Breast Pump Basics: Insurance

Navigate the Affordable Care Act with some breastfeeding brush-up from Yummy Mummy’s Amanda Cole.

Breast Pump Basics: Insurance

No matter how ready you feel for baby’s arrival, there are just some things you can’t possibly imagine until you’re actually doing them...like breastfeeding. But that doesn’t mean you can’t be prepared, especially when it comes to getting your breast pump. And now that the Affordable Care Act requires most insurance plans to cover preventative services for women, including that breast pump, it’s easier than it’s ever been to get a head start. Still, since the law only kicked in early last year, there are lots of women that don’t know exactly what it means to them, and miss out on the benefit as a result.

To help clear things up, we turned to Amanda Cole, owner of NYC breastfeeding boutique Yummy Mummy. As a durable medical equipment provider, Cole has partnered with 25 insurance companies, and as a breastfeeding expert, she’s got the staff to walk even the least prepared mama-to-be through this often confusing process.

“A lot of women just aren’t aware that their breast pump is covered by insurance,” she says. “When you’re pregnant and have so much going on, it can be easier to go out and buy a pump. But the pumps supplied through your insurance are often the same or just as good. And they’re usually free.”

Below, Cole simplifies the process.

What exactly does the Affordable Care Act cover?

With the Affordable Care Act, insurance companies are now thinking about breast pumps as a medically necessary item. Each insurer and plan varies in terms of what’s offered, but it’s usually a hand pump or a standard-electric pump. For a hospital grade pump, you’d need to make a case for an extra medical issue.

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Are rental pumps covered?

Some plans only offer rental pumps, and some plans only offer new, single-user pumps.

Do all plans have at least some breast pump provision?

Some plans have been grandfathered, meaning they don’t need to comply with the Affordable Care Act. January 1, 2015 is a key date on when some plans will go from being grandfathered to non-grandfathered, so that may be the case with yours. You may want to switch insurance plans--when a plan is grandfathered, there’s probably a lot more provisions besides breast pump they don’t need to comply with. Ultimately, it’s a personal decision. To switch your insurance for this one benefit may not be right for your needs.

What’s the process of getting a pump?

It’s never too early to look into it, even if you’re just thinking about getting pregnant. Call your insurance company, and ask them if a breast pump is covered under your plan. If it’s not, ask why. Most plans will only cover a breast pump if it’s through an in-network durable medical equipment provider, and most of those providers will handle all paperwork on your behalf. Once you provide the info they need, they'll ship it right to your door.

If there are several pumps offered on your plan, how can you decide, especially if you’ve never nursed before?

As a durable medical equipment provider, all of our team members are trained on all the different products offered through the insurance plans we partner on. Pumps do have subtle differences that might gear a mom one way or the other. Some moms come in with idea of what they want, and others need more help making their decision.

Are there any reasons a woman might want to step outside of her plan when it comes to breast pumps?

The motor and breast pump itself is the same in the insurance model as any model for purchase, but there’s some fancier models that have more bells and whistles that you can’t get through your insurance. Those extras can be a carrying tote or certain accessories, but many of those can be purchased separately anyway. Most people that are still buying pumps just don’t know about the benefit or think it’s too much of a hassle.

Can you get a new breast pump through insurance every time you have a new baby?

There’s usually a time frame restriction, like 36 months, before you can get another pump. Check with your plan.

Is breastfeeding support also covered by the Affordable Care Act?

Lactation services are also covered when a provider is in network. But not many lactation consultants are signed up with an insurance plan. It’s a benefit that’s pretty underused. Insurers are looking at how to enable moms to use that benefit more frequently.

Will we still see innovations in the breast pump industry, now that there’s less of a reason for a woman to buy off the shelf?

It could actually be more of a reason to see innovation. Maybe these breast pump companies want to be the one pump that moms will pay for out of pocket for because it’s that great. It might push them to come up with the “Aha!” change that will bring people back to the shelf.

Learn more about breast pumps and insurance coverage in the Affordable Care Act.

Watch this Yummy Mummy video to get a better handle on the issue.

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