Telehealth medication abortion is a growing alternative to expensive brick-and-mortar services, however limited information exists about its cost and affordability in the US. This study examines the use of a sliding scale payment model for telehealth abortion services to assess the affordability of care, as well as the association of sociodemographic factors and state-level policies with ability to pay. This retrospective cross-sectional study will use intake questionnaires from Abuzz, a provider of asynchronous telehealth abortion services in 46 US states, over a 12-month period to determine the average payment for telehealth abortion care and the proportion of patients requesting to use the reduced payment option. We will describe patient sociodemographic characteristics and use logistic regression to assess the association between reduced payment and factors such as age, social vulnerability, and urbanicity. We will also examine the relationship between state-level abortion policies and reduced payment, as oppressive policies have the potential to exacerbate existing health and social inequities. Given that abortion is often paid for out-of- pocket – even by individuals who hold insurance – understanding ability to pay, particularly among vulnerable groups and those residing in states with restrictive abortion policies, is a critical component of the current abortion landscape. Preliminary findings on payment for telehealth abortion were used to support the Supreme Court case FDA v Alliance for Hippocratic Medicine, fortifying access to abortion medications.