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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.
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.
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.
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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