Private health insurers in Colorado will need to cover abortion care beginning in January

Private health insurance carriers providing coverage in Colorado will have to fully cover abortion care starting in January 2025 under a law the Colorado Legislature passed in 2023.

Senate Bill 23-189 requires private health insurance plans to fully cover the cost of abortions starting in 2025. Colorado Gov. Jared Polis signed the bill into law as part of a package of abortion-related protections.

The law also requires insurance plans to cover medication abortions, contraception, vasectomies and treatment of sexually transmitted infections without copays. There is an exception for employers for whom abortion is against religious beliefs. The law also included an exception for government employers, but that could change following Colorado voters' approval of Amendment 79, which enshrines the right to abortion in the Colorado Constitution and will allow state and local government employers to cover abortion care, too.

The amendment won't affect implementation of the 2023 law, but abortion rights advocates want to see Colorado lawmakers pass legislation requiring similar coverage for public employees and Medicaid recipients when the General Assembly convenes next year.

Kiera Hatton Sena, policy director of the Colorado-based reproductive rights group Cobalt, said there is no other medical procedure that insurers do not cover "solely based on ideological means," and SB-189's requirements show that "reproductive health care is health care."

"Everybody should have access to the full spectrum of reproductive healthcare, and so what this really does is it levels the playing field so that reproductive healthcare isn't something only for the wealthy and people with means," Hatton Sena said.

State Sen. Lisa Cutter, a Littleton Democrat who sponsored the bill, said the law will close gaps related to access not only for abortion, but for STI treatment and family planning, too.

"We feel really strongly that reproductive healthcare is just an essential part of any primary and preventative care," Cutter said. "That has remained out of reach for many Coloradans, and so this bill is just aiming to address that."

Jack Teter, regional director of government affairs for Planned Parenthood of the Rocky Mountains, noted that the law also makes it so that someone doesn't need to meet their deductible to have abortion care covered. He estimated more than one million Coloradans will now have abortion care fully covered under the new law.

"A lot of people go through the entire year without meeting their deductible, and so even though a lot of people maybe had insurance coverage for abortion care in theory, in practice, that coverage would have very rarely kicked in," Teter said.

All insurance plans regulated by the Colorado Division of Insurance will fully cover abortion. The bill included language requiring individual and small group insurance to cover abortion, so long as the state got approval from the federal government to do so. The U.S. Department of Health and Human Services gave the state that approval in July.

Teter said people who work for large companies might have health insurance regulated by the federal government, so the new policy would not apply to them. A health insurance card should have "CODOI" written on it if it is regulated by the state, Teter said.

'Not something that people plan on'

State Rep. Lorena Garcia, an Adams County Democrat and another SB-189 sponsor, said it's important that people no longer need to purchase an additional rider if they want to have abortion covered by their health insurance.

"Who looks at insurance and says, 'Oh, I might get an abortion, I'm going to get an abortion rider'?" Garcia said. "No one does that, because it's not something that people plan on. It's a big difference because abortion care is something that many people end up needing… It's the same thing as, no one plans to have a heart attack, but sometimes they do."

"I'm excited that we're finally seeing implementation of a reduction in economic barriers to abortion care," Garcia added.

Teter said 93% of the patients PPRM has served in Colorado so far in 2024 paid out of pocket for abortion care, even though the organization accepts most insurance carriers. That includes people whose insurance does not cover abortion, public employees whose insurance does not cover abortion, and people who don't have any health insurance.

"To be able to use insurance is going to be a game-changer for our patients, especially those who have to worry about making ends meet and have to decide between groceries or rent and accessing the care that they need," Teter said. "We pay our premiums every month, and we count on our health when insurance to be there for us when we need access to healthcare."

Insurance coverage for abortion care will also mean less people in need of financial assistance to access abortion, Teter said, so abortion funds can direct more of their funding to people traveling from out of state or who don't have insurance.

Public funding ban for abortion gone

Teter said PPRM's top priority going into the 2025 legislative session is to implement insurance coverage for Medicaid recipients and public employees.

Garcia said she "absolutely" sees the Legislature pursuing such legislation as part of Amendment 79's implementation in 2025.

Hatton Sena said the earliest she would expect to see public coverage would be on July 1, 2025, though it could take longer given the tight budget the state will be working under next year.

"Knowing that we are in a difficult budget year, I think we have to just acknowledge that it may need to be spread over two years, but definitely no further," Hatton Sena said. "The voters were so clear that they wanted this, so I do think it should be a priority for the state legislature."

Though Republican President-elect Donald Trump said he would not support a federal abortion ban on the campaign trail, there is still concern over how his administration will target abortion access given a Republican trifecta in Washington D.C. Anti-abortion activist groups want to end other federal and state protections while vastly expanding restrictions on reproductive health care.

Even though Colorado secured the right to an abortion in its Constitution, a federal abortion ban would override state protections.

"There's lots of different horrible ways that they could approach the question of how they want to use the federal government to restrict or ban access to abortion care," Teter said about the incoming Trump administration.

Hatton Sena said there's no way to predict what Trump and the federal government might do, but that abortion access was "wildly popular across the country" in the election.

"I say bring it," Garcia said.

Cutter said Colorado officials will "continue to do everything we can to protect access" to abortion in the state.

"That is a personal freedom," she said. "And protecting that access to reproductive healthcare, and abortion care specifically, saves lives."