California’s SB 245, the Abortion Accessibility Act, requires state-regulated health plans and insurance policies to cover abortion and abortion-related services with no out-of-pocket cost to the patient. Signed into law and effective January 1, 2023, it prohibits deductibles, copayments, coinsurance, and any other cost-sharing for these services, and it bars insurers from requiring prior authorization for outpatient abortion care.1California Legislative Information. California Senate Bill 245 – Health Care Coverage: Abortion Services: Cost Sharing If you have a covered plan, your financial responsibility for an abortion is zero.
What the Law Eliminates
Two things, both at the point of care. First, cost-sharing. A covered plan cannot bill you a deductible, copayment, coinsurance, or any other charge for abortion services. Second, prior authorization for outpatient abortion. Plans cannot make you wait for internal approval before you receive care, and they cannot impose annual or lifetime limits on outpatient abortion services.2California Legislative Information. California Insurance Code 10123.1961 Inpatient abortion, which is far less common, remains subject to standard utilization review.
“Abortion” under the law means any medical treatment intended to end a pregnancy other than one aimed at producing a live birth, so both medication and procedural abortion are included.2California Legislative Information. California Insurance Code 10123.1961 The zero-cost rule also extends to preabortion and follow-up services: consultations, medically necessary testing or screening, and post-procedure care.1California Legislative Information. California Senate Bill 245 – Health Care Coverage: Abortion Services: Cost Sharing
The law applies to any plan or policy issued, amended, renewed, or delivered on or after January 1, 2023, which at this point covers essentially all active state-regulated coverage.1California Legislative Information. California Senate Bill 245 – Health Care Coverage: Abortion Services: Cost Sharing
Which Plans Are Covered
SB 245 reaches coverage regulated by the State of California. That falls into two main buckets:
- Health care service plans regulated by the Department of Managed Health Care (DMHC). Most California HMOs fall here.
- Health insurance policies regulated by the California Department of Insurance (CDI). PPOs and indemnity-style plans generally fall here.
Medi-Cal managed care plans are also subject to the law, along with their independent practice associations, preferred provider groups, and delegated entities handling physician services or utilization review.3California Legislative Information. California SB-245 – Health Care Coverage: Abortion Services: Cost Sharing Plans sold through Covered California qualify because they are state-regulated, and student blanket disability policies providing hospital, medical, or surgical coverage are included as well.2California Legislative Information. California Insurance Code 10123.1961 Specialized plans like standalone dental or vision are exempt and generally don’t cover abortion in the first place.
The Self-Funded Employer Plan Exemption
This is where people get caught off guard. If your employer self-funds its health plan rather than buying coverage from an insurer, SB 245 does not apply to you. Self-funded plans are governed by the federal Employee Retirement Income Security Act, and ERISA preempts state insurance mandates.4Office of the Law Revision Counsel. 29 USC 1144 – Other Laws
The confusing part: many self-funded plans are administered by familiar carriers like Blue Shield or Anthem, so the member ID card looks identical to a fully insured plan’s. The distinction that matters is whether your employer bears the financial risk for claims (self-funded) or pays premiums to an insurer that bears the risk (fully insured). Your plan documents or HR department can tell you which you have. Government plans and church plans are also generally outside ERISA and may have their own rules.
If You Have an HSA-Qualified High-Deductible Plan
SB 245 carves out an exception for high-deductible health plans paired with Health Savings Accounts. If your plan qualifies as an HDHP under federal tax law, the no-cost-sharing rule kicks in only after you’ve met your annual deductible for the benefit year.5California Legislative Information. SB-245 Health Care Coverage: Abortion Services: Cost Sharing
The carve-out exists to protect your HSA eligibility. Federal rules require HDHPs to maintain a minimum deductible, and waiving that for abortion before it’s met would disqualify the plan. For 2026, the minimum HDHP deductible is $1,700 for individual coverage and $3,400 for family coverage. Once you reach your deductible, abortion services are then covered at zero cost like any other plan.
Practically, this means HDHP enrollees can still face real out-of-pocket costs early in the plan year. If affordability is an issue, ask the provider about financial assistance before scheduling.
Keeping the Bill Private
Even when a plan pays everything, the Explanation of Benefits sent to the policyholder’s address can reveal what services were received. For a dependent or spouse on someone else’s plan, that’s a privacy problem. California’s AB 1184, effective July 2022, lets you ask your plan to send EOBs for sensitive services to a different address or through a confidential communication method. Abortion qualifies. Contact your plan to set up confidential communications before you receive care, not after.
Federal HIPAA rules also require plans and providers to limit the use and disclosure of your health information to the minimum necessary.6U.S. Department of Health and Human Services. Your Rights Under HIPAA
What to Do If You’re Charged Anyway
If a covered plan bills you a copay, deductible, or coinsurance for abortion services, there’s a clear enforcement path. California requires you to first file a grievance with your health plan and give it 30 days to respond. If the response is unsatisfactory or no response comes, you escalate to the state regulator.7California Department of Managed Health Care. How to File a Complaint
- For DMHC-regulated plans (most HMOs): file online through the DMHC Help Center, or submit by mail or fax. The DMHC generally resolves complaints within 30 days.
- For CDI-regulated policies (most PPOs and indemnity plans): file through the California Department of Insurance complaint portal. Note that declining the CDI’s independent review process may forfeit your right to pursue legal action against the insurer over the disputed service.
Your member ID card usually names the regulating agency. If you’re unsure, DMHC maintains a searchable directory of the plans it regulates.
If You’re Uninsured
SB 245 only works through insurance; it does nothing directly for the uninsured. California does offer other routes. Pregnancy-related care, including abortion, is generally covered by Medi-Cal, and expedited eligibility screening is often available at the clinic where you plan to receive care. California also funds an uncompensated care program for abortion services open to both residents and people traveling from out of state, which participating providers can walk you through at scheduling. ACCESS Reproductive Justice, the state’s primary abortion fund, assists with practical costs like transportation, lodging, and childcare.