Regulating Insurance Coverage of Abortion

March 1, 2023

Background

State governments have found multiple ways to limit insurance coverage of abortion, including through bans on abortion coverage in public employees’ insurance policies. Several states have restricted abortion coverage in other private health insurance plans, especially following passage of the Affordable Care Act (ACA) in 2010, which provided for the establishment of state-level health insurance exchanges. While these coverage restrictions on private health plans are in place in half of the states, other states have taken steps to protect abortion access and affordability by requiring insurance plans to cover abortion. The laws in these states either require abortion coverage or require the coverage if a health plan includes coverage for prenatal care. Some states choose to use their own Medicaid funds to cover abortion, although the Hyde Amendment prohibits the use of federal funds for abortion except in cases of life endangerment, rape or incest.

Highlights

8 states require abortion coverage in private health insurance plans.
- 2 states require plans that cover prenatal care to cover abortion.
- 8 states require abortion coverage with no copayments.

11 states have laws in effect restricting insurance coverage of abortion in all private insurance plans written in the state, including those offered through health insurance exchanges established under the ACA.
- 8 states limit coverage to cases of life endangerment.
- 1 state limits coverage to cases of life endangerment, rape, incest, fetal impairment and “substantial and irreversible impairment of a major bodily function.”
- 1 state limits coverage to cases of life endangerment and “substantial and irreversible impairment of a major bodily function.”
- 1 state limits coverage to cases of life endangerment, “substantial and irreversible impairment of a major bodily function,” rape and incest.
- 9 states permit abortion coverage beyond specified exceptions through purchase of a separate rider and payment of an additional premium.
25 states restrict abortion coverage in plans offered through health insurance exchanges.
- 7 states limit coverage to cases of life endangerment.
- 4 states limit coverage to cases of life endangerment and “substantial and irreversible impairment of a major bodily function.”
- 1 state limits coverage to cases of life endangerment, “substantial and irreversible impairment of a major bodily function,” rape and incest.
- 9 states limit coverage to cases of life endangerment, rape and incest.
- 1 state limits coverage to cases of life endangerment, rape, incest, fetal impairment and “substantial and irreversible impairment of a major bodily function.”
- 1 state limits coverage to cases of life endangerment, rape, incest and cases of “grave, long-lasting physical health damage.”
- 2 states prohibit any abortion coverage.
22 states restrict abortion coverage in health insurance plans for public employees.
- 8 states limit coverage to cases of life endangerment.
- 12 states limit coverage to one or more of these exceptions: life endangerment, threat to the pregnant person's health, rape, incest and fetal abnormality.
- 2 states prohibit any abortion coverage.
20 states have more than one of the above restrictions.

Current Policy Status Table

Insurance Coverage of Abortion
State	Coverage required	Coverage banned or restricted to specified exceptions
State	All private insurance plans	All private insurance plans	Specific to health exchanges	Insurance policies for public employees
Alabama			Life, rape, incest
Arizona			Life, severe health^†	Life, severe health^†
Arkansas			Life, rape, incest^‡
California	X*
Colorado				No coverage
Florida			Life, rape, incest^‡
Georgia			Life, severe health^†	Life
Idaho		Life^‡	Life, rape, incest	Life^‡
Illinois	X*
Indiana		Life, rape, incest, severe health^†‡	Life, rape, incest, severe health^†	Life, rape, incest, severe health^†‡
Kansas		Life^‡	Life	Life
Kentucky		Life^‡	Life^‡,Ω	No coverage
Louisiana			No coverage
Maine	X*
Maryland	X*
Massachusetts	X*			ξ
Michigan		Life^‡	Life^‡	Life^‡
Mississippi			Life, rape, incest	Life, rape, incest, fetal impairment
Missouri		Life^‡	Life	Life
Montana			▽
Nebraska		Life^‡	Life	Life^‡
New York	X*
North Carolina			Life, rape, incest	Life, rape, incest
North Dakota		Life^‡	Life^‡,Ω	Life
Ohio			Life, rape, incest	Life, rape, incest
Oregon	X*
Oklahoma		Life^‡	Life^‡	Life^‡
Pennsylvania			Life, rape, incest^‡	Life, rape, incest
Rhode Island				Life, rape, incest
South Carolina			Life, rape, incest	Life, rape, incest, severe health^†
South Dakota			Life, severe health^†
Tennessee			No coverage
Texas		Life, severe health^†	Life, severe health^†	Life, severe health^†
Utah		Life, rape, incest, severe health^† and fetal impairment	Life, rape, incest, severe health^† and fetal impairment	Life, rape, incest, severe health^† and fetal impairment
Virginia				Life, rape, incest, fetal impairment
Washington	X*
Wisconsin			Life, rape, incest, severe physical health^Ф	Life, rape, incest, severe physical health^Ф
TOTAL	8	11	25	22
* Cost-sharing is prohibited for abortion coverage. † The health exception applies to a “substantial and irreversible impairment of a major bodily function.” ‡ Abortion coverage beyond exceptions specified is available only through the purchase of a separate rider at additional cost. β A plan must cover abortion with no copayments. Ω Although the law does not specifically refer to the ACA, the restriction applies to plans offered in the health care exchange. * A plan must cover abortion if it covers prenatal care. ξ State specifically prohibits coverage of postviability “partial-birth” abortions except in cases of life endangerment and “substantial risk of grave impairment of [the patient’s] physical or mental health.” Ф Health exception applies when an abortion is necessary to “prevent grave, long-lasting physical health damage to the [patient].”