What is ACA?

The Affordable Care Act (ACA) which was signed into law in 2010. There are many parts of the ACA, but one of the most valuable is that ACA requires health plans to cover breastfeeding support and supplies. Many health plans began implementing this coverage on or after August 1, 2012.

Does this apply to me?

If you have a private insurance carrier or commercial insurer, this law applies to you. Currently this law does not cover Medicaid or WIC.

What Does My Insurance Company Cover? Every Plan is Different:

While the ACA is expanding benefits for breastfeeding, changes to coverage will vary among insurance plans. Therefore, your first step is to understand the coverage and benefits available to you through your insurance plan. Most insurance companies offer a toll-free customer service number that you can call with specific questions about your health plan. (This number is typically found on the back of your insurance card.) The insurance plan representative should be able to explain your insurance coverage for any of the products or services that you receive. It is important to know that many insurance plans require that you see an “in-network” or “participating” healthcare provider. In-network simply means that the healthcare provider or lactation consultant has made an arrangement with the health plan to provide services to its members. In some cases, going to an out-of-network healthcare provider or lactation consultant may mean that your services may not be covered at all, or that you may have to pay a higher copay than if you saw someone in your insurance plan’s “network.”

Coverage & Claim Questions You Should Ask

Your first step is to understand the coverage and benefits available to you through your insurance plan. Your insurance company (or your employer’s benefits department) can provide you with a policy handbook detailing the benefits of your plan. After reviewing the policy handbook, be sure to contact your health insurance plan’s member services department with questions. Understanding what pump you may be eligible to receive, when you can expect to get your pump, and where can you get your pump are only a few of the questions you will want to know.

Coverage Questions You Should Ask

Additional tools are available to assist with the following:

Tips for Communicating with Your Insurance Company
Lactation Consultant Coverage
Filing an Insurance Claim

Some information pages are available in PDF format for you to download at your convenience.

Information About Your Pump

If you are already familiar with the type of Medela breastpump you are receiving from your insurance provider and are looking for more information on that product, please type the part number or model number in the Search field at the top-right of this page.

Additional Reimbursement

Please note: in addition to private insurance assistance, some other state and federal programs may offer breastfeeding support and reimbursement under certain circumstances. For more information call your local Women’s Infants and Children (WIC) office< or your local state Medicaid office.

Healthcare Flexible Spending Accounts

While many health plans may begin to cover breastpumps and lactation services without cost sharing (i.e. co-payments), other plans may still require some cost sharing. For these plans, there may be tax benefits available for individuals who use health care flexible spending accounts. Get more information about Healthcare flexible spending accounts