Recent US federal government legislation and government-funded programs help breastfeeding be more accessible to mothers and babies.
Under the Patient Protection and Affordable Care Act, breastfeeding services and supplies are covered without cost sharing in health plans starting August 1, 2012.
What is the Patient Protection and Affordable Care Act (PPACA)?
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.
When do breastfeeding services and supplies need to be covered?
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.
What are details on the Affordable Care Act rules pertaining to Preventive Services for Women?
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.
Is this coverage subject to deductibles and co-pays?
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
What lactation services and supplies are covered?
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 your coverage.
How does a health insurance plan deliver breastfeeding supplies to a member?
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.
Do these requirements vary by state?
No. Requirements do not vary by state.