Health Insurance Blog

Breast Pump Coverage Issues

Posted by:
Tim Jackson
on
November 13, 2014
Under the Affordable Care Act, health plans are required to cover the cost of breast pumps for women who need them for medical reasons or because they

Under the Affordable Care Act, health plans are required to cover the cost of breast pumps for women who need them for medical reasons or because they work or are students. When the provision went into effect in 2012, it was largely heralded as a major victory for mothers and infants.

Two years later, though, advocacy groups say a lack of guidelines has led to inconsistent coverage in California and across the nation. They say that convoluted processes make it impossible–or nearly impossible–for some women to obtain breast pumps when they are needed and that there are discrepancies in the type of breast pump women are able to obtain and the circumstances under which a pump is covered.

Breastfeeding is widely promoted by medical providers because of an extensive body of research showing its optimal nutritional value and positive health outcomes, such as reducing rates of acute and chronic conditions, including gastrointestinal infections, ear infections, asthma, diabetes and obesity.

There are differing opinions on how the process for obtaining a breast pump should be regulated, and who is responsible for simplifying or streamlining the process. Should state insurance commissioners take up the issue? Should the federal government issue a directive? Should it fall to individual counties to police their Medi-Cal managed care plans? If a plan is through a health insurance exchange, should the exchange fix the problem?

We’d love to hear your thoughts.  Join the conversation.

This article was written by Victoria, a contributing writer and employee of The Health Insurance Specialists Inc.

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