By: Anna Benyo, Senior Health Policy AnalystPosted on May 26, 2015 Issues: Health Care

Last week, the National Women’s Law Center issued the third report in a series examining insurance plan compliance with the Affordable Care Act, State of Breastfeeding Coverage: Health Plan Violations of the Affordable Care Act. Previous reports on women’s health coverage and birth control coverage found extensive violations of the law. The third report examines insurance plan noncompliance with the ACA’s breastfeeding benefits and comes to similar conclusions.

The ACA Is a Huge Step Forward

The ACA made dramatic improvements in women’s health coverage. The ACA ensures that health insurance companies can no longer discriminate against women, and requires plans to offer women coverage for maternity care and prescription drugs. And they must cover preventive services, such as breastfeeding supports and supplies and birth control, without any copayments, deductibles or coinsurance.

Health Insurance Plans Must Comply With the Law

But, women only enjoy these benefits if insurance plans comply with the law, and our reports find that many don’t.

Most insurance plans are required to cover comprehensive breastfeeding support and supplies for the duration of breastfeeding. This means women have access to breast pumps and lactation counseling without any copayments, deductibles or coinsurance. In addition, based on federal rules, if an insurance company doesn’t have anyone in network to provide lactation counseling, women must be able to get these services out-of-network without out-of-pocket costs.

My Story

I know firsthand how difficult (and expensive) it is when your insurance company doesn’t follow the law. A few days after I gave birth to my son I needed to see a lactation consultant. I know all about the ACA’s coverage of breastfeeding support and supplies—I even co-authored a toolkit to publicize these benefits and help other women who cannot get coverage!

I called my insurance company and they said they didn’t cover lactation counseling outside the hospital. I knew that wasn’t right—plans have to cover this help for the duration of breastfeeding. I asked for a list of any in-network lactation counselors. They couldn’t identify any in-network providers in the entire DC-metro area. So I went to my local breastfeeding center on postpartum day three and paid up-front to meet with a lovely woman who devised a treatment plan. I continued to see this lactation consultant several times over the next few weeks. In the end, I paid hundreds of dollars out-of-pocket for services that my health plan was supposed to fully cover. I then started a months-long back and forth with my insurance company to get reimbursed.  

Dozens of women have contacted our hotline—CoverHer—sharing similar stories.

Health Insurance Companies Must Do Better

Health insurance companies must do better. And, policymakers must not only ensure that coverage complies with the law, they must engage stakeholders to develop useful standards, based on women’s real-life needs, that make this coverage real. Millions of women now have insurance coverage of breastfeeding equipment and lactation counseling. That’s a huge step forward for women and families. But, we need to make sure women actually get the tools they need to breastfeed successfully.