The Affordable Care Act requires health insurance companies, including Medicaid plans, to cover ‘breastfeeding services and supplies.’ This requirement is very broad and every company covers it a bit differently. Before you have your baby, call Customer Service at your health insurance plan to see what they will cover. Ask the following:
– What kind of pump can I get? When can I get it, and where?
- Some plans cover a manual pump, some a small electric. Ask about the brand they require.
- Some plans will ship you a pump, some require you to go to a specific store to get one.
- Some plans make you wait until after the baby is born, some let you get it ahead of time.
- Some plans let you buy whatever you want, up to a set limit, and will reimburse you. If you want more, you pay the difference.
– Do you cover hospital-grade rented breastpumps? Do you need a prescription and ‘pre authorization’ for the rental?
- Most plans need proof that such heavy-duty and costly equipment is needed.
- You would be most likely to need a rented pump if you or the baby had to stay in the hospital, if the baby could not feed well at breast for a medical reason like cleft lip or palate, or if you had to take a medication that kept you from breastfeeding but needed to keep up your supply.
If you have a hard time reaching Customer Service or getting consistent information, you can contact “Breast Pump Solutions,” a service of McKesson Patient Care Solutions, at 1-855-567-8669. They have a large database of insurance plans (public and private) and may be able to give you information on coverage.
If your health plan is not very generous concerning a pump, there are other ways to get one:
– Place your pump of choice on your Baby Registry and let others purchase it for you. Be specific on your choice, since not all pumps are equal and you get what you pay for.
– If you participate in the WIC Program, they can help you get a small electric pump if you are separated from your baby because of returning to work or school. Contact your WIC Office for more details.
– If you have a high-deductible health plan with a health savings account (HSA) or a flexible spending account (FSA), you could pay for a pump ‘pre-tax’ from those accounts. Alternatively, you could count the purchase as a medical expense if you itemize your taxes.
Doraine Bailey, MA, IBCLC, is the Breastfeeding Support Services Program Coordinator at the Lexington-Fayette County Health Department. Contact her at 859-288-2348 or at email@example.com.