Beyond the Law: The Challenge of Marketplace Coverage of Abortions

Executive Summary

From the Fall of 2017 to Spring of 2018, the National Health Law Program (NHeLP) examined if and how Marketplace plans cover abortion services in the states that do not prohibit such coverage. Our research only looked at publicly available information, principally the plans’ Summary of Benefits and Evidence of Coverage documents. In this sense, the study intended to emulate the experience of an individual shopping for plans who wants to find out if the plans cover abortions. NHeLP examined the following elements in Marketplace plans’ documents: clarity regarding the extent of abortion coverage, terminology used to describe abortion, plans’ decisions to cover abortion absent legal limitations, cost-sharing provisions and how they compare with other comparable services, and abortion coverage limitations. The goal of this research was to assess how individuals learn about abortion coverage in Marketplace plans and to ensure that enrollees get accurate information so that they can benefit from this coverage.

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