What the Abortion Ruling Means for Insurance Coverage – NBC Los Angeles

Abortion is covered by most insurance in California, even after the Supreme Court’s decision to overturn the landmark Roe v. Wade, the state insurance commissioner said in a statement Friday.

The court ruling allows states to ban abortions, but California had already put in place a series of measures to protect access to abortions.

California protects access to abortion through the right to privacy, protected by the state Constitution that guarantees residents the ability to make health care decisions, including abortion .

“California law clearly states that we protect reproductive freedom and insurance coverage for abortion. Defending everyone’s right to health care is a top priority for me and the Department of Insurance,” Insurance Commissioner Ricardo Lara said. “That’s why we’ve gathered the facts about Californians’ rights to reproductive health care insurance coverage. We want to help reduce the clutter and make sure consumers know that California law and the Department of Insurance are there to protect them.

In 1972, California voters added a right to privacy to the state constitution. State courts have cited this right to privacy while upholding numerous state abortion laws. Roe v. Wade, the landmark 1973 US Supreme Court decision that prevents states from banning all abortions, was based on the right to privacy implicit in the US Constitution.

The following information was provided by the California Department of Insurance:

Is my private insurer required to cover my abortion?

Yes, for most people. California laws clearly state that abortion is a basic health care need and that most insurance must cover the procedure. This does not apply to employers who prove “self-funded” insurance or grandfathered plans. If you have difficulty understanding your coverage, contact your insurer or call the Department of Insurance at 1-800-927-4357.

Can my private insurer discriminate against me for having an abortion?

No. The California Constitution prohibits private health insurers from discriminating against anyone undergoing a reproductive health procedure. Insurers cannot refuse to provide you with insurance or change the pricing of an insurance plan because of an abortion.

Can my private insurer require prior authorization before I get an abortion?

Yes, until December 31, 2022, when the law will change. Insurers can seek insurer approval before an abortion procedure, but they cannot deny coverage or prevent a person from having an abortion.

Senate Bill 245 requires insurance plans that already cover abortion to cover all unlicensed and cost-sharing abortion services. This will be in effect from January 2023.

In addition, you will have the right to receive timely care.

What should I do if there is no local abortion provider in my private insurance network?

If there is no local abortion provider or timely appointment, your health care provider has an obligation to arrange appointments with a local out-of-network provider in a timely manner to the same price you would pay with a network provider.

If you have trouble accessing appointments through your insurer, contact the Department of Insurance at 1-800-927-4357.

Can my private insurer require that I receive a referral from my doctor for an abortion?

No, you do not need a referral code from your doctor. An insurer cannot require a referral for gynecological care provided by a network gynecologist. You can make an appointment directly with a specialist, including abortion services.

Insurers should not require references for:

  • Pregnancy test and prenatal care
  • Contraceptive services, including sterilization and counseling
  • HIV/AIDS testing and prevention services

Does my Medi-Cal insurance cover my abortion?

Yes, the Medi-Cal QP program provides covered temporary care for low-income pregnant patients. It provides prenatal care and pregnancy-related prescription medications. Any patient who thinks she is pregnant is eligible, patients will need to find a qualified provider to to register in.

If you have difficulty understanding your coverage, contact your insurer or call the Department of Insurance at 1-800-927-4357.