Comprehensive insurance coverage of abortion is a crucial component of equitable abortion access. However, state policies on abortion coverage vary widely, meaning that where you live and what type of insurance you have often determines your ability to reliably access abortion.
This map provides an overview of the state policy landscape and includes information on how each state regulates insurance coverage of abortion in Medicaid, the Affordable Care Act (ACA) Marketplaces, and private insurance. Detailed information for each state can be found by either clicking on the state/territory in the map itself, or calling up the state from the drop-down menu below the map. This information is updated regularly by NHeLP policy staff, and there is a glossary of terms below the map.
To learn more about NHeLP’s extensive work protecting abortion access, visit our Abortion is Health Care page. If you’re an advocate looking for technical assistance or if you have questions about the map, please contact [email protected]. Reporters interested in talking with NHeLP can email [email protected] to request an interview.
Glossary
General Insurance Terms
Co-payment: This is a flat fee paid for services or prescriptions at the time you receive them. The co-pay amount varies depending on the service and type of provider delivering your services.
Coinsurance: This is the percentage of the cost of covered services that you pay after you’ve met your yearly deductible. For example, if you see a provider who charges $75 per office visit and your coinsurance is 10%, you would pay $7.50 for that visit.
Cost-sharing: The portion of covered health care costs you pay out of your own pocket (hence the cost is “shared” between the insurer and the enrollee). This includes deductibles, co-payments (co-pays), and coinsurance but does NOT include premiums or the cost of non-covered services. You can find information on the cost-sharing requirements under your plan in your Summary of Benefits and Coverage (SBC).
Deductible: This is the amount you pay for covered services in a plan year before your health plan begins covering expenses. For example, a patient may have a $500 deductible, which means they will pay out-of-pocket for all covered services until they have spent $500 in total. At this point, the enrollee has “met” the deductible and the insurer will begin paying for covered services.
Employee Retirement Security Act (ERISA): The federal law that sets the minimum standards for employer-sponsored benefits, including most employer-based health insurance plans.
Fully-insured plan: A group health plan where the employer purchases health insurance directly from a commercial insurer. Under this plan, the employer pays premium and the insurer assumes the “risk” for covering services and processing claims for enrollees. These plans are subject to state regulation and federal law.
Health plan: A general term for health insurance plans, including plans sold in both individual and group markets. The exact language often varies between states, examples include: “health benefit plan,” “health care plan,” “health insurance plan.”
High-deductible health plan (HDHP): A type of plan that has low monthly premiums but a substantially higher deductible than other traditional health plans that are used in conjunction with a Health Savings Account (HSA). These plans historically were required to meet specific Internal Revenue Service (IRS) requirements but as of 2026, Bronze or catastrophic plans sold on the ACA Marketplace may also be considered HDHPs.
Inpatient care: Health care delivered to people who are formally admitted as patients at hospitals. This typically includes an overnight stay.
Insurer: The insurance company, which offers different health insurance plans according to the metal tiers that are described in the Affordable Care Act. For example, Blue Cross Blue Shield or Kaiser Permanente are insurers.
Outpatient care: This refers to health care delivered in medical settings where the patient goes home the same day they receive care. For example, this includes care delivered at abortion clinics, federally qualified health centers, and community health centers. It can even include care delivered at hospitals if you’re not formally admitted as a patient.
Payer: This refers to who pays the bills (outside of the patient) – the insurer, the Medicaid agency, Medicaid managed care plans, etc.
Prior authorization: A policy that requires a provider to obtain approval from the payer that the service, item, or medication is medically necessary prior to delivering services. If services are rendered before obtaining prior authorization, the plan can deny coverage. In the context of abortion service delivery, prior authorization is most commonly (but not exclusively) associated with inpatient services.
Self-insured plan: A group health plan where the employer pays employees’ health claims directly, assuming the financial “risk” instead of purchasing a typical plan from a commercial insurer. These plans are generally not subject to state regulation.
Summary of Benefits and Coverage (SBC): A summary that allows enrollees to determine and compare costs and coverage between health plans. Plan shoppers can compare options based on price, benefits, and other features.
Utilization management: This refers to the category of policy levers used by payers to allegedly combat rising health care costs. It’s also referred to as utilization controls or utilization review. Examples of utilization management include prior authorization requirements, step therapy, and annual or lifetime limits.
Marketplace Terms
ACA Marketplace(s): Also known as the exchanges, this is a mechanism created under the Affordable Care Act to allow individuals who do not qualify for Medicaid or lack other forms of health insurance (e.g., employer-sponsored insurance), to purchase coverage. The ACA created three different Marketplace structures: state-based marketplaces (SBM), Federally facilitated Marketplaces (FFM), and State Partnership Marketplaces (SPM).
Grandfathered health plan: An individual health plan sold prior to March 23, 2010 that is exempt from the coverage requirements under the Affordable Care Act.
Qualified health plan: A particular health insurance plan that an individual purchases on the ACA Marketplace. A plan must cover Essential Health Benefits, follow established limits on cost-sharing, and meet the requirements under the Affordable Care Act.
Medicaid Terms
Fee-for-service (FFS): A delivery system where states contract with individual providers and pay them directly for the services or items they provide (hence, fee-for-service). This means that when a Medicaid member receives a service, such as a doctor’s visit, the doctor charges Medicaid an amount based on the state’s fee schedule. Some states “carve out” particular services from managed care and require that providers bill FFS directly – abortion is often an example of this.
Hyde Amendment: An annual federal appropriations bill rider that restricts the use of federal funding for abortion services to the narrow circumstances of rape, incest, or life endangerment. While it prohibits federal funding, states can use their own funding to provide abortion coverage beyond the three narrow exceptions.
Managed care organization (MCO): A delivery system model where state Medicaid agencies contract with private companies (managed care organizations or MCOs) to coordinate health care delivery for their enrollees. States typically pay these companies a fixed amount each month for each covered enrollee, regardless of how many services that enrollee actually uses, and allow plans to limit their provider networks. The vast majority of Medicaid beneficiaries are enrolled in managed care.
