What percentage of abortion costs are reimbursed by insurance companies?

>> Sunday, November 08, 2009

It turns out this is a difficult question to answer. Two recent studies came to quite different conclusions in regard to the related issue of how many employer-based private insurance plans offer coverage for abortion. The first study concluded that 87% of "typical" employer-based insurance plans cover abortion. The second concluded that 46% of covered workers had abortion coverage.

Obviously part of the explanation for the difference may be that the two questions aren't identical. The first study tried to determine what was offered by typical plans, and increasingly workers are being pushed into high-deductible/limited coverge plans that don't offer the same benefits as the supposedly "typical" plan. The second study surveyed HR people, who often may have not been familiar with their employers' insurance coverage at this level of detail.

Of course the question of whether abortion is theoretically a reimbursable medical expense is different from the question of how much reimbursement takes place. A 2003 study found that in 2001 the costs of 13% of abortions were directly billed to private insurance companies. This number reflects, among other things, that lots of people are uninsured or under-insured, that some state Medicaid programs cover abortion, and that it's likely a significant percentage of women who are covered by private insurance plans that reimburse abortion expenses choose not to seek reimbursement.

Relatedly, the median cost of an abortion in the U.S. is around $400, which itself indicates that private insurance plays a limited role. By way of comparison, simple outpatient procedures that are usually reinbursed by private insurance, such as ear tubes and tonsil removal, are billed out at thousands of dollars per surgery.

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