If you are experiencing an unplanned pregnancy, you may be wondering if your health insurance plan covers elective abortions in New Jersey.
Here is the bottom line. Many private plans will not cover abortion, and those that do often have big deductibles – which means you may pay most of the costs out-of-pocket anyway. Then the company will publish an explanation of benefits that another family member might see.
Only NJ Medicaid covers all abortion costs without jeopardizing your privacy. But you have to qualify to get into this program, which means three things:
- You need valid medical proof of pregnancy
- Your income must be below set limits
- Carrying twins or triplets raises the income eligibility ceiling
Only an ultrasound can determine and then offer valid proof that you are carrying multiples – which could make the difference between a denial and approval.
HEALTH INSURANCE ABORTION COST SHARING
Most health insurance plans in New Jersey contain cost-sharing features. The patient is responsible for paying all abortion-related charges not covered by the health plan.
These cost-sharing components include deductibles, co-insurance, and copayments and are unique to each plan.
Deductible
A health insurance deductible is an amount you must pay out-of-pocket each plan year before the plan begins picking up a portion of your medical expenses. Every plan has a unique annual deductible amount.
- The plan begins paying a portion of expenses once you have already satisfied the annual deductible.
- The patient is responsible for 100% of the expenses until she reaches this annual amount.
Coinsurance
Coinsurance is the percentage of the charges that your plan will pay. The patient is responsible for paying the remainder. Every plan has a unique co-insurance arrangement.
Consider this example for a plan with 80% coinsurance covering an early-pregnancy abortion costing $600 with an in-network provider.
- Allowed Amount – $600
- Paid by plan – $480
- Paid by patient – $120
Co-payments
Co-payments are mandatory charges that the clinic must collect before providing services. Each plan has unique co-payment amounts, which range from $5 to $50 – for each office visit or test.
You may need to fund three or more co-payments yourself.
- Pregnancy ultrasound
- Abortion procedure
- Follow up visits
Estimating Costs
In New Jersey, the costs you may have to pay after insurance range from a low of $350 on up to $1,500 to terminate a pregnancy at 24 weeks. Any medical complications may add to your expenses. Apply these figures to the cost-sharing features of your plan to estimate your out-of-pocket expense.
- Find surgical abortion costs here
- Find medical abortion (pill) costs here
WILL PARENTS INSURANCE COVER PREGNANCY & ABORTION
Your parent’s health insurance plan may not cover a dependent pregnancy or abortion. A free ultrasound provides the positive proof of pregnancy needed to enroll in Medicaid for those who fall into any of these four coverage gaps.
- You are too old to remain on your parents’ plan.
- Under the Affordable Care Act, dependents can remain on their parent’s health plan until age 26 without paying an additional premium for more than one child.2
- Under New Jersey insurance law, certain dependents can remain covered until age 31 but must pay an additional premium.3
- Your parent bought the plan covering dependents through work.
- 70% of group health plans do not cover dependent pregnancies.4
- These plans may not cover abortion either.
- Your parent’s plan covering dependents does not pay for abortion.
- Federal government plans do not cover abortion except when the woman’s life is endangered, or when the pregnancy results from rape or incest.5
- Your parent’s plan does not cover dependents. The policyholder chooses between four basic coverage types.
| Choice | Cover Dependents |
|---|---|
| Single | No |
| Husband/Wife | No |
| Parent/Child | Yes |
| Family | Yes |
ABORTION SHOWING UP ON INSURANCE DOCUMENTS
One of the biggest drawbacks to using your health insurance to pay for your abortion is that your parents may find out. You could lose control of your privacy when the clinic bills the insurance company and the procedure shows up on the insurance company Explanation of Benefits (EOB). Insurance companies routinely process an EOB after every submitted claim.6
The insurance company will then either send the printed EOB to the policyholder (often parents) by mail or post it online if the policyholder chooses electronic delivery. With at least one large New Jersey insurer (as of December 2016), a parent can log in online and view the EOB for every family member on the plan.
The EOB may contain some or all of this confidential information about an abortion procedure.
- Provider name (Planned Parenthood, etc.)
- Provider address
- Patient name (Yours)
- Date of service
- Procedure description
- Medical billing code
- Cost and payment information
Under federal privacy regulations, patients can request that insurers not disclose confidential information or ask that they send the EOB to an address of their choosing.7 However, if you live with your parents the letter will arrive in their mailbox.
Your parents will never find out about a free pregnancy ultrasound. We will not bill the insurance company. Therefore, they will not generate an EOB that your parents might read.
WAITING PERIODS FOR INDIVIDUAL PLANS
You can purchase an individual health insurance plan covering elective abortion in New Jersey. Enroll through the state marketplace if you earn too much money to qualify for Medicaid (see qualifications below).
Under the Affordable Care Act, all plans must cover pre-existing medical conditions with no waiting period. However, there is a catch. You can only opt into a new plan during an open enrollment period– unless you experience a qualifying life event.8
OPEN ENROLLMENT LIMITATIONS
The annual open enrollment begins November 1 and ends January 31 of each calendar year. The coverage becomes effective on January 1, or February 1 if you enroll during January.
New Jersey state law prohibits abortion procedures 24 weeks after your last menstrual period (LMP).9 Therefore, the two-month enrollment window makes abortion-related coverage work like a lottery based on the date of conception.
| LMP | 24 Weeks | Covered |
|---|---|---|
| Jan 1 | Jun 17 | If enrolled by 1/31 |
| Feb 1 | Jul 18 | No |
| Mar 1 | Aug 16 | No |
| Apr 1 | Sep 16 | No |
| May 1 | Oct 16 | No |
| Jun 1 | Nov 16 | No |
| Jul 1 | Dec 16 | No |
| Aug 1 | Jan 16 | If enrolled by 12/31 |
| Sep 1 | Feb 16 | If enrolled by 1/31 |
| Nov 1 | Apr 18 | If enrolled by 1/31 |
| Dec 1 | May 18 | If enrolled by 1/31 |
A free fetal age ultrasound can help you determine whether the open enrollment timing expires before you reach 24 weeks past your last menstrual period.
Qualifying Life Events
Becoming pregnant does not allow you to skip over the open enrollment requirements. You do not automatically qualify for a special enrollment period. Here are the qualifying life events.
- Loss of health coverage
- Moving to a new service area
- Marriage
- Delivering a baby
- Adopting a child
MEDICAID ABORTION COVERAGE IN NJ
New Jersey Medicaid does cover abortions for pregnant women who are residents of the state and meet income eligibility requirements. Medicaid also covers prenatal care, plus labor and delivery should you choose to carry your baby to term. You can enroll anytime during the year without waiting for an open enrollment period as with individual coverage.
Schedule your free ultrasound to obtain the medical confirmation of pregnancy required by Medicaid.
- You will need positive proof of pregnancy in order to begin coverage.
- The ultrasound may expand your income-based eligibility.
Multiple Pregnancy
Pregnant women are eligible for Medicaid based in part on the number of babies she carries in her womb. The state determines income limits based on household size.10
- A woman with a single pregnancy counts as two people.
- A woman carrying twins counts as three people.
- A woman carrying triplets counts as four people.
Therefore, a pregnancy ultrasound is a critical first step. You cannot verify whether you are carrying twins or triplets from a blood or urine pregnancy test.
| Family Size | Monthly Income Limit |
|---|---|
| 2 | $2,429 |
| 3 | $3,052 |
| 4 | $3,675 |
| 5 | $4,299 |
| 6 | $4,922 |
| 7 | $5,545 |
| 8 | $6,169 |
Income Sources
New Jersey Medicaid counts income from a variety of sources to determine eligibility. Gather information about the following income sources before applying.11
- Gross wages, tips, commissions
- Social Security Income
- Interest or dividends
- Pensions, annuities
- Inheritances, gifts, prizes
- Veterans’ benefits
- Legal settlements
- Payment from trust funds
- Unemployment compensation
- Alimony or child support
- Public or private disability compensation
- Worker’s compensation
- Income from a parent(s) of needy children
- Rental income
Below are the sources of information for this article- last updated January 2017.
