As the third open enrollment period winds down聽on the health insurance marketplaces, one thing hasn鈥檛 changed much since the online exchanges opened: It鈥檚 still often hard to find out whether a plan covers abortion services.
The health law requires聽insurers to say one way or the other, and they have gotten better about reporting abortion coverage details this year, advocates on both sides agree. But the federal government has yet to put out final instructions on how insurers should handle the issue on their summary of benefits and coverage overview. Lacking specific instructions about what to say and where聽to say it, many insurers have simply left the information out of the summary, advocates said.
That leaves consumers in a bind. 鈥淚t鈥檚 not easy to figure out whether a plan covers abortion and if it does, to what extent,鈥 says Kinsey Hasstedt, a public policy associate at the Guttmacher Institute, a聽reproductive health research organization that supports abortion rights.
The whether marketplace plans can聽cover abortion services. Half of states to some extent, often limiting it to cases of rape, incest or if the mother鈥檚 life is endangered, the standard the federal government uses for coverage in its employees鈥 plans and for聽health care programs, such as Medicaid.
However, even in states that permit insurers to cover abortion聽beyond the limited聽exceptions, marketplace plans聽may not have that benefit.
鈥淚n Texas, there鈥檚 no ban on abortion services, but depending on where you live, you may to choose a plan that includes abortion coverage,鈥 said Alina Salganicoff, director of women鈥檚 health policy at the Kaiser Family Foundation (KHN is an editorially independent program of the foundation).
The lack of easily accessible information makes it hard to know whether the number of plans that currently provide abortion services on the exchanges is increasing or decreasing.
Advocates on both sides of the issue have their eyes on multi-state plans. To encourage competition, the health law called for at least two multi-state plans to be offered on聽every state marketplace by 2017, at least one of which excluded abortion services. In subsequent guidance, the Office of Personnel Management, which administers the multi-state program, said that multi-state insurers had to offer that excludes abortion coverage starting this year.
But the .听The number of states offering multi-state plans dropped to 32 plus the District of Columbia in 2016, down from 35 last year.
In those states, most multi-state plans don鈥檛 cover abortion, and the coverage information is easy to find, said Genevieve Plaster, a researcher at the ,聽which opposes abortion. Of the 261 multi-state plans available in 2016, just four plans in two states 鈥 Connecticut and Alaska 鈥 provide abortion services, according to OPM.
However, abortion opponents said that because multi-state plans aren鈥檛 yet available in every state, there鈥檚 no guarantee consumers can find a plan that doesn鈥檛聽cover abortion聽if that is their priority. In two states, Hawaii and Vermont, for example, all plans available cover abortion. Neither state has multi-state plans.
Abortion-rights supporters have a different beef with the multi-state plan program. They say it鈥檚 not fair to require the marketplace to offer plans that exclude abortion聽without also requiring plans that include abortion coverage. They also take issue with OPM鈥檚 decision that insurers must offer two multi-state plans that exclude abortion coverage, instead of the single one that the law requires.
OPM isn鈥檛 considering any changes to the program at this time, a spokesman said.
In the meantime, advocates聽on both sides聽hope that the final instructions for the coverage summaries will make it easier for consumers to learn whether聽plans cover abortion.
Questions remain about where in the eight-page summary of benefits and coverage the information appears: Some advocates want it near the section that describes covered services 鈥渋f you are pregnant,鈥 rather than under 鈥渆xcluded services and other covered services,鈥 as the federal government has proposed.
And advocates on all sides agree that the language describing abortion services needs to be clear and consistent rather than the mishmash of descriptions that appear in current documents, where it may be called 鈥渋nterruption of pregnancy鈥 or 鈥渆lective termination of a normal pregnancy,鈥 among聽other terms.
In a released last June, federal regulators said they would clarify requirements for the language and placement of abortion services in the coverage summary in the final template, which聽was scheduled to be finished this month.听
鈥淲e鈥檙e still waiting for that,鈥 said Gretchen Borchelt, vice president for health and reproductive rights at the National Women鈥檚 Law Center.
The Centers for Medicare and Medicaid Services didn鈥檛 respond to a request for information about when the new template would be released. The 2016 enrollment ends Jan. 31.
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