Affordable Care Act and Breastpump Coverage

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 went into effect on August 1, 2012. After the plan went into effect, insurance companies had one year to implement a fee structure and details of 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:

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?

Types of Breast Pumps

Breast pumps come in handy for a variety of reasons, whether you’re headed back to work after maternity leave, you can’t breastfeed directly due to medical reasons, you are away from your baby travelling or running errands, or if Dad wants to participate in feedings. Whatever the reason, it’s important to check out all the available options out there for breast pumps.

There are different levels of breast pumps, according to Consumer Reports. The first one we’ll talk about is the hospital-grade, electric pump. This one is pricey, so you may want to check out renting one from the hospital or a specialty store if purchasing one doesn’t fit your budget. You’ll still have to purchase accessories if you rent, so be mindful of that when planning for your budget. Hospital-grade costs more than other pumps because it is much faster (takes approximately 15 minutes to pump, on average, for the dual pump), and it has multiple settings for speed and pressure for your comfort. The hospital-grade pump weighs anywhere from five to 11 pounds and is generally about the size of a shoebox.

The next level is the personal-use, electric pump. You can find these for around $200 to $350. Still pricey, but if you’re planning on keeping up with breast milk and you’re returning to work, these pumps are pretty nice to have. These pumps also come with multiple settings and are fairly fast, especially if you get the dual pump. It generally comes with all the necessary accessories, including a handy carrying case for when you need to bring it to your place of employment.

There are also small, electric pumps. These are smaller and lighter than the personal-use electric pumps and generally run between $65 and $130. There are fewer options than the previously mentioned pumps, meaning you don’t have a choice when it comes to speed and pressure. So, plan for a longer time pumping. But they are compact and very portable, and they are perfect if you’re just pumping occasionally.

Lastly, there is the manual pump. These are fairly affordable, between $35 and $50. These are quite a bit slower. And, usually these come with singular pumps, and that adds to the amount of time you’ll be spending pumping. Some pros are that it is portable, great for travel and camping (if you don’t have an electrical source), and you can still somewhat control the pressure because of the manual pumping.

All in all, your choice really depends on your budget and the time you are willing to spend pumping. Also, if you have sensitive breasts and/or nipples, you may want to consider buying a pump with the multiple settings for comfort. Consumer Reports recommends a few different brands, such as Ameda, Medela, and Whittlestone.


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