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Affordable Care Act Information | Breastfeeding Benefits

Brooke Phillips, CWCMS
Editor | Shield HealthCare
03/27/14  11:37 PM PST
Affordable Care Act Breastfeeding

How does the ACA affect pregnant and breast feeding women?

The Affordable Care Act (ACA) expanded coverage of preventive services for women, including pregnant and breastfeeding women. The ACA requires most* health insurance plans to provide breastfeeding support, counseling and equipment (such as a new or rental breast pump) to pregnant and nursing women. These new benefits must be covered without cost-sharing – which means that insurance companies can’t charge a co-payment, co-insurance or deductible for these services.

*Effective January 1, 2014, this requirement is mandatory for all health insurance plans except for grandfathered plans. Not sure if your health insurance plan is grandfathered? Click here to learn more about grandfathered plans on HealthCare.gov.

What breast pumps are covered?

Health insurance plans are now required to provide you with a breast pump at no charge. This pump may be either a rental or a new pump that you can keep. The type of pump, pump manufacturer, pump accessories, rental duration and date of eligibility (before or after the baby’s birth) are different with each health care plan. Some health care plans may cover a single or dual electric pump, while others cover a manual pump. Each individual health care plan will determine what breastfeeding services, breast pumps and breast pump accessories they cover. If you have any questions regarding your specific health plan coverage, please contact your health insurance provider.

Click here to see what breast pumps we offer at Shield HealthCare.

Are breast pump accessories covered?

Generally, breast pump accessories are not covered. However, some health insurance plans may cover certain accessories, such as bottles or flanges. For more information regarding your specific health plan coverage, please contact your health insurance provider.

Click here to see what breast pump accessories we offer at Shield HealthCare.

Will I be charged a co-pay or deductible for my breast pump?

No. The Affordable Care Act requires that health insurance plans provide breast-feeding support, counseling and equipment without cost-sharing. This means that you cannot be charged a co-payment or deductible for your covered breast pump.

Does a doctor need to prescribe my breast pump?

Prescriptions are not usually required, however some health insurance plans may require pre-authorization from your doctor to ensure that you are receiving the right supplies and services. It is important to talk to your doctor about what is medically appropriate for you. In many cases, health insurance providers will follow your doctor’s recommendations.

My health insurance provider says I’m covered. How do I receive my pump?

Each insurance plan determines their method of delivering breastfeeding supplies. To find out if you are eligible to receive a covered breast pump from Shield HealthCare, please call your local Shield HealthCare Office:

California

  • Fresno 800.675.8842
  • Inland Empire 800.557.8797
  • Los Angeles 800.372.6205
  • Sacramento 800.675.8842
  • San Diego 800.557.8797
  • San Francisco 800.675.8840

Colorado

  • Denver 800.525.8049

 Illinois

  • Chicago 800.675.8847

 Washington

  • Seattle 800.720.7440

 Texas

  • Dallas 800.407.8982
  • Fort Worth 800.407.8982
  • Houston 800.493.7863
  • San Antonio 800.495.0999
  • West Texas 800.495.0999

To learn more about the breast pumps and breast pump accessories we offer at Shield HealthCare, click here to visit our Breast Pump Information page.

What other breastfeeding related coverage is offered by the Affordable Care Act?

Learn more about pumping at work in this ACA Fact Sheet: Fact Sheet #73: Break Time for Nursing Mothers under the FLSA.

For more information about the Affordable Care Act, visit the U.S. Department of Health and Human Services and HealthCare.gov, which provided source information for this article.

About Shield HealthCare

Since 1957, Shield HealthCare has been an industry leader focused on meeting the medical supply needs of families and caregivers at home. 99% of our customers would recommend us to friends and family*. Shield HealthCare operates in ten locations, serving California, Colorado, Washington, Illinois and Texas.

*2013 annual customer survey conducted by Press Ganey Associates Inc.

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