Coverage Guidelines Under Patient Protection and Affordable Care Act:
Breastfeeding Services and Supplies Are Covered Without Cost Sharing in Health Plans
As of August 2012, the Affordable Health Care Act states that “Pregnant and postpartum
women will have access to comprehensive lactation support and counseling from trained
providers, as well as breastfeeding equipment.”
The following Questions and Answers
may help you understand your benefits. Consult your insurance company for how to be
reimbursed for breastfeeding supplies. Most companies require that you purchase from
a DME (Durable Medical Equipment) supplier such as Lactation Connection
{The Nursing Mother's Milk Supply}
The following Questions and Answers may help you understand your benefits.
Consult your insurance company for how to be reimbursed for breastfeeding
supplies. Most companies require that you purchase from a DME (Durable
Medical Equipment) supplier such as Lactation Connection.
QUESTION: What is the Patient Protection and Affordable Care Act (PPACA)?
ANSWER: The Patient Protection and Affordable Care Act is the health
insurance reform legislation signed into law that requires health plans to
cover preventive services at no cost. Preventive services that have strong
scientific evidence of their health benefits, such as breastfeeding, must be
covered and plans can no longer charge a patient a co-payment, co-insurance
or deductible for these services. Recently the Supreme Court upheld the
majority of the Affordable Care Act. Under Preventive Services for Women,
provisions require health plans to cover breastfeeding services and supplies
without cost-sharing (i.e. no co-payment). Many health plans will need to
implement this change with the first plan/policy year that begins on or after
August 1, 2012.
QUESTION: When do breastfeeding services and supplies need to be covered?
ANSWER: If your insurance plan is affected by the Affordable Care Act, coverage
is for health insurance plan years beginning on or after August 1, 2012.
Your insurance provider is your source to confirm if your plan is affected.
QUESTION: What are details on the Affordable Care Act rules pertaining to
Preventive Services for Women?
ANSWER: Under the Affordable Care Act, women’s preventive health care
services – such as mammograms, screenings for cervical cancer, and other
services – are already covered with no cost sharing for new health plans.
On August 1, 2011, the Department of Health and Human Services (HHS)
adopted additional Guidelines for Women’s Preventive Services that will be
covered without cost sharing in new health plans starting in August 2012.
Coverage includes breastfeeding support, counseling and supplies, well-woman
visits, contraception, and domestic violence screening. The guidelines were
recommended by the Institute of Medicine (IOM) and based on scientific evidence.
QUESTION: Is this coverage subject to deductibles and co-pays?
ANSWER: No. Breastfeeding services and supplies must be covered with no
cost-sharing (no co-payments, co-insurance or deductibles) in plan years
starting on or after August 1, 2012.
QUESTION: What lactation services and supplies are covered?
ANSWER: The provision states: It is important to understand that each health
care insurance plan will determine their specific lactation support and services,
as well as breast pumps and supplies. Please consult your health plan provider
to find out more information about your insurance coverage.
QUESTION: How does a health insurance plan deliver breastfeeding supplies
to a member?
ANSWER: Each insurance plan independently determines their method of delivery
of breastfeeding supplies. Your insurance plan provider is your primary resource
for understanding the benefits of your policy and how to obtain your supplies.
QUESTION: Do these requirements vary by state?
ANSWER: No. Requirements do not vary by state.
QUESTION: Where can I access additional information?
ANSWER: Comprehensive information is available at the following government sites:
You may also want to check with your health insurance provider for
their preventive services policy.
www.healthcare.gov
www.hrsa.gov/womensguidelines
www.healthcare.gov/news/factsheets/2011/08
womensprevention08012011a.html
* Ameda publication September 2012.
References:
1. Institute of Medicine. (2012). Women’s preventative services recommended by
IOM to be covered under affordable care act. Retrieved from
http://www.iom.edu/Reports/2011/Clinical-Preventi... the-Gaps/Action-Taken
2. Institute of Medicine. (2011). Clinical preventative services for women:
Closing the gaps. Retrieved from http://www.iom.edu/Reports/2011/Clinical-Preventi...
3. HealthCare.gov. (2012). Affordable care act rules on expanding access to
preventative services for women. Retrieved from http://www.healthcare.gov/news/factsheets/2011/08...
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