New Guidelines
Coverage of Breastfeeding Supplies and Services Under The Patient Protection Affordable Care Act
Ameda is delighted to share the news of the coverage of breastfeeding supplies and equipment without copayment in health plans starting August 1, 2012, under the Affordable Care Act. Now the many products and services that support breastfeeding are accessible at no cost.
The following questions provide information on the provision under the Affordable Care Act for breastfeeding services and supplies, and how it will impact mothers and babies. The information provided is the most current available at the date of publication*. For any questions regarding your specific health plan coverage, please contact your insurance provider.
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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 copayment, coinsurance 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.
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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)2 and based on scientific evidence.
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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.
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Is this coverage subject to deductibles and co-pays?
No. Breastfeeding services and supplies must be covered with no cost-sharing (no copayments, co-insurance or deductibles) in plan years starting on or after August 1, 2012.
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What lactation services and supplies are covered?
The provision states: "Pregnant and postpartum women will have access to comprehensive lactation support and counseling from trained providers, as well as breastfeeding equipment".
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.
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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.
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Where can I access additional information?
Comprehensive information is available at the following government sites:
www.healthcare.gov/news/factsheets/2011/08/womensprevention08012011a.html
You may also want to check with your health insurance provider for their preventive services policy.
*Ameda publication September 2012.
References
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Institute of Medicine. (2012). Women's preventative services recommended by IOM to be covered under affordable care act. Retrieved from http://www.iom.edu/Reports/2011/Clinical-Preventive-Services-for-Women-Closing-the-Gaps/Action-Taken
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Institute of Medicine. (2011). Clinical preventative services for women: Closing the gaps. Retrieved from http://www.iom.edu/Reports/2011/Clinical-Preventive-Services-for-Women-Closing-the-Gaps/
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HealthCare.gov. (2012). Affordable care act rules on expanding access to preventative services for women. Retrieved from http://www.healthcare.gov/news/factsheets/2011/08/womensprevention08012011a.html
About Ameda
More than 70 years ago in Sweden, engineer Einar Egnell made it his life’s work to help breastfeeding mothers. After years of research, Egnell created the first comfortable and effective breast pump. In the process, Egnell also created the vacuum and cycling standards that today’s lactation consultants use to judge breast pump quality.
Today’s Ameda breast pumps combine Egnell’s innovative technology with the features a 21st century mother expects. Everything Ameda offers—Ameda breast pumps and products, Ameda breastfeeding education, Ameda’s support of lactation professionals— reflects our passion for breastfeeding. We know how much breastfeeding matters to mothers and their babies.
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