Does Health Insurance Cover Breast Pumps?
Health insurance companies are now required to cover breast pumps, thanks to a provision in the Affordable Care Act. The provision was signed into law in March 2010, although health insurance plans may not have been updated to reflect the change until they had gone through their annual renewal process after the provision went into effect, according to the Resources and Services Administration (HRSA)
The provision that allows for breast pump coverage is in the category of Women’s Preventative Services. This category also includes coverage for other services related to women’s wellness, such as screening for cervical cancer, mammograms, and well-woman preventative care visits to a healthcare professional.
What Does the Provision Say?
The provision text provided by HRSA says health insurance companies must cover items relating to breastfeeding supplies, support, and counseling. Breast pumps fall into the supplies category, while the support and counseling can come from regular visits to a lactation consultant during and directly following the woman’s pregnancy.
The provision also notes that the well-woman preventative coverage is available with no co-pay or other cost to the woman receiving the services, as well as no cost share to others who carry the insurance from the same provider. While the provision offers the guidelines for required coverage, each insurance company can add specifics to the guidelines that must be followed, depending on your individual health insurance plan. Health insurance plan specifics will also include how soon you must obtain a pump after giving birth and how frequently you can get a new pump if you have more than one child.
Can I Buy Any Breast Pump?
Running to the store to purchase any breast pump you want is not the way to go about ensuring that you’ll get one that’s covered by your insurance company. Health insurance companies are required to follow the general guidelines for providing a breast pump at no cost, but they are free to adjust the specifics as they see fit.
That means they can work with only select breast pump suppliers, offer only certain types of breast pumps, or have different restrictions regarding breast pump purchases versus breast pump rentals. Reviewing your health insurance policy’s exact requirements and then following them exactly is the best way to ensure the breast pump you choose will be covered.
Aren’t All Breast Pumps Pretty Much the Same?
While the FDA says all breast pumps contain the same basic components, the specifics of each can vary widely. The three components of every pump are the breast shield, the pump, and the milk container.
Variations exist in the way a pump is powered. Some are manual, others operate on batteries, and still others are electric and plug into an outlet. Another choice is picking between single or double pumps, with the latter being able to get the job done in half the time by expressing milk from both breasts at once. Prices can also vary widely, with some of the higher-end pumps costing $400 or more.
What Should I Look for in a Breast Pump?
Because all breast pumps are considered medical devices and regulated by the FDA, you can at least breathe easy knowing that whatever device you choose has received government approval before it hits the market. The scope of breast pumps that your health insurance company covers, however, may not necessarily include the very high-end or expensive pumps.
The FDA points out the most important factor to keep in mind when selecting a breast pump is to make sure it will best suit your needs. You should assess how much time you’ll be able to spend using it and where and when you expect to use it. Manual and battery-operated pumps are much easier to transport than big, bulky electric pumps, although electric pumps may be quicker and require less effort.
Another factor to consider is the overall purpose of the pump. While all pumps are meant to express milk, the speed and capacity of the pump comes into play if you intend to store larger amounts of milk for longer periods. A smaller pump may be adequate if you only need small amounts of milk at a time while a larger one may be more feasible if you are planning to return to work or be away from your baby for an extended length of time.
Two additional factors include the fit and the instructions. The breast shield needs to be the correct size and hopefully not uncomfortable. The instructions need to be clear and easy for you to understand.
Why Would I Need a Breast Pump?
In addition to storing milk for later feedings if you’re away from your baby for extended periods a breast pump can be helpful in other ways. Even if you’re not planning to go back to work or be away from your child, breast pumps can help supplement regular breast feedings or be useful while traveling. They can express milk for comfort reasons or from milk ducts that are plugged.
Not every woman will necessarily want or need a breast pump following the birth of her baby, but the Affordable Care Act made them available at no cost for those who do.