Breast Pumps & Insurance Coverage: What You Need to Know

Ramping up for Reform Toolkit
Opportunities for reimburseable nutrition counseling and lactation support for RDs and IBCLCs in clinic and private practice settings.

Insurance Coverage FAQs from Ameda
Includes a searchable database of Durable Medical Equipment (DME) providers from which to obtain a pump covered by insurance.

Information about the Affordable Care Act and Required Coverage

Source: www.amchp.org

ACA Section 2713:

Lactation support for new health insurance plans through the Women’s Preventive Service Regulation beginning on or after August 1, 2012.  This includes comprehensive support, counseling, and costs of breastfeeding equipment without charging a co-payment, co-insurance, or deductible.

  • Support: interventions that are available both during pregnancy and after birth to promote breastfeeding.  Support be available to women with each birth.
  • Counseling: Provide a trained provider of counseling services to all pregnant and postpartum women to achieve successful initiation and duration of breastfeeding.
  • Equipment: Costs of renting breastfeeding equipment

 

ACA Section 4002:

Support community efforts to promote breastfeeding through the Prevention and Public Health Fund.

This includes the Baby Friendly Hospital designation program Best Fed Beginnings and the Community Transformation Grant to support community-level efforts to reduce chronic diseases through increased policies and practices in health care, community, workplaces, and childcare settings.

 

ACA Section 4207:

The ACA requires employers provide a reasonable break time to allow for breastmilk expression for up to one year after the birth of the child. It also requires a private, non-restroom, location to express milk that is free from intrusion.  The law does not require employers to compensate an employee for this time.  Summary points for the break include:

  • Frequency: Depending on infant age, nursing employees will typically need 2-3 breaks during an eight-hour shift.
  • Length: It is suggested that it should take approximately 15-20 to express milk with additional consideration being provided for location of private area and the proximity to washing and storage areas.
  • Space: Where practical a locked room should be made available.  If unavailable a space can be created using partitions and curtains.  Windows should be covered and signs should be posted.  The employee must have a space to sit and a flat surface other than the floor to set the breast pump. Reasonable storage must also be provided, either refrigeration or allowing employee to bring insulated containers to work and have a space to store it and the breastpump.  A bathroom/locker room without differentiation between the toilet area and space reserved for expressing milk do not meet the law requirements.