Learn About the Benefits of the Affordable Care Act
 
Affordable Care Act

Learn About the Benefits of the Affordable Care Act

Did you know that the Affordable Care Act covers the cost of a breast pump for breastfeeding moms? Whether you’re going back to work or have responsibilities that require you to be away from your baby for more than a few hours, a breast pump can make all the difference to help you continue breastfeeding. For moms who want to use a breast pump, however, the cost can be a huge hurdle.

Prices for double electric breast pumps, the style that many moms prefer, can range from $100 to $400! Manual breast pumps are less expensive, ranging from $20 to $50, but can still be a luxury.

How does the Affordable Care Act Help?

US federal government legislation and government-funded programs help breastfeeding be more accessible to moms, by providing breast pumps and lactation consultant services at no cost to you. Under the Patient Protection and Affordable Care Act, breastfeeding services and supplies are covered without cost sharing under most health plans.1

Guidelines for Coverage of Breastfeeding Services & Supplies

  • Requirements do not vary by state
  • Only applies to consumers with private insurance or commercial insurers – not Medicaid or WIC (For information on how to obtain a breast pump through WIC or Medicaid, contact your state WIC agency)
  • Many insurance providers require you visit an "in-network" or "participating" healthcare provider to obtain services and supplies
  • Lactation consultant visits and breast pumps are covered without co-payment, coinsurance or deductible for "in-network" providers

Coverage can vary among insurance plans – it's important to understand what is available to you under your own insurance plan. Contact your insurance toll-free customer service number (this number is typically found on the back of your insurance card) for questions on coverage and benefits under ACA. Be sure to have the following list of questions ready to ask when you call!

Questions to Ask Your Insurance Provider about Coverage

It’s never too early to start asking questions! Most insurance providers will only cover the cost of a breast pump or lactation consultant services within 60-90 days after you give birth, so do the legwork now to be prepared.

Type of Breast Pump

  • What type of breast pump can I get (hospital-grade, double electric, single electric, battery, manual)?
  • What brand(s) of breast pump can I get?
  • Do I have to get the "recommended" breast pump from my insurance provider, or can I get an "out-of-network" breast pump and submit a receipt for reimbursement? What amount will be reimbursed?
  • For medical necessity (such as a pre-maturely born baby in the NICU), do I have a rental hospital-grade pump option? Do I need a prescription for proof of medical necessity?

Lactation Consultant Services

  • Where can I receive lactation consulting services?
  • Are there approved in-network providers or can I submit reimbursement for an out-of-network provider?
  • Is there a limit on the number of visits I can have with a lactation consultant?
  • Do I need a prescription for a lactation consultant visit?
  • Is there a maximum dollar amount covered each visit?

Pre-Approval

  • Do I have to get the breast pump or lactation visits approved first, before purchasing the pump or visiting the lactation consultant?
  • Do I need to obtain a prescription for the breast pump before I purchase it?

When to Obtain a Breast Pump

  • When can I obtain my breast pump (before birth, after birth)?
  • How long after birth can I obtain my breast pump within the coverage limit?

Where to Obtain a Breast Pump

  • Where can I obtain my breast pump (“in-network” provider, durable medical equipment provider, or any retail location such as Target)?
  • How do I obtain my breast pump (show insurance card, file claim for reimbursement with receipt, buy online, buy in store, buy at pharmacy, etc.)?