Under the rule, a health plan that covers all abortions may participate in an exchange unless a state enacts a law that explicitly prohibits such coverage (known as an "opt out" law). If a health plan covers abortion, the rule forbids the plan from calling attention to that fact in any of its advertising or explanatory materials. The disclosure of abortion coverage can be provided "only as part of the summary of benefits and coverage explanation, at the time of enrollment." This provision seems designed for no other purpose than to ensure that many people who would not deliberately sign up for abortion-covering plans will do so inadvertently, because of the federally enforced gag rule.
Once a person is enrolled in an abortion-covering plan, he or she will be required to pay a defined monthly charge for the abortion coverage, dubbed the "abortion surcharge" by critics. This abortion surcharge is not optional — every enrollee in the plan must pay it, including families that have moral objections to abortion and/or that contain no females of reproductive age.
Some media stories have reported that the "abortion surcharge" will be $1 per month, but in fact, the law and rule say something quite different — they say that the surcharge must not be "less than one dollar per enrollee, per month." The surcharge could be a good deal more than $1, depending on how many abortions are paid for and how much they cost.