February 24, 2024

Women will incur added expenses for travel, caretakers and lodging if they leave the state for abortions. Many may ask: Will I have to pay out of pocket for the procedure, or will health insurance cover it?

For those who have employer-sponsored insurance in Texas, they first need to know if their insurance is “fully funded” or “self-funded.” Fully funded employers rely on insurance companies to cover the costs to health services, essentially paying the insurers premiums. Self-funded employers pay all or most of health insurance claims themselves and hire insurers to administer their plans.

Under a state law passed in 2017, fully funded employers can’t include abortion coverage in their comprehensive plans. Employees would need to purchase supplementary plans to cover abortions, under the law.

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Critics of the law argue that no one plans on having an abortion and would anticipate needing such coverage. It’s unclear how many insurance companies offer these plans.

The state, however, has no authority over self-funded employer plans, which are regulated by the federal government. It’s up to the employer whether to cover abortion services.

In a case called Dobbs v Jackson Women’s Health Organization, the Supreme Court on Friday overturned the landmark Roe v. Wade decision, which in 1973 established a constitutional right to abortion, and left the legality of abortion to state legislatures and Congress. About half the states are poised to outlaw or severely restrict abortions. Texas has in place a so-called trigger law, tied to the overturning of Roe, that will soon outlaw abortion in the state except in a few narrow circumstances.

The largest insurance companies in Texas — Blue Cross Blue Shield and UnitedHealth Group — are still evaluating how the decision will affect them.

“We are evaluating potential impacts the ruling by the US Supreme Court in the case of Dobbs v Jackson Women’s Health Organization relating to abortion services may have on our customers and members,” a spokesperson for Blue Cross Blue Shield of Texas said in a statement. “We are here to support our customers and members in a thoughtful way as we navigate this complex and evolving situation, in compliance with federal, state and local laws.”

UnitedHealth Group said it, too, is still considering the impact of the decision.

“Our teams have been actively preparing for this decision,” the company said in a statement. “We are reviewing the court’s opinion now and will communicate more information as soon as possible.”

Most Americans did not have insurance that covered abortion before the Dobbs decision said Ken Janda, a former health insurance executive who heads Wild Blue Health Solutions, a consulting firm. Under the so-called Hyde amendment, federal funds can’t be used for abortion, with the exceptions for rape, incest or if the pregnancy is a danger to the woman’s life.

Some states use their own funds to pay for abortion under Medicaid, but Texas is not one of them.

Most patients pay out of pocket for abortion, research shows. About 69 percent of patients surveyed patients at six abortion-providing facilities nationwide, paid for the procedure themselves, including those with private health insurance, according to a 2014 study in Women’s Health Issues, a peer-reviewed academic journal. The most common reason reported for not using insurance was that abortion was not covered.

Meanwhile, the costs of the procedures are rising as fewer abortion clinics take insurance, according to a report from Health Affairs, a peer-reviewed health care journal. From 2017 to 2020, abortion clinics accepting insurance fell to 80 percent from 89 percent while the median price for a medication abortion increased to $560 from $495 and first-trimester procedural abortion rose to $575 from $475.

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