Is an abortion pill covered by Medicare?
Discover if Medicare covers medication abortion, including information on eligibility, state laws, and associated costs. Compare rates from top insurance providers and request a free quote today to secure comprehensive coverage tailored to your needs. Ensure peace of mind with the right insurance plan.
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Dani Best
Licensed Insurance Producer
Dani Best has been a licensed insurance producer for nearly 10 years. Dani began her insurance career in a sales role with State Farm in 2014. During her time in sales, she graduated with her Bachelors in Psychology from Capella University and is currently earning her Masters in Marriage and Family Therapy. Since 2014, Dani has held and maintains licenses in Life, Disability, Property, and Casualt...
Licensed Insurance Producer
UPDATED: Jun 29, 2023
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UPDATED: Jun 29, 2023
It’s all about you. We want to help you make the right coverage choices.
Advertiser Disclosure: We strive to help you make confident insurance decisions. Comparison shopping should be easy. We are not affiliated with any one insurance company and cannot guarantee quotes from any single insurance company.
Our insurance industry partnerships don’t influence our content. Our opinions are our own. To compare quotes from many different insurance companies please enter your ZIP code above to use the free quote tool. The more quotes you compare, the more chances to save.
On This Page
- Medication abortion is not covered by Medicare, except for two specific reasons
- The Hyde Amendment restricts abortion coverage under the Indiana Health Service, Medicare, and the Children’s Health Insurance Program
- Recipients of Medicare coverage should be aware that different states have different laws regarding abortion services available
Welcome to our comprehensive guide on the coverage of abortion pills by Medicare. In this article, we will explore the important question: “Are abortion pills covered by Medicare?” We delve into the eligibility criteria, state laws, and associated costs related to Medicare coverage for abortion pills.
Additionally, we provide valuable insights into how insurance providers can help meet your specific needs. To ensure you have the best coverage at competitive rates, enter your zip code now to compare quotes from top insurance providers in your area. Take control of your healthcare decisions and find the insurance plan that suits you best.
Does Medicare cover medication abortion?
Medicare typically covers individuals over the age of 65 who are past reproductive years. Even so, certain disabilities can qualify some younger people for Medicare.
A medication abortion — also known as the abortion pill — requires the use of two pills that are taken up to 48 hours apart. This is not covered by Medicare, except for two reasons:
- The pregnant woman’s life is in danger.
- The pregnancy is due to rape or incest.
The Hyde Amendment restricts abortion coverage under the Indiana Health Service, Medicare, and the Children’s Health Insurance Program.
Recipients of Medicare coverage should be aware that different states have different laws regarding abortion services. This means that even though an abortion procedure may be covered by Medicare, it may not be available in your state. Even still, some of the best insurance companies may offer Medicare coverage.
Here are some standard Medicare rates:
| Medicare Taxes and Rates Summary | Estimated Monthly Medicare Rates | Estimated Annual Medicare Rates |
|---|---|---|
| Medicare taxes for less than 30 quarters, standard Part A rate | $458 | $5,496 |
| Medicare taxes for 30-39 quarters, standard Part A rates | $252 | $3,024 |
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How much does medication abortion cost?
The cost of an abortion pill varies depending on the state you receive care and your health insurance.
It could be free or low-cost with health insurance. You should call your insurance provider directly to find out if insurance covers abortions directly; some policies don’t cover them and some only cover it in certain cases.
Centers, such as Planned Parenthood, will work to give you the services you need whether or not you have insurance.
Medication Abortion
According to Medicare.org, medication abortion requires the use of two pills that are taken up to 48 hours apart. The first pill contains mifepristone, which causes the body to stop using its progesterone. This stops the pregnancy from progressing. The second pill has misoprostol, which causes the uterus to empty itself.
Depending on how far along you are in your pregnancy, medication abortion is anywhere between 91% and 98% effective. The further into your pregnancy you are, the less effective it is.
A follow-up visit is typically scheduled a week or two later to confirm that the pregnancy was terminated via ultrasound or blood test.
| Max. gestational age | Up to 70 days (10 weeks) |
|---|---|
| Mifepristone dosage | 200mg (one pill), taken orally |
| Mifepristone administration | Dispensed in office; Where the medication must be taken (home or clinical setting) |
| Misoprostol dosage | 800mg (four pills), taken buccually (placed in cheek) or vaginally |
| Misoprostol timing | 24-48 hours after mifepristone buccally, or 6-72 hours after mifepristone vaginally |
| Misoprostol administration | Taken at home |
| Follow-up visit | 7-14 days after mifepristone, no location specified |
| Prescriber requirements | By or under the supervision of a prescriber that has been certified by the manufacturer |
There are three provisions that come with medication abortion.
- Mifepristone must be dispensed to patients only in certain healthcare settings, specifically clinics, medical offices, and hospitals, by or under the supervision of a certified prescriber.
- A provider must become a certified prescriber by completing and sending a Prescriber Agreement Form to the specific distributor — Danco Laboratories or GenBioPro — which confirms they are able to assess the duration of a pregnancy, diagnose ectopic pregnancies, and provide surgical abortion in the case of an incomplete abortion.
- The certified prescriber must obtain a signed Patient Agreement Form from the woman before dispensing the drug as documentation of safe use conditions.
Medication abortion can occur within the first 10 weeks of pregnancy.
Abortion pills can be found at Planned Parenthood health centers or they can be sent through the mail via telehealth or telemedicine services.
If your local Planned Parenthood health center does not provide the abortion pill, they would be happy to refer you to a location in your area where you may obtain it.
Learn if your insurance covers medication abortions. Enter your ZIP code and get a free quote today.
Case Studies: Is an Abortion Pill Covered by Medicare?
Case Study 1: Maria’s Dilemma
Maria, a 30-year-old Medicare beneficiary in the US, sought an abortion pill to terminate an unwanted pregnancy. She reached out to her Medicare provider to inquire about coverage, only to find out that abortion services, including the pill, were not covered. This placed Maria in a difficult financial situation, as she had to bear the full cost of the procedure independently.
Case Study 2: James’ Experience
James, a 25-year-old man, stood by his partner Sarah’s decision to have a medical abortion using an abortion pill. Despite her Medicare coverage, they discovered that Medicare did not cover the cost of the pill, unlike other healthcare treatments. Consequently, James and Sarah had to shoulder the entire expense of the abortion pill themselves, as Medicare offered no financial assistance.
Case Study 3: Linda’s Challenge
Linda, a 40-year-old Medicare beneficiary, faced a challenging predicament when she discovered she was pregnant. Continuing the pregnancy posed health risks, so her doctor suggested the abortion pill. Unfortunately, she learned that Medicare did not cover the pill, adding to her emotional distress.
Case Study 4: Michael’s Confusion
Michael, a transgender male on Medicare, faced confusion about abortion pill coverage during an unexpected pregnancy. Contacting his Medicare provider yielded contradictory information, with one staff member denying coverage and another suggesting potential exceptions. Uncertain about his actual Medicare coverage, Michael sought clarity in navigating his situation.
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Frequently Asked Questions
Are abortion pills covered by Medicare?
Yes, abortion pills are typically covered by Medicare, but coverage may vary depending on the individual’s specific plan.
What are abortion pills?
Abortion pills are medications that are used to end an early pregnancy. They are typically taken orally and work by blocking the hormone progesterone, which is needed to maintain the pregnancy.
What types of abortion pills are available?
There are two types of abortion pills available: mifepristone and misoprostol. Mifepristone is taken first, followed by misoprostol a few days later. Together, these medications are highly effective in ending an early pregnancy.
How much do abortion pills cost?
The cost of abortion pills varies depending on the brand and where they are obtained. However, for individuals with Medicare coverage, the out-of-pocket cost is usually minimal.
Are there any age restrictions for obtaining abortion pills?
The availability of abortion pills may vary depending on the state and the specific healthcare provider. However, in general, there are no age restrictions for obtaining abortion pills with a valid prescription from a healthcare provider.
Do I need prior authorization from Medicare to obtain abortion pills?
Prior authorization requirements may vary depending on the individual’s specific Medicare plan. However, in general, abortion pills are considered a covered medication and should not require prior authorization. It is always best to check with your specific plan to confirm coverage details.
Where can I obtain abortion pills?
Abortion pills can be obtained from a healthcare provider who is authorized to prescribe them. Planned Parenthood clinics and some women’s health clinics may also offer abortion pill services.
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Dani Best
Licensed Insurance Producer
Dani Best has been a licensed insurance producer for nearly 10 years. Dani began her insurance career in a sales role with State Farm in 2014. During her time in sales, she graduated with her Bachelors in Psychology from Capella University and is currently earning her Masters in Marriage and Family Therapy. Since 2014, Dani has held and maintains licenses in Life, Disability, Property, and Casualt...
Licensed Insurance Producer
Editorial Guidelines: We are a free online resource for anyone interested in learning more about insurance. Our goal is to be an objective, third-party resource for everything insurance related. We update our site regularly, and all content is reviewed by insurance experts.