Smart Money Podcast: Your Guide to Reproductive Health Care Costs, Options and Economic Implications

Tess Vigeland
Sam Taube
Sean Pyles
By Sean Pyles,  Sam Taube and  Tess Vigeland 
Published
Edited by Kathy Hinson

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Welcome to NerdWallet’s Smart Money podcast, where we answer your real-world money questions. In this episode: Understand recent and upcoming changes in costs and access to reproductive care, as well as resources to manage them.

This episode delves into the complex and ever-changing landscape of reproductive care costs. Hosts Sean Pyles and Sam Taube discuss the financial implications of recent high-profile court cases, including the overturning of Roe v. Wade and the Burwell v. Hobby Lobby decision, which significantly transformed insurance coverage for birth control. Sean and Sam break down the before-insurance costs of contraceptives and explain how a new over-the-counter birth control pill, Opill, could help make birth control more accessible.

Sam also speaks with Daily Garcia, a director at the Planned Parenthood Federation of America, about the costs and barriers associated with reproductive health care, particularly birth control and abortion. She explains how birth control and abortion costs can vary significantly based on type, insurance coverage and individual circumstances. She also addresses the impact of state restrictions and resources available to help people overcome them.

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Episode transcript

Sean Pyles: Health care in general is rarely, if ever cheap, it costs the average working age American up to 15% of their income, including insurance payments. But for people needing reproductive care, the costs can go far beyond that, especially with the overturning of Roe v. Wade.

Daily Garcia: Barriers to accessing abortion and other health care services can be finding child care, taking time off work, navigating the costs of transportation and lodging associated with that travel, and oftentimes hundreds if not thousands of miles.

Sean Pyles: Welcome to NerdWallet's Smart Money Podcast. I'm Sean Pyles.

Sam Taube: And I'm Sam Taube.

Sean Pyles: Today, we feature episode two of our Nerdy deep dive into the cost of bodily autonomy.

Sam Taube: And today, we're looking at the financial side of reproductive care. It's something that's really in flux right now.

Sean Pyles: When you say reproductive care, you're talking about things like birth control, right?

Sam Taube: Yeah, birth control is part of it, but so is access to abortion.

Sean Pyles: Indeed. So Sam, you're taking the Smart Money Podcast into some politically contentious territory here.

Sam Taube: Well, Sean, the thing is that the cost of reproductive care is changing so fast right now because the issue is contentious. Laws are changing, the approval status and insurance coverage of certain medications is changing, and people's family planning is affected by that.

Sean Pyles: Sure.

Sam Taube: And I just want to say, I know that we have a diversity of listeners here, and some folks who are hearing this episode might object to things like abortion and birth control, maybe for religious reasons or personal reasons, and I'm not here to change anyone's mind about those things.

I am going to talk about the costs of those things, and I'm also going to talk about different resources and financial strategies to help folks afford those costs. Because regardless of your beliefs about abortion and birth control, the fact is that they're in demand for quite a lot of people. The Centers for Disease Control and Prevention say that about a quarter of women aged 15 to 49 use either birth control pills or a contraceptive device.

Sean Pyles: So we're talking about the health care needs of tens of millions of people here?

Sam Taube: Exactly.

Sean Pyles: Well, let's get into it. When I think of changing laws about reproductive care, my mind goes to the overturning of Roe v. Wade last year.

Sam Taube: Sure. The Supreme Court's ruling on Dobbs v. Jackson Women's Health Organization in June of ’22 got rid of the federal right to abortion that had been in place since Roe was decided in 1973. And that's had needless to say, massive ongoing effects on the cost of reproductive care, and we'll get to that in a bit.

Sean Pyles: But I notice you keep bringing this conversation back to birth control.

Sam Taube: I do. When we talk about the changing costs of bodily autonomy health care, whether it's birth control or abortion or HIV prevention or gender-affirming care or whatever, we're often talking about a chain reaction of court cases that affect the legality and the insurability of these things. And that chain reaction really starts with the Supreme Court case about birth control insurance coverage that was actually decided eight years before Dobbs.

Sean Pyles: Wait, I remember this. Was this the Supreme Court case about Hobby Lobby?

Sam Taube: Indeed, it was. Yep. So back in 2014, the Supreme Court ruled in Burwell v. Hobby Lobby that employers don't have to provide coverage for certain kinds of birth control through their health care plans if they felt that those birth control methods were against their religion. This case established some really important precedents for limiting insurance coverage for health care that gives people autonomy over their own bodies. And the impact of that is going to come up several times throughout this series. I think we already touched on it, in how it's affecting HIV prevention, in the last episode.

Sean Pyles: Yeah, we did, but let's stay on track here. What did this court case do?

Sam Taube: Right. So the immediate effect of Burwell v. Hobby Lobby was that tens of thousands of people lost birth control coverage through their employer-sponsored health insurance, and tens of millions more were put at risk of losing it if their employer decided to stop covering it. And the pre-insurance costs of birth control can be pretty hefty. Pills can cost up to $600 per year without insurance, while some birth control devices like the NuvaRing can cost up to a thousand dollars a year.

Sean Pyles: Not something you want to have to pay out of pocket for.

Sam Taube: No, you don't. I actually had a conversation with Daily Garcia, a director at the Planned Parenthood Federation of America, about how people meet some of these out-of-pocket costs.

Daily Garcia: Birth control related expenses, including access to free birth control, varies really from state to state and person to person. Individual costs can depend on the type of birth control a person decides to use and their insurance coverage. Luckily, thanks to the Affordable Care Act, all birth control methods should be at zero copay to patients with health insurance, including those who are covered by Medicaid.

Sam Taube: While we're on this topic, we should also probably mention the new over-the-counter birth control pill.

Sean Pyles: Yes, I've heard about this. It's called Opill, right?

Sam Taube: Yeah, Opill. It's a daily oral contraceptive, much like a regular birth control pill, and the FDA approved it back in July. So there are two major differences between Opill and prescription birth control pills. Number one, Opill only contains one hormone, progestin, while most birth control pills contain progestin and estrogen. Number two, Opill is available over the counter without a doctor visit required.

Sean Pyles: That number two difference seems like a pretty big deal, especially when it comes to accessibility.

Sam Taube: Oh, definitely. More than 100 million Americans don't have a primary care doctor, which is something that you generally need to get any kind of prescription drug, including prescription birth control. Also, the reality is that some people have to keep their birth control secret, and if you're hiding it, say from a disapproving parent or intimate partner, then this could make your life easier because it cuts out a visit to the doctor. It makes it easier to be discreet.

Sean Pyles: Well, let's talk about the cost of Opill. Do we know what it's going to be for folks?

Sam Taube: We don't know yet. HRA Pharma, which is the company that makes Opill, hasn't released a price yet, and we also don't know how insurers are going to cover Opill if they do at all. Insurers are required to cover birth control with no copay if it's prescribed by a doctor, but that requirement doesn't necessarily apply to over the counter contraceptives like condoms, for example.

Sean Pyles: So it seems like cost could be a real roadblock here, especially if insurers don't cover it.

Sam Taube: It definitely could, and we just won't know for sure until HRA Pharma sets a price and insurers decide where they stand with it. But we do know two things. Number one, HRA Pharma is a business and they presumably want Opill to be competitive in the market, so it's going to need to compete with prescription birth control pills, which as we've discussed, can be up to $600 a year, but are often free with insurance. Number two, they're working on a consumer assistance program for people who have trouble affording Opill.

Sean Pyles: I guess on the one hand, they want everyone to be able to get it, but on the other they think some people aren't going to be able to afford it without help.

Sam Taube: Exactly.

Sean Pyles: All right. Well, let's take a quick break and when we come back, we'll dive into the costs around ending a pregnancy. To share your ideas, concerns, solutions around the cost of bodily autonomy, leave us a voicemail or text the Nerd hotline at 901-730-6373. That's 901-730-NERD, or email a voice memo to [email protected].

Sam Taube: So Sean, we can't discuss the costs of reproductive health care without also mentioning abortion and how the costs of abortion are changing in the post Roe v. Wade era.

Sean Pyles: Right. It's a controversial topic, but as you said earlier, it is in demand.

Sam Taube: Yep. About 600,000 legal abortions were performed in the U.S. in 2020 according to the CDC. Now, when we talk about abortion, it's common to center the discussion around the right and ability to end an unwanted pregnancy, but it's important to remember that people terminate pregnancies for a number of reasons.

Sean Pyles: Right.

Sam Taube: The same procedures people use to end an unwanted pregnancy are also used to expedite some miscarriages and end potentially life-threatening pregnancies. And in the Dobbs ruling, the Supreme Court basically gave states the ability to restrict the access to abortion procedures however they choose no matter what the person's reason for needing one is.

But even before June 2022, abortion was very hard to access for many Americans. This is another topic that I talked to Daily Garcia about.

First, can you tell me a bit about the cost before insurance of different types of abortions like medication versus surgical?

Daily Garcia: Before giving you a hard number I think it's important to take into consideration that cost really does vary depending on, for example, the type of abortion you need, how far along in the pregnancy you are, the state or health center where you get your care, whether you have health insurance, whether that's private or you have governmental insurance like Medicaid that will help you pay for your abortion and whether you can get other types of financial assistance to help you cover that cost.

Another thing that helps that variation is really the restrictions in certain states. So for example, if a state requires for you to have an in-person waiting period, so you have to come in twice into the clinic, then that means that it's a higher cost for the patient.

Overall, the abortion pills or how you say, a medication abortion, right? Can cost up to and around $800, but it's often less. The average cost that we see at Planned Parenthood affiliates is usually around $580.

An in-clinic abortion are what a lot of people refer to as your surgical abortion. In the first trimester, they can cost a few hundred dollars all the way up to $1,500. It varies widely. And the average cost of the first trimester in clinic abortion at Planned Parenthood though is about $600. The cost of a second trimester abortion starts at around $715.

Sam Taube: You kind of touched on my second question, but I want to kind of ask in more detail with the context of Dobbs. Do insurers typically cover abortion-related costs and has that changed because of Dobbs or is it expected to change?

Daily Garcia: There are states actually where private insurance and Medicaid can cover the cost of an abortion, but I will also warn that the reality is that there's about 10 states that have already passed bans prohibiting comprehensive plans from covering abortion, and 25 states actually have banned coverage for abortion for the insurances that you can purchase in their health insurance marketplace. Sometimes even those, you'd have to purchase a separate rider for those that qualify for Medicaid.

Luckily, I think for a lot of patients that come to Planned Parenthood and our independent partners, so other clinics that are non-Planned Parenthood, there are resources that we provide to support patients to be able to afford an abortion if they find themselves unable to. There's also abortion funds that play a critical role in supporting accessibility to an abortion.

We do feel like in this time what the Dobbs v. Jackson case has done is really embolden state legislatures to continue to pass more and more bans on being able to use their health insurance or being able to use Medicaid.

Sam Taube: The next thing I wanted to ask about are some of the kind of indirect costs that can come with getting an abortion post-Dobbs, like travel and lodging. If you could speak to what some patients encounter. And the other follow-up question that I want to ask is how often it's actually necessary for people to travel to a facility to get an abortion.

Daily Garcia: We knew when this Supreme case happened that wealthy individuals and those with resources and in power, right, will always be able to access abortion. That was the case before Roe as well. The impact of overturning Roe is largely felt by Black, Latino and indigenous people, immigrants, people with low incomes and people in rural areas. If you’ve ever tried to navigate somebody out of their rural area who doesn't have a car, it is incredibly hard.

These are all communities who have long faced barriers to abortion access due to just systemic discrimination and neglect.

Barriers to accessing abortion and other health care services can be finding child care, taking time off work, navigating the costs of transportation and lodging associated with that travel, and oftentimes hundreds if not thousands of miles. Those things have always existed and are now really at the front of mind for people who have to travel for their abortion.

It can be very expensive when you're talking about planning a trip, how much gas is going to cost you to fill up your tank when you're having to do a road trip of hundreds of miles, how much does it cost to buy a last-minute airplane ticket. Right? You're talking about a time-sensitive procedure. If you need to fly out, that's going to be hundreds of dollars, hundreds of dollars that people just don't have and are struggling to come up with.

I'm going to shift into your last question of how often is it necessary now. I mean, Sam, when you're talking about people who live in banned states, the ability of a state where abortion is still accessible to provide a telemedicine abortion, right, or mail pills, that's only available if you live in that state. So if you live in a state where abortion is banned, that is not a possibility for you.

You still have to travel out of your state into a safe state to go into the clinic to access your abortion service. So unfortunately, even though we have this amazing amount of technology and resources that is able to allow us to mail medication abortion now, it only helps those that are in safe states. It doesn't help the ones that are struggling to get out of a state that has deemed this health care not available for them.

Sam Taube: You already kind of touched on this a little bit, but what resources are available to help cover abortion-related costs, whether that's the bill itself or the secondary costs we've been talking about?

Daily Garcia: Our affiliates have patient navigators who support patients traveling with the cost of travel. These patient navigators use our own internal funds as well as they coordinate with local abortion funds from the National Network of Abortion Funds to help patients with basic things, briefly like food, lodging, gas money, even flights.

In states that are receiving many of the patients who are traveling from banned states, we provide travel assistance to anywhere from 20 to 60% of the patients who need to travel out to see a Planned Parenthood. So these are Planned Parent specific statistics. On average, we provide around $300 per patient for this support. Many people are living paycheck to paycheck these days, and sometimes $300 is literally all they may have in their savings. And if we're thinking about longer distances to last-minute travel, that cost of travel balloons and could be up to a thousand dollars. Or perhaps you have a child that you don't have any child care with that would need to travel with you or you want your partner to come with you, that all adds up and becomes a serious barrier.

Sean Pyles: Now, Sam, in your interview Daily mentioned that Planned Parenthood and the National Network of Abortion Funds can help out with costs, and we'll provide links to both of those services in the show notes, but there are other organizations that provide assistance to abortion patients too, right?

Sam Taube: Definitely. There are a number of web portals and hotlines and things that can give prospective abortion patients information and connect them with organizations that can help them in their area. One of those is the National Abortion Hotline, which can be reached by phone or online, and they do consultations, they provide information and they sometimes offer limited financial assistance.

Sean Pyles: And isn't there also an abortion access website that works like a search engine?

Sam Taube: Yeah. That's ineedana.com. That one lets you filter your search for groups that provide specific kinds of assistance, like legal help or help for transportation costs or whatever that are near you.

Sean Pyles: Gotcha. Well, we will also include links to those websites in the show notes as well.

Sam Taube: Yep. Now Sean, Dobbs isn't the only recent court case that is making abortion harder to access.

Sean Pyles: Yeah. There was also recently a ruling about the medications that are used in some abortions, right?

Sam Taube: Yes, there was. On April 7, a federal judge in Texas issued a nationwide ruling that attempts to revoke the FDA approval of mifepristone, which is one of the two drugs that are used for most medication abortions.

Sean Pyles: So that would affect medication abortions nationwide, not just in states with anti-abortion laws?

Sam Taube: Correct. If the ruling goes into effect, it would still be possible to get a medication abortion using only the other medication abortion drug, which is called misoprostol. But that drug on its own might be less effective and often causes more painful side effects. People who want an abortion but aren't comfortable with those side effects might then need to travel to a clinic to get a procedure done instead of receiving virtual care and a medication abortion.

Sean Pyles: So this might be another example of making abortions more expensive via travel costs?

Sam Taube: Exactly.

Sean Pyles: Sam, you said if the ruling goes into effect, is there a question about that at this point?

Sam Taube: Yeah. So the ruling hasn't been implemented yet because it's tied up in appeals right now. The Supreme Court has basically blocked the decision for now. So mifepristone is still available while those appeals are being decided.

Sean Pyles: So Sam, we've talked about a lot of costs in this show, hundreds of dollars for birth control, hundreds of dollars for abortions, hundreds or even thousands of dollars in travel costs for people living in states with anti-abortion laws.

Sam Taube: That's right.

Sean Pyles: And we've also talked about how the insurance coverage of all of these things is in flux.

Sam Taube: Yeah. With all these court cases between Burwell v. Hobby Lobby and Dobbs v. Jackson Women's Health Organization, it's hard to keep track of what the actual costs of these things are.

Sean Pyles: It seems like one consequence of all of this is that a lot more people might face surprise bills for reproductive care in the years ahead. Are there any strategies our listeners can use to financially prepare for those kinds of bills?

Sam Taube: I don't know if there are any silver bullets, but there are a few things that can definitely help. One is just knowing your options for health insurance.

Sean Pyles: What do you mean by that?

Sam Taube: Well, as we've discussed, Burwell v. Hobby Lobby gave employers the right to opt out of providing insurance coverage for birth control. So if you have employer sponsored health insurance, as so many people do, it's important to read your plan materials and maybe even call the insurer to figure out what is and isn't covered. And if you have a plan that does exclude birth control, you do have other options. You can get to your state's online health insurance marketplace via healthcare.gov, although some people find those state marketplace sites kind of difficult to use.

Sean Pyles: And at NerdWallet, we have a tool that makes that a lot easier, don't we?

Sam Taube: Yes, we do, Sean. We will leave a link to NerdWallet's health insurance shopping tool in the show notes here.

Sean Pyles: All right, Sam. Well, what's next for our series on the cost of bodily autonomy?

Sam Taube: In the next episode, we'll be looking at some of the unique health care costs faced by LGBTQ+ people, how recent events have increased those costs, and where LGBTQ+ Americans can find help affording health care.

Andrea Romero: You can easily expect to be out for two, three, maybe as long as six months, depending on your surgical regimen and what's going on in other existing conditions. The ability to not earn income in three to six months, that will add up quickly to 10-, to 20- to 30,000 depending on what your income is and where you live.

Sean Pyles: All right. That's it for this episode of NerdWallet's Smart Money Podcast. Do you have a money question of your own? Turn to the Nerds and call or text us your questions at 901-730-6373. That's 901-730-NERD. You can also email us at [email protected]. Visit nerdwallet.com/podcast for more info on this episode and remember to follow, rate and review us wherever you're getting this podcast.

Sam Taube: This episode was produced by Tess Vigeland and me, Sam Taube. Sean helped with the editing, as did Liz Weston. Alana Benson and Pamela de la Fuente did our fact checking. Kevin Tidmarsh mixed our audio. And a big thank you to the folks on the NerdWallet copy desk for all their help.

Sean Pyles: Here's our brief disclaimer. We are not financial or investment advisors. This Nerdy info is provided for general educational and entertainment purposes and may not apply to your specific circumstances.

Sam Taube: And with that, until next time, turn to the Nerds.