The Affordable Care Act (ACA), more commonly known as Obamacare, was designed to meet the needs of millions of low-income Americans and other underserved groups unable to obtain needed medical services because of the high cost of health insurance (or due to other circumstances such as preexisting conditions that made them ineligible for many insurance policies).
One of the groups singled out for special attention under Obamacare was pregnant women. In fact, women’s health in general became a priority. Being a woman is no longer treated as a preexisting condition and women may not be charged higher rates for health insurance simply because they might get pregnant and incur associated expenses for medical care.
In terms of covered care, women are now able to gain access to affordable insurance that covers many preventive services, including annual well-woman visits and regular mammograms, access to FDA-approved contraceptives, screening for a variety of STDs, counseling services for HIV and domestic violence, and so on. Pregnancy-related services are also available.
For example, screening for gestational diabetes is now covered by insurance. Also covered are support, supplies, and counseling for breastfeeding. If you are a new mother in need of help when it comes to breastfeeding and a pump is required for some reason, say if you are returning to work or if you’re sharing feeding duties with your partner, you could get this necessary equipment for free. Here’s how.
See Your Doctor
The place to start the process is by speaking with your doctor. There are a variety of reasons why you might need a breast pump to make your life easier when it comes to caring for your newborn, and your doctor can help you to understand your options and decide which products are preferable.
This is not only a good idea for educational purposes, but you may also need a doctor’s recommendation before your insurer will agree to cover your expenses where a breast pump is concerned. Your carrier might also require pre-authorization from your doctor before benefits will kick in. Most insurers will follow a doctor’s recommendations.
What You Are Eligible For
Under Obamacare, certain services are guaranteed for coverage thanks to mandatory minimum standards. Breastfeeding services are included in this category, including support, counseling, and supplies like breast pumps
It’s possible that not all expenses related to breastfeeding will be covered in full, however. Although all insurance plans are now required to cover the cost of a breast pump and related equipment for the duration of breastfeeding, you may be subject to some amount of cost sharing or restrictions under your particular policy. For this reason, it’s important to understand exactly what coverage you qualify for.
Check Your Plan
Before you purchase a breast pump, you need to understand the ins and outs of your particular health insurance policy concerning breast feeding supplies. As noted above, your plan may require some measure of cost sharing for specific products or services. You will want to do everything you can to ensure that your equipment is free.
This may mean speaking with a representative from your insurance provider to ask pertinent questions. For example, you need to know which suppliers are approved under your policy. There are several different brands of breast pumps to choose from, not to mention models.
You need to know which vendors are approved under your policy as well so that you can select from the brands and/or models they have available. Did you know there are both manual and electric models? Your insurance provider may prefer (and pay for) one over the other.
Some providers prefer renting equipment over buying, while others require just the opposite, and some have no preference, allowing you to choose. If you want a pump that is not “in your network”, so to speak, will any of the cost be covered or will you have to pay entirely out-of-pocket?
Once you’ve found out what is covered and selected a model, your next order of business is to understand the logistics of purchasing or renting your breast pump. Will you be able to obtain it prior to giving birth so you have time to familiarize yourself with how it works before you bring baby home, or do you have to wait until after childbirth to get it?
Is pre-approval from your doctor required? When you purchase or rent your breast pump, will you have to pay out-of-pocket and seek reimbursement or will vendors bill your insurance for the costs (and bill you for any remaining cost sharing)?
Are you eligible to use a service that supplies your breast pump and all associated parts, or will you have to purchase the pump and accessories separately? Are maintenance and replacement parts covered?
These are all important questions you need to have answered so that you can make sure to follow all necessary rules to receive your breast pump and other equipment for free.
What if You Don’t Have Obamacare?
If you signed up for health insurance coverage through your state exchange, you know that the plans offered meet mandatory minimum standards for guaranteed coverage. What if you’re not covered under Obamacare, though? What if you have a policy through your work, you purchased private coverage, or you’re covered under Medicaid?
Under the ACA, all insurance policies must meet mandatory minimums for coverage, regardless of whether they are offered through the health insurance marketplace or elsewhere. The only plans that are exempt from this law are those that are grandfathered in. At this point, most have been phased out, and if your health coverage doesn’t meet mandatory minimums, it may be time to upgrade to a new policy anyway.
As for Medicaid, you should be covered, but it may depend on your state of residence. Some states elected not to participate in the Medicaid expansion under the ACA. These states may or may not provide coverage for this specific purpose.
If you are in a state where the Medicaid gap exists and breast pumps are not covered under Medicaid or you are exempt from coverage because the gap leaves you ineligible for affordable coverage options, you should see if you qualify for WIC and if free breast pumps are included in those benefits.