Obamacare Provokes 21 States Into Banning Abortion Coverage By Private Health Insurers

"What they're trying to do make abortion more difficult to access and unaffordable for women, and this is one of the ways they can do that," said Gretchen Borchelt, director of state reproductive health policy at the National Women's Law Center in Washington. "It's part and parcel of the larger effort to make abortion harder for women to get."

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Women who want to make sure abortion is a covered service -- or want to be certain that it isn't -- will have to look at the fine print when choosing a health plan, but won't need to worry about the complex movement of money behind the scenes, Borchelt said.

"It's not wraparound coverage. It's not supplemental coverage. It is just part of the regular, comprehensive plan that's being offered, so it's just the way insurance works now," Borchelt said. "We used to talk about it as being two checks that the consumer would have to write because of the segregation requirements, but that's not the way it's being implemented."

In states like Pennsylvania and Missouri, however, the situation is more complicated. These and other states allow women to buy a "rider," or supplemental insurance plan, solely to cover abortion. The trouble is, abortion-rights advocates say, these insurance products don't seem to exist.

"We haven't been able to ascertain if health plans are actually offering these riders," Borchelt said. "My sense has also been that health plans also don't know that riders are supposed to be offered or available." And women aren't likely to know they should ask, and generally don't consider abortion coverage to be a main determinant of what health insurance they choose.

"Abortion should just be part of the comprehensive plan that women get because they don't necessarily look for that or think, 'Oh, I might need an abortion,'" Borchelt said. "They're not going to ever predict a situation in which they're going to have an unplanned pregnancy or a problem pregnancy or a sexual assault leading to pregnancy. It's not something that you plan for."