Does Medicare cover abortions?
Medicare generally does not cover abortions except in specific cases, such as if carrying the pregnancy to term would be dangerous for the pregnant person.
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Generally, Medicare is for people ages 65 years or older. Medicare may also be available for younger people who have a disability, end stage renal disease, or amyotrophic lateral sclerosis (ALS).
Medicare will not cover abortion procedures except in the following situations:
if the pregnancy is the result of rape or incest
if a doctor has certified that carrying the pregnancy to term would endanger the pregnant person’s life
Although federal programs cannot fund abortions, some states — such as California, Illinois, New York, Oregon, and Washington — use their own funds to offer broader coverage for abortions through Medicaid.
As a result of new legislation, abortion coverage laws are constantly evolving. This can lead to sudden changes in coverage and availability from state to state.
The Dobbs decision
On June 24, 2022, the Supreme Court of the United States overturned Roe v. Wade, the landmark 1973 ruling that secured a person’s constitutional right to an abortion.
This means that individual states are now able to decide their own abortion laws. As a result, many states will ban or severely restrict abortion access.
The information in this article was accurate and up to date at the time of publication, but the facts may have changed since. Anyone looking to learn more about their legal rights can message the Repro Legal Helpline via a secure online form or call 844-868-2812.
Medicare and abortion coverage
This article originally appeared on Medical News Today
Federal law forbids the use of federal funds for abortion services except in cases in which the pregnancy is a result of rape or incest and cases in which carrying the pregnancy to term would endanger the life of the pregnant person.
These exceptions apply to Medicare and Medicaid, both of which are government-funded healthcare programs.
If a person has Medicare Advantage (Part C), they may want to check with the plan provider, as some private insurers might offer additional coverage options or benefits. However, these insurers must still follow federal regulations on funding for abortion services.
Medicare resources
For more resources to help guide you through the complex world of medical insurance, visit our Medicare hub.
Medicaid and abortion coverage
As with Medicare, federal laws restrict Medicaid’s coverage for abortion.
The Hyde Amendment, a law that restricts the use of federal funds for abortion, limits Medicaid coverage to cases of rape, incest, or life threatening risk to the pregnant person.
However, 17 states use their own funds to offer Medicaid coverage for abortion beyond these exceptions.
States such as California, New York, and Illinois provide Medicaid coverage for abortion, while others strictly limit it to the conditions specified by federal law.
Learn more about abortion.
Which states cover abortion?
Abortion coverage varies widely by state, with some states providing broad access to coverage through Medicaid and private insurance and others strictly limiting or banning it.
Below is an overview of states that cover abortion services under Medicaid using state funds and those that do not, along with details on private insurance restrictions and any additional state policies.
States that use state Medicaid funds to cover abortion
Seventeen states allow Medicaid funds to cover abortions in a broader range of cases than those allowed by the federal Hyde Amendment.
These are:
Alaska
California
Connecticut
Hawaii
Illinois
Maine
Maryland
Massachusetts
Minnesota
Montana
New Jersey
New Mexico
New York
Oregon
Rhode Island
Vermont
Washington
In these states, people with a low income who have Medicaid coverage have greater access to abortion coverage than in most other states.
In many of these states, abortion services may be fully covered, depending on individual circumstances and specific Medicaid policies.
Eight states provide funds voluntarily: Hawaii, Illinois, Maine, Maryland, New York, Oregon, Rhode Island, and Washington.
Nine states do so pursuant to a court order, which means that the state’s Medicaid program will provide funds for an abortion if a court has ordered it to do so. These are Alaska, California, Connecticut, Massachusetts, Minnesota, Montana, New Jersey, New Mexico, and Vermont.
States that follow the Hyde Amendment restrictions
In most states, Medicaid coverage for abortion is limited to the Hyde Amendment exceptions, meaning that Medicaid will cover abortion only if the pregnancy is due to rape or incest or poses a life threatening risk to the pregnant person.
The following states adhere strictly to the Hyde Amendment restrictions:
Alabama
Arizona
Arkansas
Colorado
Delaware
Florida
Georgia
Idaho
Indiana
Iowa
Kansas
Kentucky
Louisiana
Michigan
Mississippi
Missouri
Nebraska
Nevada
New Hampshire
North Carolina
North Dakota
Ohio
Oklahoma
Pennsylvania
South Carolina
South Dakota
Tennessee
Texas
Utah
West Virginia
Wisconsin
Wyoming
Washington, D.C., also falls into this category.
These states do not offer additional Medicaid coverage beyond Hyde exceptions. In these states, people who need an abortion but do not meet the federal exceptions must pay for the procedure out of pocket.
Iowa, Mississippi, Virginia, and West Virginia also provide state funds for abortions in cases of fetal impairment. This means that if a fetus has a serious health condition or abnormality that may affect its development, quality of life, or ability to survive outside the womb, state funds will cover an abortion.
Indiana, Utah, West Virginia, and Wisconsin also provide state funds for abortions that doctors deem necessary to prevent long lasting damage to the pregnant person’s physical health.
South Dakota allows abortions only if the pregnant person’s life is at risk. This stance may conflict with federal regulations.
State restrictions on private insurance coverage
Some states have laws that restrict or forbid private insurance plans, including Affordable Care Act marketplace plans, from covering abortion unless the pregnant person’s life is at risk.
These restrictions limit options for people with private insurance in those states.
The following states have banned private insurance coverage for abortion in most plans, except in very limited circumstances:
Other states restrict abortion coverage in marketplace health plans under the Affordable Care Act, requiring separate billing or restricting coverage to life threatening situations.
States with abortion insurance mandates
Some states have laws that require private insurance plans to cover abortion services, ensuring that more people have access to abortion coverage. These states are:
In these states, state-regulated health insurance plans are required to cover abortion services, often without out-of-pocket costs or restrictions.
Additional notes
Travel reimbursement by employers: In restrictive states, some employers provide travel benefits to help employees seek abortion services out of state if they’re not covered by local insurance.
Evolving laws: Abortion coverage policies and laws are constantly changing as a result of new legislation, legal battles, and shifting state priorities. Sudden changes in coverage or availability may occur across states.
Each state’s approach reflects a complex mix of federal rules, state regulations, and responses to recent legislative changes. This means facilities such as Planned Parenthood may have limited services depending on the state.
Resources and support
Here are some helpful resources for people who are considering or going through an abortion:
The Guttmacher Institute, an organization that supports reproductive rights, provides an interactive map detailing each state’s abortion policies.
Planned Parenthood offers counseling, information about abortion options, and financial assistance. Planned Parenthood clinics provide both in-clinic and medication abortions, depending on location and gestational age.
The National Abortion Federation provides information on abortion procedures, funding, and a directory of trusted clinics.
The National Network of Abortion Funds is a network of organizations that help people pay for abortion services and related costs, such as travel and lodging.
The Rape, Abuse & Incest National Network (RAINN) provides support through a 24/7 confidential hotline and online chat for people who have experienced sexual violence. RAINN offers resources for emotional support, legal guidance, and connections to local services. The hotline is 1-800-656-HOPE (4673).
Frequently asked questions
Does Medicaid pay for abortions at Planned Parenthood?
Medicaid coverage for abortions at Planned Parenthood depends on state laws. As a result of the Hyde Amendment, federal Medicaid funds cover abortion only in cases of rape, incest, or life threatening risk to the pregnant person.
However, 17 states use state funds to cover abortions more broadly, including for reasons such as personal choice and health.
In states that follow the Hyde Amendment, Medicaid covers abortion only in the limited cases allowed by federal law. For other situations, people may need to pay out of pocket or seek financial assistance.
Do taxpayers pay for abortions in 2024?
In 2024, taxpayers may indirectly contribute to the cost of abortions, but this depends on the state and the specific circumstances.
As a result of the Hyde Amendment, which restricts federal funds to cases of rape, incest, or life endangerment, federal tax dollars do not pay for most abortions.
However, state-level funding varies. In some states, taxpayer dollars through Medicaid cover abortions beyond these federal exceptions, allowing broader access to abortion services.
In other states, Medicaid may not cover abortion services at all, and people must pay for them privately. So, while most federal tax dollars do not fund abortions, state taxpayers in certain states may fund them.
Summary
Medicare generally does not cover abortions, except in specific cases.
Federal law, under the Hyde Amendment, prevents Medicare from covering abortion except in cases of rape, incest, or life threatening risk to the pregnant person.
Outside of these exceptions, Medicare does not pay for abortion services. Additionally, coverage may vary with Medicare Advantage plans, but they must still follow these federal restrictions.
View the original article on Medical News Today
