The Affordable Care Act and Breastpump Coverage

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The Affordable Healthcare Act applies to you if you have private or commercial medical insurance.  The Affordable Care Act (ACA) is a law that was passed by President Obama in 2010.  The main purpose of the ACA is to improve the quality, affordability, and rate of health insurance coverage, as well as decrease the costs of health care for Americans.  Part of the ACA mandates health care plans to pay for breastfeeding support and supplies, including breastpumps.  The ACA became effective on August 1, 2012.  Once the plan went into effect, insurance companies had one year to implement a fee structure and details of the benefits for each specific health care plan.      

Navigating your health care plan to obtain a breastpump can prove to be very difficult.  Before I delivered my baby, I started inquiring about the process with my medical insurance.  Since this was before August 1st my insurance plan had no set fee schedule or specific written plan.  Each customer service representative I spoke with told me different information about my plan.  I had no idea what questions to ask and was naive in thinking they would be able to give me the information I needed.  The only specific information my insurance company provided me with is was that I could not obtain a breastpump until after my baby was born and they required a doctor's order.  

If you plan on obtaining a breast pump through your heath insurance, start researching your coverage early.

Once my baby was born, I contacted my insurance company again, only to meet another obstacle.  I could not find a medical supply store who accepted my insurance and carried breast pumps within 100 miles of where I lived.  In the meantime, my milk came in and I suffered from painful engorgement, so I ended up renting a breast pump until I could sort out the mess.  It took me another 2 weeks to find a store who would ship me a breast pump.  Currently, I am waiting for my insurance company to complete the necessary paperwork, so I can order my pump.  It has been a very frustrating and time consuming process.  Certainly not something I wanted to tackle while caring for a newborn.                

Individual health plans have different coverage allowances, supplies, vendors, and timelines required to request a breast pump.  It's important to ask your insurance company the right questions when determining what your plan covers.  Benefits vary,  as some insurance plans will cover the cost of a double electric pump, while others will only cover a manual hand pump.  Benefits also may be different if your baby has a medical condition, such as prematurity or Down Syndrome.  

If you plan on obtaining a breast pump through your heath insurance, start researching your coverage early.   Also, keep a written log to track the important details, deadlines, and contact phone numbers.  Here are the questions you will want to ask your insurance company:  

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Questions for Insurance Company about Breast Pump Coverage:   

What type and brand of pump is covered (hospital-grade rental, double or single electric, manual pump)?

Do I need to go through a medical equipment supply company to obtain a breastpump?  Is it possible to purchase one out-of-network and be reimbursed? If so, how much will I be reimbursed? (If your plan only covers a breast pump purchased through a durable medical equipment company be sure to ask for the list of in-network providers.) 

When will I be able to get a breast pump – before or after I deliver?  

Do I have to submit proof of medical necessity in order to acquire a breastpump?  If so, do I need a letter of medical necessity and/or a physician order?  

Is there a rental breastpump option?  If so, what does it cover?

Other Helpful Links About Breastpump and Lactation ACA Insurance Coverage 

Women's Preventitive Services Guidelines
Medela-The Affordable Care Act: Breastpumps, Lactation Services and Coverage

Remember every medical insurance provider writes their own policy of benefits for lactation services and breastpump coverage, so it's important to speak with a representative about your insurance coverage as soon as possible.    

What do you think?

The Affordable Care Act and Breastpump Coverage

Mindi is a working mom with three boys ages 4, 2, and an infant (born June 2013). She spent her first 8 years of her career in Speech-Language Pathology at a Children's Hospital. She currently works with adults and children in home health. The real fun for her happens when she is at home with her boys, chasing them around and pretending to be a super hero. She blogs about life as a working mom at Simply Stavish. Her weekly feature, Words in the Sand, teaches parents how to grow their child's s ... More

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24 comments

  1. CM says:

    As far as I know, most health insurance plans do cover for a free breast pump. Usually it’s for an Ameda or Medela pump. Just to let you know if you have Kaiser Permanente Insurance (and probably some other health insurance plans) you are allowed to apply for a pump up to 180 days after giving birth. That way if you give birth early or get so overwhelmed the first week or two you still have time to get your pump for 6 months before buying one. Don’t waste your money on these pumps if you can get one for free!

  2. Maria says:

    Check out Aeroflow Breastpumps! They have great customer service, and you can qualify easily on their website.

  3. Grace says:

    I didn’t know that they could be possibly covered, glad I read this article.

  4. Ashleigh says:

    I think this is wonderful!

  5. Melissa says:

    I have BCBS IL PPO, and I took advantage of the free pump (why not, I’m somehow paying for it through my insurance anyway, right?). I used markdrugmedicalsupply.com and I was so impressed by their efficiency and friendliness. They made the entire process so easy and fast. I would highly recommend them!

  6. Alanna says:

    Oh my! Hateful, hateful.
    I found the article to be very informative. I did not know that a pump could be covered by insurance. I’m glad I didn’t add one to my registry yet.

  7. Cassy says:

    Very informative article. It still depends on your plan, but be sure to contact your insurance company if you are planning on pumping. Many breast pumps are covered by Obamacare! I still need to contact my insurance company about whether or not I’m covered, guess I better get on that since I’m due in November!

  8. Morgan Hart says:

    Quite frankly, I’m not interested in any propaganda-pushing article that tries to sell the ACA as a good thing. The skyrocketing rate increase our family has been hit with thanks to this stupid law has cost me extra fees probably worth ten breast pumps! Also, my pump was fully paid for out of my HSA account the year before Obama put so many stupid restrictions on how I spend my own money out of my HSA account. This article didn’t tell us anything new-some insurance plans cover breast pumps, some with many restrictions, and others not at all. This is the way insurance works, and has nothing to do with the ACA.

  9. Abby says:

    This article just pushed me to contact my insurance company (GHI) immediately. I am 100% covered. The medical supply company that they are contracted with is Better Living Now. Customer Service on both ends were great. My doctor just needs to fax them an order with my selection and I am good to go! As soon as they receive the order from my doctor, they said I should receive it in a few business days. I am due in October. I had a choice of three different breast pumps. I chose the Medela Advanced Double Electric Breast Pump. Thanks for the info and questions to ask Everyday Family!

  10. Kimberly says:

    I have bcbs of Texas, PPO. My double electric pump was completely covered. I’m due in a month and was able to order it with a referral from my dr. The main obstacle was finding a medical supplier that offered breast pumps. I ended up going through Sante Mama in Vancouver and having it shipped. It literally was delivered two days after I ordered it. Very happy with the whole process.

  11. April says:

    I’m an attorney that specializes in compliance under the Patient Protection and Affordable Care Act (and I’m nine months pregnant and trying to deal with my own insurance company about this issue right now). Your group health plan does NOT have to offer coverage for this benefit if it is considered a “grandfathered” plan, meaning that it’s been in place since at least March 23, 2010 (when the law was signed into effect) and hasn’t made many changes since that time period. Most plans, however, are non-grandfathered plans and are required to provide coverage. But, even nongrandfathered plans don’t have to cover all types of breast pumps, and they only have to cover for in-network expenses. Whatever type or types they have offered under the plan must be covered without any cost-sharing – that means no copayments or coinsurance and before your deductible hits. There’s a big list of other preventive care requirements that also apply to nongrandfathered group health plans at no cost – you can see a list of them here: https://www.healthcare.gov/what-are-my-preventive-care-benefits/#part=2

    • Melissa says:

      Of course I just found out my plan was one of these “grandfathered” ones who offers no coverage for breastpumps. I guess I just don’t understand this loophole. This is all the more strange to me as my plan is covered through my employer which is a HOSPITAL. They also say they don’t cover lactation services at all. Any advice or am I just out of luck? Are you having this same issue?

  12. Nicole says:

    My insurance company keeps saying that one isn’t covered! So frustrated.

  13. Danielle says:

    I have bcbs of mn and a breast pump on my plan is covered under my deductable which means i would be paying for it myself. I didn’t even meet my deductable after hospital costs.

  14. lauraejh says:

    I have BCBS of TX (PPO) and as soon as we got home from the hospital, my husband called to ask what we needed to do to get a pump covered. They just said “You’re covered; here’s a number to call our medical supplier and tell them what you want.” Within a week I had a pump delivered to my home! I was expecting to need a prescription and to prove it was medically necessary (I had IUGR and the baby wasn’t putting on weight after birth, so I was having to pump and supplement), but it was covered regardless. I’m so happy and relieved, because the medical problems and the financial burden add hugely to the already overwhelming state of new-parent-hood, and being able to get a pump covered 100% made that one aspect so much easier.

  15. Jennifer says:

    Hello, I have BCBS of AZ (PPO plan) I called and was told nothing was covered under Breastpumps?! If I have a script from my Doc will it be covered then if He states it is a medical necessity? Just wondering if anyone else has a plan like this and received a pump at little or no cost to them.. Thanks for any feedback.

    • Since this is such a new plan healthcare insurance providers are still working out details and benefits. I would call again to get clarification of what is deemed medically necessary. (needing it for working vs a baby in the NICU etc). Many doctors aren’t sure either. When I asked my doctor to write me a script he just wrote “breast pump”. I’m not sure that would help your case so you may have to clarify with the doctor and insurance company. Good luck!

  16. Brandy says:

    With Blue Cross Blue Shield Federal, they told me about the pumps and provided me with the number to call. They sent it to me a couple months before my due date, no hassles with paperwork or anything. We also get additional storage bags every 90 day day for a year.

  17. Phammom says:

    If I didn’t find the media pump and a garage sale not even used I would be going threw the insurance company.

  18. Heather says:

    I’m so glad my insurance company, United Healthcare, has this all sorted out. They are the ones who informed me that I was eligible for breast pump coverage.

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