Trends In Self-Pay Charges And Insurance Acceptance For Abortion In The United States, 2017-20

Health Aff (Millwood). 2022 Apr;41(4):507-515. doi: 10.1377/hlthaff.2021.01528.


The Hyde Amendment prevents federal funds, including Medicaid, from covering abortion care, and many states have legal restrictions that prevent private insurance plans from covering abortion. As a result, most people pay for abortion out of pocket. We examined patient self-pay charges for three abortion types (medication abortion, first-trimester procedural abortion, and second-trimester abortion), as well as facilities' acceptance of health insurance, during the period 2017-20. We found that during this time, median patient charges increased for medication abortion (from $495 to $560) and first-trimester procedural abortion (from $475 to $575) but not second-trimester abortion (from $935 to $895). The proportion of facilities that accept insurance decreased over time (from 89 percent to 80 percent). We noted substantial regional variation, with the South having lower costs and lower insurance acceptance. Charges for first-trimester procedural abortions are increasing, and acceptance of health insurance is declining. According to the Federal Reserve, one-quarter of Americans could not pay for a $400 emergency expense solely with the money in their bank accounts-an amount lower than any abortion cost in 2020. Lifting Hyde restrictions and requiring public and private health insurance to cover this essential, time-sensitive health service without copays or deductibles would greatly reduce the financial burden of abortion.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Abortion, Induced*
  • Female
  • Financial Management*
  • Humans
  • Insurance, Health
  • Medicaid
  • Pregnancy
  • United States