abortions, making exceptions only for pregnancies that threatened the woman’s life or were the result of rape or immorality. The issue of abortion coverage was at the center of much debate before the passage of the ACA, and then renewed legislative measures at the state level to limit abortion coverage, this time in private insurance plans. As insurance and Medicaid coverage for abortion is increasingly restricted by state and federal regulations and insurers’ insurance policies, millions of women seeking abortion services each year are left without coverage in many states—even though They may be victims of rape or immorality. If the pregnancy is a risk to their health. This brief examines current federal and state policy regarding Medicaid and insurance coverage of abortion services, and provides state-by-state estimates of the availability of abortion coverage for women enrolled in private plans, marketplace plans, and Medicaid.

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