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Breastfeeding, Insurance & You

Affordable Care Act

Breastfeeding is an important step in starting your baby off right. Not only does it provide many benefits for both baby and mom, the Affordable Care Act allows for health care policy holders to take advantage of helpful coverage options for breastfeeding supplies and/or accessories.

In our commitment to your growing family, we've compiled basic information and resources to help you determine what is and what is not covered under your insurance policy and what you should know along the way.

The Affordable Care Act requires insurance carriers to provide support for breastfeeding mothers. Under these laws, breastfeeding supplies and accessories are covered under private and commercial insurance providers. The Women's Infant and Children program and Medicaid are not covered under the Affordable Care Act, though some state and federal programs may offer breastfeeding support and reimbursement for supplies. Please contact your nearest WIC or Medicaid location for more information.

And remember, even though breastfeeding accessories or lactation consultant visits may be covered by your insurance carrier it is important to be aware of any co-payments you may be responsible for. If your insurance requires you to pay a co-payment, you may be able to use your pre-taxed Flexible Spending Account contributions towards your co-payment.

Insurance Coverage

Breastfeeding Coverage & Insurance

While breastfeeding insurance benefits have increased, it's important to check with your insurance provider to fully understand what is and what is not covered under your current health care plan. The easiest way to find information about your breastfeeding coverage is to call your insurance company and ask what is provided in your plan. Look on your insurance card for a toll-free phone number to call.

Just like other health benefits you receive from your insurance provider, your insurance carrier will require you to visit an in-network or participating lactation consultant or health care provider.

What Breastfeeding Accessories Does My Insurance Cover?

All insurance companies have different policies regarding what is covered for breastfeeding mothers. When reading your insurance policy or discussing your coverage with an insurance representative make sure to ask plenty of questions and request your policy in print or in a digital file if you do not already have it. You will also want to consider the following when determining what level of breastfeeding coverage your policy provides.

Breast Pump Coverage

  1. Check with your insurance to see if they require a prescription or proof of medical necessity for using a breast pump.
  2. Ask about what breast pump brands are covered.
    • Medela, Hygeia and Lansinoh are a few popular brands to ask about.
  3. Ask about what breast pump styles are covered. Here are some popular options:
    • Hospital-grade rental breast pumps
    • Double or single electric breast pumps
    • Battery or manual breast pumps
  4. Find out if you need approval from your insurance company before making any purchases.
  5. Ask if you're required to get a recommended breast pump or if you'll be reimbursed for buying a breast pump from an out-of-network provider.
    • Make sure to ask about any dollar limits on purchases.
  6. If you prefer to rent a breast pump, make sure to check that this is covered by your carrier.
  7. Already have a breast pump? You can still ask if you'll be reimbursed.

Getting a Breast Pump

  1. Ask if you are able to purchase your breast pump before giving birth.
  2. Ask if there's a specified time period for purchasing a breast pump.
  3. Find out if you are able to choose where you purchase the breast pump.

Lactation Consultants

  1. Ask if lactation consultants in your area are covered or if you are able to choose whomever you prefer.
  2. Find out if there are specific locations to receive lactation services.
  3. There may be a limit on how many lactation visits that are covered. Make sure to ask if this applies to your health care plan.
  4. Ask if you will be reimbursed in case you choose an out-of-network lactation counselor.

Resources & Forms

Filing Claims with Right Start Purchases

A vendor tax ID number may be needed when completing insurance claims. Please use the following If you are filing a Right Start purchase:

  • Right Start's tax ID number:26-4756982

Forms & Policies**

Resources

Breastfeeding & Insurance Info From Medela

Communication with Your Insurance Company

Lactation Consultant Coverage

Filing a Claim

**These resources and forms are merely a guide. Please consult your insurance company to find out more about your health coverage.
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