The Affordable Care Act lets insurers on its marketplaces cover abortions beyond the narrow cases where federal money may pay for them, which GAO calls "non-excepted" services. Where they do, the law requires the coverage to be paid for separately: a separate premium of at least $1 per enrollee per month, kept apart from federal subsidy money.
GAO was asked by a group of senators and representatives to count those plans for 2026 and check how the money is handled. Its report came out September 15.
How many plans, and where
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.
Those plans were in 19 jurisdictions, D.C. included. State law largely decides it:
| State law | States | Plans covering |
|---|---|---|
| Coverage prohibited | 14 | 0 of 2,109 |
| Allowed only in limited circumstances | 11 | 0 of 2,235 |
| Coverage generally required | 13 | 1,609 of 1,620 |
| No law either way | 13 | 110 of 691 |
"None of the QHPs in the 25 states with laws restricting the coverage of non-excepted abortion services provide such coverage."
Enrollment: "About 4.4 million individuals enrolled in QHPs, or about 24 percent, were enrolled in a QHP that provided coverage of non-excepted abortion services in June 2026," out of about 19 million marketplace enrollees. The figure is preliminary.
The $1 charge
All 15 insurers GAO surveyed charge exactly $1 per enrollee per month, the legal minimum. All 15 first estimated the actual cost at less than that. Of the eight that shared an estimate, all put it under 50 cents a month, and five at 15 cents or less. Three told GAO they collect more in these premiums than they spend on the coverage. CMS guidance from December 2025 lets insurers treat the leftover as ordinary premium once the year's claims are settled.
Where GAO found gaps
- Billing: of 13 insurers that bill enrollees directly, two "did not follow one of the three methods identified in CMS regulation" for showing the separate charge. One has said it will add a notice.
- Paperwork: one insurer had no segregation plan for one state, and three had plans but did not submit them because their states do not ask for them. Most assurance statements were unsigned.
- Oversight: "CMS officials told us they do not collect or review information issuers are required to submit to state departments of insurance." CMS says the law gives that oversight to the states.
- Shopping: two insurers said consumers cannot see the full scope of the coverage until after they enroll.
In California, Colorado and Minnesota, insurers receive these premiums from the state for some or all enrollees. California officials said the money comes from the state's general fund, with no federal funds.
What GAO did not find or recommend
- It makes no recommendations. It told CMS about the gaps so CMS can decide whether more guidance or outreach is needed. CMS said it would decide case by case whether to investigate, offer technical help or take enforcement action.
- It does not find that federal funds paid for any abortion. Its language is that practices "may have been inconsistent with federal requirements."
- It does not count how many abortions were covered or what was spent.
- Its insurer findings come from 15 insurers and are not generalisable.