The average out-of-pocket cost for medication abortion is increasing, new study confirms

Published April 11, 2022

Limited information exists on the total out-of-pocket charges for an abortion without insurance coverage. Now, ANSIRH researchers have provided an in-depth look at trends of abortion cost using data for all 50 states and DC, from 2017 through 2020.

Historically and presently, the U.S. government and many states have enacted restrictions—like the Hyde Amendment—on federal funding for abortion. As a result, most people pay out-of-pocket for their abortions. We examined the total out-of-pocket charges for 3 abortion types: medication abortion, first-trimester procedural, and second-trimester abortions, as well as facility acceptance of health insurance from 2017-2020. We found that charges for first-trimester abortions are increasing and acceptance of health insurance is declining, a troubling trend for those who face financial barriers to abortion.

Key Findings

The median patient charges increased for medication abortion ($495 to $560) and first-trimester procedural abortion ($475 to $575).
The median patient charges decreased for second-trimester abortion ($935 to $895).
The proportion of clinics that accept insurance decreased over time (89% to 80%).
There was notable regional variation, with the South having lower costs and lower insurance acceptance.

Study Design

A graphic of a woman doing a search online, and text that reads "Each year, we check data for all facilities in the Abortion Facilities Database from the prior year, identify any changes (including closures), and add any facilities that have newly begun to offer abortion care."

We used data from ANSIRH’s abortion facility database, which includes data on publicly advertising abortion facilities and was updated every summer between 2017 and 2020. Through web searches and calls, we documented data on each abortion facility, including location, types of abortions offered, self-pay charges for medication abortion, first-trimester procedural abortion, and second-trimester abortion, and whether the facility accepted any type of insurance for abortion care.

Implications

In 2021, President Joe Biden introduced a 2022 budget that completely omitted the Hyde Amendment, but the increase in both cost and state-level restrictions on the use of insurance for abortion continue to cause financial challenges for clinics and patients. History and science both show that a lack of financial resources can create an overwhelming barrier to abortion, especially for Black women, people of color, and people living on low incomes. Based on the findings of this study, we recommend that public and private insurance reimbursement rates must be increased to reflect actual abortion facility costs, so that these facilities are more willing to accept insurance. Expanding public insurance coverage of abortion in more states will also be necessary to reduce financial burdens on those who are most economically vulnerable.

“Increasing costs for the abortion are occurring as more states restrict access to abortion, which means higher patient travel costs for abortion.”

The article, Trends In Self-Pay Charges And Insurance Acceptance For Abortion In The United States, 2017–20, is available in Health Affairs.

Areas of Research