Will your health plan pay for an abortion now that the Supreme Court has overturned Roe v. Wade?

Even before the June 24 ruling, insurance coverage for abortion varied widely. Now the difficulty is much more complex as states set various rules — about half are expected to limit or ban abortion in just about all circumstances.

To be clear, though, the query of whether an insurance plan covers abortion just isn’t similar to whether abortion is allowed in a state. Coverage issues are more complicated and governed by a wide selection of things, including the extent of abortion access a state allows.

How dense a thicket is it? Abortion could also be covered by a health plan, but when no providers can be found, patients do not have access. Nevertheless, individuals with insurance that doesn’t cover abortion can still get one — but provided that it’s available of their states or they’ll afford to travel and pay out-of-pocket. There are also a bunch of unanswered questions on whether states that restrict abortion may have the legal authority to focus on abortion coverage in employer plans.

The problems will likely be before the courts for years to come back.

“States will pass laws, there can be some conflict, after which it goes to the courts,” said Erin Fuse Brown, director of the Center for Law, Health & Society on the Georgia State University College of Law. “It might be some time.”

Within the meantime, listed below are answers to a few common questions.

1. Are health plans — or employers — required to supply coverage for elective abortions?

The straightforward answer is “no.”

“There is not any law that requires any health plan, employer-based or anything, to cover an elective abortion,” Fuse Brown said.

Whether or not they do is more complicated.

Some job-based health plans cover elective abortions. Patients can search their plan documents or call their insurers directly to examine.

Coverage is more likely in plans offered by self-insured employers because a federal pensions law generally preempts state regulation of those health plans. Self-funded employers, which are likely to be the larger ones, pay the medical bills, although they often hire third parties, sometimes health insurers, to handle claims and administrative work.

Still, thousands and thousands of Americans work for smaller employers, which are likely to buy plans directly from health insurers, which then pay the medical bills. Those plans, often known as “fully insured,” are subject to state laws, whose approaches to abortion coverage have long varied.

Eleven states bar those private plans from covering abortion in most circumstances, in line with KFF, although among the states allow consumers to buy an insurance rider that may cover abortion costs.

If you happen to’re unsure what style of health plan you’ve got, ask the administrators.

“There isn’t a technique to tell from the face of your insurance card in the event you are fully insured or self-funded,” Fuse Brown said.

For the greater than 14 million Americans who buy their coverage through the Inexpensive Care Act marketplaces, their state of residence is essential.

Twenty-six states restrict abortion coverage in ACA plans, while seven states require it as a plan profit, in line with KFF. Those states are California, Illinois, Maine, Maryland, Latest York, Oregon, and Washington.

The principles for Medicaid, the federal-state health program for individuals with low incomes, also vary. Thirty-four states and the District of Columbia follow the so-called Hyde Amendment, which bars federal funds from paying for abortions, except in cases of rape or incest or to save lots of the lifetime of the mother, although some states allow coverage for other medically mandatory abortions.

For all those reasons, it isn’t surprising that research published within the journal Health Affairs in April noted that patients paid out-of-pocket for nearly all of abortions (69% in a single study). The researchers found that the median cost of a medicine abortion was $560 and that abortion procedures ranged from a median of $575 in the primary trimester to $895 within the second.

2. What about coverage for pregnancy-related complications that require treatment just like abortion?

Insurance policies must cover take care of essential health services, including medically mandatory pregnancy care and abortion when carrying a pregnancy to term would endanger a patient’s life.

Under the Pregnancy Discrimination Act of 1978 and other rules, Fuse Brown said, “pregnancy and prenatal care, including high-risk pregnancies, and obstetric care usually is required to be covered.”

In an ectopic pregnancy — when a fertilized egg implants outside the uterus — the embryo just isn’t viable, and the condition is usually life-threatening to the mother without medical treatment. Many other scenarios could come into play, including situations during which a girl has a miscarriage but not all of the tissue is expelled, potentially resulting in a dangerous infection.

Although all state laws that currently restrict abortion include an exception to save lots of the lifetime of the mother, what constitutes a life-threatening scenario just isn’t at all times clear. Meaning physicians in abortion-ban states could have to weigh the pregnant person’s medical risk against possible legal ramifications.

“That is less of a coverage query and more of an issue of whether providers within the states that ban abortion are going to supply the care,” said Katie Keith, a research faculty member on the Center on Health Insurance Reforms at Georgetown University. “All of those laws are designed to relax behavior, to make it so unattractive or scary to providers to maintain them from doing it in any respect.”

3. Can residents of states where abortion is against the law get coverage in other states or help with travel costs?

In recent weeks, many large employers — including Microsoft, Bank of America, Disney, and Netflix — have said they are going to arrange programs to assist pay travel costs so employees or other beneficiaries in states with bans can travel to get an abortion elsewhere.

However it is not as straightforward because it sounds. Employers may have to determine whether employees will access this profit through the health plan or another reimbursement method. Protecting privacy, too, could also be a problem. Some consultants also said employers will need to contemplate whether their travel reimbursement profit conflicts with other rules. If an employer, for instance, covers travel for abortion procedures but not for an eating disorder clinic, does that violate the Mental Health Parity and Addiction Equity Act? If a plan has no providers willing or in a position to do abortions, does it violate any state or federal network adequacy rules?

Lawmakers must take into consideration these conflicts, said Jessica Waltman, vp for compliance at worker advantages company MZQ Consulting. “They might be putting all of the employer group plans of their state in a really precarious position if that state law would prohibit them from complying with federal law,” she said, particularly in the event that they restrict access to advantages called for within the Pregnancy Discrimination Act.

There are other potential conflicts if an employer is in a state that enables abortion but a employee is in a state that restricts it. “If I’m an Oregon-based company, my insurance plan must provide for abortion coverage, but what do I do about an Oklahoma worker? I do not know the reply,” said René Thorne, a principal at Jackson Lewis, where she oversees litigation that involves self-insured firms.

Also uncertain is whether or not state laws will take aim at insurers, employers, or others that supply advantages, including travel or televisits, for abortion services.

Laws that restrict abortion, Thorne wrote in a white paper for clients, generally apply to the medical provider and sometimes those that “aid or abet” the abortion. Some states, including Texas, allow private residents to sue for $10,000 anyone who provides an illegal abortion or helps an individual access an abortion.

Whether those laws can be applied to employers or insurers will undoubtedly find yourself within the courts.

“We’re in uncharted territory here, as we have never before been in a situation where plans, in addition to their employer sponsors and people administering the plans, might face criminal liability in reference to a plan profit,” said Seth Perretta, a principal on the Groom Law Group, which advises employers.

Answers won’t come soon, but “there can be a lot litigation around this,” said Thorne.