Health Insurance Exchanges: Coverage of Non-Excepted Abortion Services by Qualified Health Plans in 2026

What GAO Found

Under federal law, insurance plans offered in health insurance exchanges—known as qualified health plans (QHP)—may cover abortion services consistent with federal and state laws. Based on federal law applicable in 2026, QHPs are prohibited from using federal funds, such as income-based tax credits, to help pay for abortion services except where the pregnancy is the result of rape or incest, or the life of the pregnant woman would be endangered unless an abortion is performed. GAO refers to services that do not meet that exception as “non-excepted abortion services.”

In 2026, federal data show 26 percent of QHPs (1,719 of 6,655) in the 50 states and District of Columbia covered non-excepted abortion services. Coverage of these services varied across states, mostly due to state laws restricting or requiring QHP coverage of non-excepted abortion services.

State Laws and Coverage of Non-Excepted Abortion Services by Qualified Health Plans (QHP), 2026

Source: GAO analysis of state laws and Centers for Medicare & Medicaid Services data. | GAO-26-108995

Federal law places requirements on the provision of non-excepted abortion services coverage, including requiring issuers to estimate the costs of this coverage at no less than $1 per enrollee, per month. All 15 selected issuers in 10 selected states from which GAO obtained information reported that the average estimated cost of this coverage was less than $1 per enrollee, per month, and that premium amounts were set to $1 to comply with federal requirements. Eleven selected issuers indicate on bills to enrollees or in plan materials that part of the premium is for non-excepted abortion services coverage. All 15 issuers reported that information about this coverage is in publicly available documents.

According to GAO’s review of documents and interviews with Centers for Medicare & Medicaid Services (CMS) officials, the agency provides general guidance to states and issuers on how to comply with federal regulations on coverage of non-excepted abortion services. For example, CMS provides issuers templates for submitting information on coverage of these and other services on standardized benefits and coverage documents. CMS officials told GAO that the oversight of this coverage also differs based on the type of exchange. States with state-based exchanges, according to CMS officials, retain the role of regulating insurance, and as a result, maintain a prominent role in QHP certification.

GAO identified instances where issuers’ practices may have been inconsistent with federal requirements related to non-excepted abortion services coverage. In August 2026, CMS officials stated that they would determine what actions to take, depending upon the facts of the situation.

Why GAO Did This Study

In 2026, about 19 million people enrolled in QHPs through federal and state-based exchanges. Federal law requires these plans to cover a package of essential health benefits. While this package does not include abortion services, QHPs may cover such services, consistent with federal and state laws.

GAO was asked to review QHPs that do and do not cover abortion services, and to describe other aspects of that coverage. This report describes whether QHPs offered on exchanges cover non-excepted abortion services in 2026, and provides additional information—such as information on the scope and the cost of non-excepted abortion services coverage—for selected QHPs that covered such services. It also describes the role CMS plays in ensuring compliance with applicable federal requirements.

GAO analyzed CMS data for 2026, and federal and state laws related to abortion services coverage. GAO also reviewed documents and interviewed representatives from 15 selected issuers offering QHPs that cover non-excepted abortion services across 10 selected states. States and issuers were selected based on geographic variance, 2025 insurance marketplace enrollment, and the number of QHPs covering non-excepted abortion services in each state, among other things.

For more information, contact John E. Dicken at DickenJ@gao.gov.