Total Confusion on Elective-Abortion Coverage
Asked if plans cover abortion, insurance agents give every answer in the book — except a straight one.

Explaining Obamacare at a fair in Miami, December 2013 (Joe Raedle/Getty Images)


Now ten months since the rollout of Obamacare, with about three months to go until the next enrollment period begins, we’re seeing a shift in how insurance companies delimit and describe their coverage of elective abortion. Unlike the pervasive, confused silence on the issue of elective-abortion coverage reported last October by the Charlotte Lozier Institute, insurance companies now are seemingly able to answer the question, “Do your individual plans offered on the exchange cover elective abortion?” The only problem: Those answers keep changing depending on who’s talking.

To begin at the beginning, CLI selected New York’s health-insurance exchange as a starting point to identify which individual plans include or exclude elective abortion — or “interruption of pregnancy,” as it is also termed in the state’s insurance lingo. Via the exchange’s web chat, CLI recently asked a representative whether the multi-state plans offered in New York cover elective abortion. The representative replied, “This information is not in my portal.” But she did provide a helpful URL to the directory of all the insurance companies in question, so that CLI could contact each directly.

And down the rabbit hole we went.

Our findings include these exceptional instances of readily given and yet inconsistent replies to the question of whether elective abortion is covered:

United Healthcare’s plans in New York In sum: No, none do; and, yes, all do.

One agent contacted by phone on July 7 said that none of their plans covers elective abortion. Another representative informed CLI by phone on July 22 that all United Healthcare plans on the New York exchange cover elective abortion, quoting the plan as permitting “one procedure per member per calendar year.”

Empire BlueCross BlueShield’s plans in New York In sum: Yes, all do cover elective abortion, including the multi-state plans (MSPs). (But, under the terms of Obamacare, at least one MSP in each state must exclude coverage of elective abortion.) And, no, none do.

Two licensed agents contacted by phone on July 1 and 2 stated, “All of [Empire’s plans on the New York exchange] cover elective abortion.” When asked if the MSPs offered on the exchange do as well, both emphatically confirmed this twice, one declaring that the “benefits do not change” according to whether the plan is an MSP or not.

The Office of Personnel Management (OPM), on the other hand, states: “As required by the Affordable Care Act, MSP insurers in each State must offer at least one plan that does not include elective abortion services.” CLI sent a letter to Empire BlueCross BlueShield on July 10 requesting clarification; we still await a reply.

Two live-chat agents contacted on July 22 informed CLI that no elective abortions are covered, one explaining that “it will be considered” only if it is medically necessary.” When asked for the definition of medical necessity, the agent responded: “health-care services or supplies needed to prevent, diagnose, or treat an illness, injury, condition, disease, or its symptoms and that meet accepted standards of medicine.” The agent then apologized that there wasn’t a plan document online stating this. She added: “I know that information because that is what the direct-sales team has been told.” The second live-chat agent likewise stated, “None of our plans cover elective abortion.”

CLI also looked at individual-marketplace plans in Vermont, a state that lacks legislation banning elective abortion in the exchange and that does not currently participate in the Multi-State Plan Program — which means that all plans in Vermont are free to cover elective abortion. (It is also on the fast track to being the first state with a single-payer system.)

MVP’s plans in Vermont ​ In sum: No, none do; no, you need authorization; yes, all do, and you do not need authorization; yes, all do again; sorry, really, none do.

A live-chat agent informed CLI on July 16 that elective abortion is not covered. We were inexplicably disconnected after asking for a plan document stating this.