If you are pregnant or have recently had a baby, you may be thinking about using a breast pump. The American Academy of Pediatrics recommends breastfeeding as the preferred method of feeding newborns and infants (although if you are unable to or do not wish to breastfeed, it’s important to remember that formula is certainly an acceptable supplement, as “fed is best”.)
For many new mothers, feeding directly from the breast may not be possible, or simply may not be preferred. For these women and their children, breast pumps are an invaluable tool. Pumping can enable nursing mothers who are returning to work the opportunity to still nourish their babies with their breast milk; pumps can help to facilitate easier breastfeeding, as they can encourage the production of a higher volume of milk; pumps can also serve as a way to allow fathers the chance to participate in feeding their babies. Breast pumps are also well-suited for women who would like to offer their young breast milk, but do not or cannot nurse directly.
Whatever the reason, if you are considering using a breast pump, you will find that these tools – while certainly useful – can be exorbitant. Fortunately, there is a way that you can procure a breast pump and forego the heft out-of-pocket expense. How? – You can obtain a pump through your health insurance company.
Breast Pumps and Health Insurance
Thanks to the Affordable Care Act (ACA or “Obamacare”) insurance companies are required to cover the cost of breastfeeding support services. This includes breast pumps and the assistance of a lactation consultant. Any health insurance plan that went into effective on August 1, 2012 or after must offer breastfeeding support devices and services, such as breast pumps, and these devices and services must be covered 100 percent; in other words, there is no out-of-pocket expense to the insured, including no copays or cost-sharing.
How to Get Your Insurance to Pay for Your Breast Pump
If you are interested in having your insurance company pay for the cost of your breast pump, use the following steps:
- Find out what type of healthcare plan you have. The first thing you need to do is find out if your plan is under the Affordable Care Act. If your policy was in place prior to March 23, 2010 (the date that the ACA was signed) and it is grandfathered, it may not cover the cost of a breast pump, as grandfathered plans are not required to cover breastfeeding support; however, there is a chance that even if you have a grandfathered plan, it may offer coverage for breast pumps. As mentioned, any plan that went into effect on August 1, 2012 or thereafter must provide 100 percent coverage for breastfeeding support, including breast pumps.
- Find out what benefits you have. Once you determine what type of insurance plan you have (even if it is grandfathered), find out exactly what type of benefits your plan offers. Contact your carrier and have them issue you a copy of your benefits in writing. Not only is it important to find out if your plan covers breast pumps, but if it does, what type of breast pumps are covered. While the ACA requires all plans to offer full-coverage for breast pumps, the exact rules regarding coverage do vary from carrier to carrier. Find out the following:
- The type of pumps that are covered; electric or manual; single or double
- The brand of the pumps that are covered
- Whether your plan only covers rental fees, or if it covers the cost of purchasing a pump, too
- If there are specific suppliers that you have to purchase a pump from, such as a medical supply distributor, a pharmacy, or a retailer
- If a prescription from your doctor is required
- Whether or not you can purchase or request to rent a pump prior to the birth of your baby
- If there are an extenuating circumstances. For example, under normal circumstances, your carrier may not cover the rental of a double electric breast pump; however, they may make exceptions for special circumstances, such as premature babies, babies who are diagnosed with medical conditions and require neonatal intensive care, or babies who are diagnosed with conditions that make it nursing difficult, such as cerebral palsy, spina bifida, or Down syndrome. They may also make exceptions if you are having difficulty establishing your supply of breast milk and a health care professional or a lactation consultant has recommended the use of an electric breast pump to help encourage the production of milk.
Nutrition is inherent for the health, well-being, and proper development of newborns and infants. For that reason, under the ACA, health insurance companies are now required to provide complete breast feeding support coverage, which includes breast pumps. Find out the exact details of your plan to learn what type of options are available to you.