Breastfeeding Benefits and the Affordable Care Act
The health care law requires most health insurance plans to provide breastfeeding support and supplies, like breast pumps, equipment and counseling for pregnant and nursing women.
Visit these sites to learn more about the heath care law and the breastfeeding benefits:
Breast Pumps and Supplies
A sample breast pump prescription from the Maryland Breastfeeding Coalition can be found here.
Women, Infants and Children (WIC) has a limited number of pumps available for WIC participants, whose babies are in the NICU or are returning to work. Mothers should contact the breastfeeding coordinator for her local WIC program. For more information, call the Partners for Healthy Babies hotline at 1-800-251-BABY (2229) or visit 1800251baby.org.
Breastfeeding supplies and services that assist lactation and are not covered by your insurance are now considered medical care by the IRS and are may be tax deductible. Some may qualify for reimbursement through a health flexible spending account (FSA) or health savings account (HSA). Contact your employer’s benefit provider to find out what is covered under your specific FSA or HSA and the steps needed for reimbursement. If you do not have an FSA or HSA, you can deduct breastfeeding costs if you itemize your tax returns and if your total un-reimbursed medical expenses exceed 7.5 percent of your adjusted gross income. (Re-posted from the Maryland Breastfeeding Coalition).
National Rehab (NR) can help you obtain a breast pump through your health insurance.
NR product specialists are able to:
To learn how to obtain a breast pump through your insurance plan, call National Rehab Equipment, Inc. at 1-800-451-6510, and Press 9 or go to http://www.nationalrehab.com/breastpump.html.
Policy and Guidelines for Insurers (Payers) and Providers
United States Breastfeeding Committee– Model Policy: Payer Coverage of Breastfeeding Support and Counseling Services, Pumps and Supplies– This model policy was created in partnership with the National Breastfeeding Center to identify best practices for supporting coverage of services, pumps and supplies appropriately.
National Breastfeeding Center– Breastfeeding Policy Scorecard, September 2013– This report card assesses healthcare insurance companies’ published policies and guidelines for breastfeeding support and equipment coverage, and assigns a grade based on the adequacy of coverage provided.
CMS Issue Brief: Medicaid Coverage of Lactation Services– (Jan 10, 2012) This issue brief describes the current levels of State Medicaid coverage for lactation services and explores how CMS can encourage and assist States in increasing access to such services.
AAP Federal Support For Breastfeeding– Created in partnership with the AAP Department of Federal Affairs this resource provides information on what federal and breastfeeding benefits are included in the Affordable Care Act, and guides pediatricians in educating their patients on how to advocate for those benefits. While designed for pediatricians, the information will be helpful to many who work with breastfeeding mothers and we encourage you to disseminate this widely.
AAP President Thomas K. McInerny, MD, FAAP Letter to Payers – Advocating for Coverage and Payment for Lactation Support and Breast Pumps– This letter was developed for payers; encouraging them to be supportive of the ACA provisions regarding coverage for breastfeeding equipment and services. This letter is written for the payers. This letter is meant to be shared with private payers or used as a template within your state chapter or coalitions as you advocate for insurance coverage.