Health insurance companies in the United States are now required to cover breast pumps (and lactation consultants!) for any woman who wants to breastfeed her baby. This section of Obamacare (the Affordable Care Act) went into effect for 2013.
The law states that insurance companies must cover some kind of breast pump, but not what kind. At this point (Feb., 2013), many insurance companies are only offering a manual pump. These are worked by hand, not electricity, and usually do not have any of the bells and whistles that come on higher-priced models, but still work well. Some insurance companies will only cover rentals of high-end, hospital-grade pumps, and some will cover either rentals or purchases. Some women may still want to buy or rent their own, depending on what kind of pump they would prefer to have, and what their insurance covers.
What to Know About Insurance and Breast Pumps:
- Health insurance must cover pumps, but your company can choose what kind, and whether to cover rentals, purchases, or both.
- Check with your insurance company to find out what type(s) of breast pumps they cover. Ask if there is a difference if baby comes prematurely, or has other medical needs.
- Learn about the model(s) of breast pump your health insurance covers. Read manufacturer information and reviews to see if that pump could be a good fit for your situation, or to help you decide if your insurance company offers a choice.
- Decide how much you will work, and where, for baby’s first year. If you are planning to stay home for much of that time, a basic model pump may be fine, or you may not need a pump at all. This can also be the case for working from home/telework, or even some part-time jobs. If you plan to work full time, a basic pump may also be a good fit if your company has on-site daycare or someone will be able to bring your baby to you to nurse a few times during the workday. If you will work full time far from home, you may want to invest in a higher-quality pump if your insurance company does not cover it. The more expensive pumps are generally much faster and more comfortable for frequent pumping.
- The healthcare law specifies that breast pumps and lactation consultants should be covered without cost to the insured, so you should not pay anything.
- Medicaid is not included under the Affordable Care Act for breastfeeding support, but most states have decided to cover some pumps. Call your Medicaid contact to see if pumps are covered in your state.
- If you have any breastfeeding challenges, ask your insurance company to refer you to a lactation consultant they cover. Be aware that reimbursement rates for lactation consulting are low, so some excellent LCs and IBCLCs will not work with insurance companies.
What to Do to Get a Breast Pump Covered by Insurance:
- Around 36 weeks, check with your insurance company to find out what pumps they cover.
- When you check with your health insurance company, ask where you need to get the pump from. Different insurance plans cover different vendors.
- Order the pump based on when you are planning to return to work. If you will be home for a few months, order the pump after baby is born. If you will be returning to work around baby’s 6th week, order the pump before baby is born, as early as 36 weeks of pregnancy or earlier if you insurance company allows it. This way, you can be certain it will arrive before you need to return to work. Many companies are currently backed up on shipping pumps because of the high demand. Hopefully, this backlog should be resolved as companies adjust to the demand.
What do you think? Will this coverage help you, and will you use it?