If you want an abortion in the U.S., one of your first steps might be figuring out whether your insurance will cover the service.
And even though 11 states restrict insurance coverage of abortion in all private insurance plans, many employer-based insurances do cover abortion.
This may come as a surprise to people who recently saw well-known companies like Amazon, Microsoft and Lyft announce abortion coverage for employees after the leak of a Supreme Court draft overturning Roe v. Wade and the passing of other restrictive laws in states like Texas and Oklahoma. Before the Supreme Court officially overturned Roe, more than a dozen employers announced plans to support staffers seeking abortions, mainly through expanding healthcare benefits and reimbursing any out-of-state travel expenses associated with an abortion service.
But two separate studies by the Guttmacher Institute and the Kaiser Family Foundation indicate that most Americans with employer-based insurance currently do have coverage for abortion, including scenarios beyond limited circumstances like rape or incest.
Many people just don’t know this unless their company is open about it, or they dig up the information themselves.
California-based reproductive rights organizer Larada Lee-Wallace, for instance, learned that she could use her current employer’s insurance for her abortion because her company explicitly told her the services were covered when she signed up for an insurance plan.
“It’s basic human rights, but I’m very glad that I was able to receive the knowledge that I needed because a lot of people don’t,” she said.
Proactively sharing that abortion is covered as part of their corporate benefits is something more companies should be doing, said Ushma D. Upadhyay, a public health social scientist and associate professor at University of California San Francisco’s School of Medicine.
Upadhyay co-authored a survey of 639 women getting abortions in different U.S. healthcare facilities and found that the most common reason people said they were not using private insurance to cover their abortion was either because it wasn’t covered (46%) or because they were unsure if it was covered (29%).
“They just assume their insurance did not cover it or they also didn’t want to go through the hassle of trying to figure it out,” Upadhyay said.
“It’s a good thing for employers to make it explicit about whether their health insurance is covering it. I think there is a lot of fear in putting the word ‘abortion’ in health insurance information,” she added. “But I think it’s so important that it’s very clearly stated. Even when someone is considering accepting a job, that is something that they should know.”
Travel is just one cost among many that employers can help with.
The first time Lee-Wallace got an abortion, she was on Medicaid in Ohio as a student and used an abortion fund to pay for the medications she needed. At a previous job, she paid for an abortion out of pocket because her then-employer’s insurance required a waiting period and a video doctor’s telehealth appointment before care was covered. It dragged out the process when time was of the essence.
Her bigger concern for the surgical abortion she got in May was the cost of the service itself.
Paying out of pocket for abortion services can be steep. In 2020, on average, a medication abortion cost $560, while a first-trimester procedural abortion cost $575 and a second-trimester abortion cost $895, according to Upadhyay’s research. Many Americans do not have this kind of money to drop at a moment’s notice: 40% of U.S. adults do not have enough savings to cover a $400 emergency expense.
And then there are the fees. Just because an insurer says they will fully cover the service does not guarantee it will be free for you. Lee-Wallace, a California resident, initially worried that she might have to deal with a large copay, but California, Illinois, Oregon and New York state passed bills that ban insurance fees like copays and deductibles for abortion services.
But if you are not in a state where these insurance fees are banned, using your company health insurance to pay for an abortion could end up costing you about the same as just paying out of pocket.
This is a topic Upadhyay wants more companies to discuss as they share details about their abortion services: “If the deductible is $1,000, it means people have to pay out of pocket for anything up to $1,000. Most abortions are less than $1,000. Even though it’s covered, does it mean people end up paying out of pocket?”
The costs of services are the greatest barrier to getting an abortion, but there are other barriers, too. Upadhyay cited the costs of getting time off work, arranging for childcare or eldercare and arranging for transportation, like renting a car and even the price of an overnight stay if someone cannot get an appointment right away, if it requires two visits or if they have to travel to another state or area to receive care.
“It’s important that these companies understand all of the costs,” she said. “It’s not just for the procedure itself or the actual abortion. There are so many costs involved.”
More companies are taking a stand. But to be more effective, they need to expand support beyond their own employees.
Beyond figuring out if your insurance will cover abortion services, you will also want to know whether or not your company will have your back if you do get an abortion. Twenty-six states are certain or likely to ban abortion now that the Supreme Court overturned Roe.
Starbucks, for example, said in May that all full-time and part-time employees and their dependents who are enrolled in the company’s U.S. healthcare benefits program can get abortion-related travel expenses reimbursed if abortion care is not available within 100 miles of an employee’s home. Yelp, which already had insurance coverage for abortion services, will now provide travel benefits for U.S. employees and their dependents covered by its insurance who need to travel out of state to access abortion services.
Some companies already had structures in place before the high court’s draft decision was leaked in May. Since January, Zendesk has offered employees who are pregnant, the partner of a pregnant person or a surrogate parent up to 15 days of paid time off for pregnancy loss, including abortion. In response to Texas’ ban on abortions after six weeks, Texas-based Match Group, which owns OkCupid, Hinge and Tinder, partnered with Planned Parenthood Los Angeles. Now, Match Group employees and their dependents living in Texas can arrange for abortion by calling a specific PPLA number to confirm their eligibility. PPLA will then do the leg work of arranging and paying for travel and verifying with an employee’s insurance about which services are covered — all without sharing information with Match Group.
Privacy concerns are a big reason employees will pay out of pocket even when their insurance could potentially cover abortion. “They don’t want a statement that comes to their house that says that they had an abortion,” Upadhyay said.
“There are so many people who will be denied access to care just by virtue of not working for that company. We have always seen people who have resources pre-1973 and in ‘22 get out of state because they had the resources to get care.”
- Planned Parenthood President Alexis McGill Johnson
Planned Parenthood president Alexis McGill Johnson expects companies to offer more details about their plans after the Supreme Court issues its decision.
“One thing that will have to become more apparent for companies and their workforces is clarity on their policies,” she said. “We are going to see in the coming weeks ― we’ve already seen it ― a number of companies issuing guidance to their employees in light of the decision, and those will be moments where workers will see whether or not the provision is covered. Companies will have to assure them of their privacy.”
But the decision of corporations to expand a healthcare benefit for staff will ultimately only help a small select group of workers in America.
“It’s not enough just to say that ‘We are standing with our workers,’ which in itself I think is a very important statement. But we really do want to see more companies step up and say ‘This is not acceptable for the communities for which we work, the communities in which we are providing services and jobs,’” Johnson said. “There are so many people who will be denied access to care just by virtue of not working for that company. We have always seen people who have resources pre-1973 and in ’22 get out of state because they had the resources to get care. It’s going to be the folks who are living at the margins who are also part of a broader corporate community who are not going to get that access.”
Upadhyay likened the corporate approach of expanded care to putting a bandaid on a patient that is bleeding out: “It is not going to make a dent in the national access problem.”
If companies really wanted to step up, she said, they would be vocally advocating in their state to keep local abortion legal. “All of those efforts that these companies are putting in to establish these funds, it’s a drop in the bucket. And really what they should be doing is being vocal at state legislatures,” she said.
Everyone has a role in supporting colleagues’ access to abortion.
Beyond what your health insurance and executive leadership say they will do for you, you will also want to know how your colleagues will support you if you decide to get an abortion.
“I just felt like if there ever was a time for me to share, it was then.”
- Larada Lee-Wallace, reproductive rights organizer
Lee-Wallace said that before the SCOTUS leak, she would likely not have disclosed her reason for requesting time off to her manager. But even though she felt vulnerable and hesitant, she felt like she needed to this time.
“I know I’m not obligated, but I also wanted to put it on people’s radars that this was something I was experiencing in real time while we’re having conversations about how to support people regardless of what the Supreme Court decides. I just felt like if there ever was a time for me to share, it was then,” Lee-Wallace said. “I was going to need a lot of grace, I was not feeling well [and] it was going to be an extra week or so before I could get my appointment.”
When she first told her manager that she was pregnant and needed to schedule an appointment, he congratulated her before she clarified that it was for an abortion. His assumption was off-putting to Lee-Wallace.
“It was interesting for me, because we are having a nationwide conversation about why it’s important to trust people who get abortions and to uplift them, and to be on the receiving end of [my manager’s comment], I didn’t feel like I was receiving that same love and care,” she said.
Lee-Wallace’s story is an example of how employers can make the abortion experience easier or much harder, depending on company policies and on managers’ levels of sensitivity. Abortion access is a workers’ rights issue that is critical for gender equity in the workforce. According to a study in the American Journal of Public Health, women who could not get an abortion were three times more likely to be unemployed after six months and to be in poverty for four years, compared to women who had abortion access.
Lee-Wallace said that her abortions allowed her to focus on finishing her studies and getting her degree. “Being able to do things like packing up and moving across the country and traveling are all things I know wouldn’t have been possible for me if I had not been able to access my abortions,” she said. “I’m so thankful for having been able to make the best decisions for myself and my life when the time came to make the decision.”
Her advice is for everyone to listen if a co-worker decides to share their abortion story, rather than making assumptions.
“I think now that we are having enough conversation about it, I just would say to listen to the people who are navigating the experience and asking them what they need, and how you can support, and not assuming. Because everyone’s situation is different,” she said.