Abstract
Importance Due to legal restrictions, many patients pay out of pocket for later abortion care in the US. Knowledge of facility availability, self-pay prices, and state Medicaid acceptance may enable timely access to care.
Objective To estimate quoted self-pay prices and assess state Medicaid acceptance for later abortion care from 23 to 33 weeks of pregnancy duration.
Design, Setting, and Participants This cross-sectional study used a mystery caller design from November 2024 through April 2025. Contacted US health care facilities (clinics and hospitals) advertised offering abortion care at or after 23 weeks in August 2024.
Exposure Mystery calls at 2-week pregnancy duration periods advertised for providing care (23, 25, 27, 29, 31, and 33 weeks) to request self-pay prices. Facilities in states permitting Medicaid coverage received additional calls regarding acceptance.
Main Outcomes and Measures Facility availability by pregnancy duration, quoted self-pay prices, and reported state Medicaid acceptance.
Results A total of 130 facilities in 20 states and the District of Columbia advertised providing abortion care at or after 23 weeks of pregnancy (52 clinics, 78 hospitals). The overall response rate for obtaining at least 1 usable quoted self-pay price or range was 60.2% (112 of 186 facilities). Median self-pay prices increased from $3000 at 23 weeks to $17 250 at 33 weeks, with a statistically significant increase of $2541 from 23 to 25 weeks. The number of facilities providing care declined from 130 at 23 weeks to 31 at 25 weeks and 3 at 33 weeks. Among facilities in states with Medicaid coverage, 73 of 105 (69.5%) consistently reported accepting Medicaid; acceptance declined at later pregnancy durations and varied by state.
Conclusions and Relevance In this cross-sectional mystery call study of 130 facilities advertising later abortion care in August 2024, self-pay prices increased with pregnancy duration, while service availability and Medicaid acceptance declined. Improving self-pay price transparency and expanding the availability of later abortion care, especially in states with Medicaid coverage, may facilitate more timely access to care.