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

* Ameda Publication

References:
1. Institute of Medicine. (2012). Women’s preventative services recommended by IOM to be covered under affordable care act.
2. Institute of Medicine. (2011). Clinical preventative services for women: Closing the gaps.
3. HealthCare.gov. (2012). Affordable care act rules on expanding access to preventative services for women.

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