Breast Pumps Now Covered Under Affordable Care Act

Category: News
May 9, 2013

What is the Affordable Care Act?

According to the U.S. Department of Health and Human Services, the Affordable Care Act (ACA), which was signed into law by President Obama on March 23, 2010, helps make prevention affordable and accessible for all Americans by requiring health plans to cover preventive services and by eliminating cost sharing. Preventive services that have strong scientific evidence of their health benefits must be covered and plans can no longer charge a patient a copayment, coinsurance or deductible for these services when they are delivered by a network provider.”

What does it mean to me?

It means that commercial and private insurers are required to cover comprehensive lactation support and counseling from trained providers, as well as breastfeeding equipment for pregnant and postpartum women.

When did it take effect?

This benefit applies to non-grandfathered plans with renewals starting on or after August 1, 2012. Your insurance provider is your source to confirm if your plan has renewed. To find out what a grandfathered plan is click here.

Where can members purchase breast pumps covered under the ACA?

Expectant and postpartum mothers can buy a breast pump from any in-network durable medical equipment (DME) supplier. It is important to know that many insurance companies require that you see an “in-network” or “participating” DME supplier. In-network simply means that the DME supplier has made an arrangement with the insurance company to provide services to its members. In some cases, going to an out-of-network DME supplier may mean that your breast pump may not be covered at all, or that you may have to pay a higher copay than if you went to an in-network provider.

Will breast pumps be covered if purchased from a retail store?

Retail stores such as Buy Buy Baby, Babies“R”Us and are not DME suppliers, so breast pumps purchased from these types of stores are not covered. However, some self-insured plans may grant exceptions to purchase breast pumps from retail stores.

What does my insurance cover?

Changes to coverage will vary among health insurance plans. The first thing you should do is to call your insurance member services and find out if your plan has renewed and if so, are you able to obtain a breast pump covered at 100%. Most insurance companies offer a toll-free member services number that you can call with specific questions about your health plan. This number is typically found on the back of your card.

Is the coverage subject to deductibles and co-pays?

You should not be subject to any deductible or co-pay. However, there are some variations, depending on your insurance carrier and plan. In some cases, going to an out-of-network DME supplier may mean that your breast pump may not be covered at all, or that you may have to pay a higher copay than if you went to an in-network provider.

Is a prescription required?

When purchasing a breast pump through a participating DME supplier, most if not all health insurance companies are requiring a physician’s prescription.

Are all types of breast pumps covered?

Standard manual and electric breast pump models are covered for purchase at 100%, up to the amount of the contracted allowable rate.

Are breast pump supplies covered?

Yes, breast pump supplies are covered with no cost share for mothers with expanded benefit when purchased from an in-network DME supplier.

How do I get a breast pump through Acelleron Medical Products?

When it comes to helping expectant and postpartum mothers get their breast pump, Acelleron tries to make the experience as easy and hassle-free as possible. Here’s how the ordering process works:

1. Fill out our Breast Pump Request Form.
2. Fill out Breast Pump Order. The form must be completely filled out, signed by you and prescribing physician/nurse practitioner.
3. Completed form should be mailed, uploaded to our secure portal or faxed to Acelleron at 866-615-6082.
4. Once fax is received and insurance benefit is verified, we call to help you pick out a breast pump that will best suit your breastfeeding needs.
5. We ship the breast pump directly to you, free of charge!

Why order your breast pump through Acelleron?

• We verify and bill your health insurance company.
• Free shipping.
• Our breast pumps have been carefully selected from only the highest quality manufacturers.
• We are committed to providing you with safe, effective and trouble-free products.

What breast pumps are available from Acelleron?

Acelleron carries double electric breast pumps from top brands in the industry, including Ameda and Medela. View our entire inventory of breast pumps.

Can I return my breast pump?

Breast pumps are non-refundable.