Some 9,000 people in Rhode Island lost abortion coverage when they were automatically re-enrolled this month in health insurance plans they previously bought. Many of these people were likely to be unaware of the change, local media reported, and unless these consumers actively switched plans by Dec. 23, their health insurance coverage would continue to exclude abortion.

Customers who lost abortion coverage would be notified by letter, Maria Tocco, spokeswoman for HealthSource RI, the state’s health insurance exchange, told Rhode Island Public Radio. “We are taking steps to ensure that all customers are being adequately notified,” she said.

In June, as part of a religious exemption variation, Rhode Island Gov. Gina Raimondo, a Democrat, signed a new policy requiring state health insurers to offer a minimum number of plans that do not cover abortion. For every tier of health insurance that a company offers – the Rhode Island state exchange offers coverage in four tiers: gold, silver, bronze and catastrophic – it now must offer at least one plan that excludes abortion coverage, two years ahead of the Affordable Care Act’s requirement that by 2017, state marketplaces must offer a minimum of one multistate plan that excludes abortion coverage.

In 2015, 31,513 Rhode Islanders bought healthcare coverage through the exchange. As of Nov. 7 -- one week after a national open enrollment period for health insurance began -- 30,680 people had bought insurance through the exchange for 2016, nearly all of them through the automatic renewal of plans in a process known as “mapping,” where customers are either kept in the same plan as before or switched into a comparable one.

During the “mapping” process this year, following the new policy passed in June, roughly 9,000 customers were put into plans that offered severely reduced abortion coverage, or the federal bare minimum of “cases of rape, incest or when the mother’s life is in danger,” the Providence Journal reported. Both insurers and the Rhode Island exchange have said they would notify customers of the changes and how to pick a different plan, but some doubted the message would get through to everyone who might be affected.

"I'm hoping that the letters will be sufficient," Jamie Rhodes, director of public policy in Rhode Island for Planned Parenthood, said. Whether people had actually received and read the notification would remain to be seen, he said, and the proof would be when, or if, a patient went to see a doctor next year seeking an abortion only to learn that the procedure was not covered by her insurance.

Those signing up for new health insurance plans might simply opt for the choice that appears to be cheapest, even if it does not cover abortion, according to the blog RIFuture. Or, young adults who can stay on their parents' health insurance until they turn 26 may not realize it if their parents' plan was one that lost abortion coverage.

According to Rhodes, at the beginning of 2014, only five people selected health insurance plans that did not cover abortion. Now, with 9,000 people automatically put on plans that exclude abortion, it would be difficult to gather data on what plans people actually wanted, he added.

Most of the customers who lost abortion coverage were in Blue Cross & Blue Shield of Rhode Island or Neighborhood Health plans, which in February constituted the vast majority – around 97 percent – of insurance plans bought via the state exchange, according to official data.

Rhode Island’s abortion rate has dropped over the past two decades, but it has consistently been higher than the national average. In 2011, 19.8 women out of 1,000 had legal abortions in Rhode Island, compared to 16.9 out of 1,000 nationwide, according to the Guttmacher Institute, which produces research and analysis on reproductive health. That year, 4,210 women got abortions in Rhode Island.

Whether or not a health plan offers abortion coverage may seem inconsequential or irrelevant to certain families. But for those who end up needing coverage, sometimes late in the pregnancy, in order to save a woman’s life, not having coverage can amount to tens of thousands of dollars in costs.