Planned Parenthood Services and the Economic Landscape of Abortion Care
Planned Parenthood health centers are often described as “an irreplaceable component of our country’s healthcare system” and as providers of “lifesaving care.” These claims suggest that Planned Parenthood’s services are unique and not easily available from other providers. Planned Parenthood, by almost any measure, is a large organization with nearly 650 health centers in the U.S. alone and an international presence through Planned Parenthood Global Health Partners. It has $1.5 billion in net assets and $1.1 billion in current annual revenue, receiving approximately $555 million in government funding in the fiscal year ending June 30, 2016.
The Service Profile and Clinical Volume
In 2015, Planned Parenthood health centers saw 2.4 million patients during 4 million clinical visits and provided 9.5 million services. Planned Parenthood centers are largely focused on contraceptive services, sexually transmitted infection testing, and abortions. A service is defined as a “unique clinical interaction” – a term used within their reporting structure. The largest volume of services is for Sexually Transmitted Infection (STI) testing and treatment. According to the annual report, nearly 99% of Planned Parenthood STI services involve testing – not treatment. Of the 4,266,689 services totaled in this category, only 53,396 involved treatments.
The second largest volume of Planned Parenthood’s services is for contraception. Of that group of services, 1,936,360 services, or 68.9%, were for reversible contraception clients as follows:
- Oral pill (41%)
- IUD and implant (16%)
- Progestin-only injectable (15%)
- Combined hormone ring (5%)
- Combined hormone patch (2%)
- Other (21%)
Cancer screenings and prevention services include breast exams and pap tests. However, there is little or no demonstrable capability for definitive diagnosis or a range of treatments for any disease or condition at Planned Parenthood centers. For example, breast exams are insufficient for a confirmatory diagnosis of breast cancer, as additional diagnostic testing or technology such as a mammogram or biopsy is required.
Economic Analysis of Abortion Care and Out-of-Pocket Costs
Most females who used their private insurance to pay for their abortion had out-of-pocket costs for their services, including 62% of those who accessed medication abortion and 76% of those who received a D&E procedure. Median private insurance reimbursement rates for abortion and ancillary services vary significantly based on the procedure type. For those with coverage through employer sponsored insurance plans, median out-of-pocket costs were less than $100 for medication abortion but rose to over $200 for D&E procedures, typically done later in pregnancy.
Comparison of Costs and Reimbursements
The following data illustrates the median financial landscape for various abortion procedures based on insurance claims analysis:
| Procedure Type | Median Private Insurance Reimbursement | Typical Out-of-Pocket Cost |
|---|---|---|
| Medication Abortion | $562 | Less than $100 |
| D&C Procedure | $1,046 | Less than $100 |
| D&E Procedure | $4,872 | Over $200 |
Ancillary Services and State Policy Impacts
For non-bundled scenarios, other services commonly billed as part of the abortion service include ultrasounds, pain medication/sedation, Rh testing, and the office visit. Ultrasounds were commonly billed with a D&C procedure (71%) and D&E procedure (69%). Ultrasound is not a medical requirement for first-trimester abortion care but is required by some state laws. Furthermore, out-of-pocket costs were substantially higher for D&C and D&E procedures provided in ambulatory/outpatient hospital settings than office-based settings.
In recent years, insurance coverage of abortion has been the focus of state lawmakers in their efforts to either restrict or expand access to abortion services. In the five states that had policies eliminating cost-sharing for abortion services in place in 2023, the share of women with cost-sharing for an abortion decreased substantially. However, even before these state actions, many women did not use their insurance to pay for abortions, even when it was covered, because of the highly confidential and stigmatized nature of abortion care. As a result, most people with private insurance end up paying the full costs of abortion that can range from $563 for medication abortion to upwards of $895 for second-trimester abortion.