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Objectives
We sought to understand implementation of new state policies requiring public and
private insurance coverage of abortion and the role coverage had in patient experiences
of abortion care.
Methods
We conducted phone interviews between July 2021 and February 2022 with 50 Illinois
residents who recently sought abortion prior to 11 weeks’ gestation at clinics throughout
Illinois. We conducted semi-structured interviews to explore the impact of insurance
coverage on experiences obtaining care. We coded transcripts using Dedoose software
and conducted thematic content analysis.
Results
Twenty-eight participants reported having private insurance, 21 reported Medicaid
insurance, and one reported having no insurance. Participants with Medicaid insurance
reported that it often covered all costs and that many clinics enrolled eligible patients
using Medicaid Presumptive Eligibility. Few patients with private insurance reported
coverage for care; challenges included: no coverage for abortions or only for “medically
necessary” abortions; obstacles with referrals or plan networks; high deductibles
and cost-sharing; privacy concerns; and assumptions that care would not be covered.
Benefits of public and private coverage included: relief from cost-related stress,
earlier appointments, and agency to choose method knowing all costs would be covered,
including sedation. Some participants only learned of insurance coverage or denial
at the time of the appointment.
Conclusions
Illinois’ expansion of Medicaid coverage to include abortion care appears to have
reduced or removed out-of-pocket costs for most eligible patients. Alternatively,
many privately-insured participants reported paying out of pocket. State agencies
responsible for oversight of private coverage requirements should collect data to
ensure compliance.
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Copyright
© 2022 Published by Elsevier Inc.
