The Affordable Care Act is a comprehensive health care reform that has revolutionized health care for pregnant, breastfeeding, and postpartum women, ensuring that they have access to inclusive and affordable care throughout their reproductive journey.
By mandating coverage to individuals for essential health benefits, prohibiting discrimination based on pre-existing conditions, and expanding access to Medicaid, the ACA has helped close coverage gaps and improve health outcomes for women and their families.
Some of the information included in the plan can be a bit confusing and, let’s face it, overwhelming. That’s why we’re here to break it down for you. We’ll help you understand which aspects of it apply to new and expectant mamas and how you can make the most of your coverage:
History
The Affordable Care Act (ACA) was signed into law by President Barack Obama on March 23rd, 2010. Upheld by the Supreme Court in 2012, the ACA stands as one of the most significant reforms in the United States health care system. The ACA was designed to reform health care in America by expanding coverage, controlling health care costs, and improving health care delivery and systems.
The ACA has had a profound impact on women’s health, especially for those who are pregnant, breastfeeding, or in their postpartum period. Before the ACA, access to maternity care and coverage for essential health care services varied significantly among insurance plans, often leaving many women without adequate protection due to coverage gaps.
However, the ACA ensures that women receive comprehensive care throughout their reproductive journey. It has completely changed how policies cover specific services and items, including breastfeeding equipment, supplies, and other maternity services.
Benefits for Women’s Care
By mandating coverage for a wide range of preventive services with no cost-sharing requirements, the ACA has helped the health care industry make strides in women’s health. Preventive services like screenings, counseling, and support for various health conditions affecting women across different stages of life are covered under its policies! This helps keep women safe and healthy and empowers them to take control of their health care.
Preventive Services and Care
Some of the included screenings and preventive procedures include mammograms, obesity prevention in middle-aged women, screenings for urinary incontinence, anxiety, cervical cancer, breast cancer, well-woman preventive visits, and counseling for sexually transmitted infections (STIs), human immunodeficiency virus infection (HIV), and interpersonal and domestic violence.
Coverage of these tests may only be eligible for certain women, depending on their age. Without just medical cause (meaning, without your doctor deeming one of these tests necessary due to signs or symptoms), you can expect to be screened at the following age under the ACA:
- Mammograms: women aged 40 and older, typically on an annual or biennial basis.
- Cervical Cancer: women starting at age 21, with frequency determined by age.
- Urinary Incontinence: as deemed necessary by your health care provider or as symptoms present.
- Anxiety: as deemed necessary by your health care provider or as symptoms present.
- STI Testing: as deemed necessary by your health care provider or as symptoms present.
- Well-Women Exams: annually, typically beginning around ages 13-15.
In addition to these services, the ACA also mandates coverage for a range of other preventive services with no cost-sharing for women, including contraceptive counseling and methods, screenings for anemia and osteoporosis, tobacco cessation counseling and interventions, and immunizations, including HPV vaccination.
Benefits for Pregnancy Care
The prenatal period is a significant but sometimes fickle time for maternal and fetal health. While pregnant, the physical and hormonal changes your body undergoes to accommodate your baby can impact your health in different ways. Every mama wants what’s best for her little one, so access to prenatal care and support services for both mom and baby is incredibly important.
Coverage for Maternity Care
One of the key provisions of the ACA is that it requires insurance plans to cover maternity care as an essential health benefit. This includes labor and delivery, as well as prenatal and postpartum care. Before the ACA, maternity coverage was often offered as a costly add-on or excluded altogether from many plans, leaving pregnant people with significant medical expenses and barriers to accessing these essential services.
With the ACA, maternity care became a standard component of qualified health plans, ensuring that women receive the care they need without facing extreme out-of-pocket expenses. This has significantly improved access to prenatal care to help monitor the health of both mama and baby throughout pregnancy.
The ACA also prohibits insurers from imposing lifetime or annual limits on coverage or essential health benefits, including maternity care. This ensures that pregnant women do not face coverage caps that could jeopardize their access to necessary medical services during pregnancy and childbirth. By removing these barriers, the ACA has helped to promote healthier pregnancies and reduce maternal and infant mortality rates across the United States.
Preventive Services and Care
In addition to coverage for maternity care, the ACA mandates coverage for a range of preventive services with no cost-sharing for pregnant women. These services are aimed at identifying and addressing health issues early in pregnancy to promote healthier outcomes for both mama and baby.
Preventive care is very important for pregnant women because it allows health care providers to monitor the progress of the pregnancy, screen for potential complications, and provide education and support to expectant mothers. Under the ACA, prenatal care visits, including screenings for gestational diabetes, anemia, and genetic disorders, are covered without cost-sharing, ensuring that all pregnant women have access to these essential services.
Pregnancy as a Pre-Existing Condition
Before the ACA, attempting to obtain insurance coverage after getting pregnant often made the pregnancy classified as a pre-existing condition. This discriminatory practice left many pregnant women without access to comprehensive coverage and allowed insurers to deny coverage or charge premiums to pregnant women seeking health insurance and care.
Under the ACA, pregnancy can no longer be considered a pre-existing condition, ensuring that all pregnant women have access to the care they need, regardless of their health history or insurance status before becoming pregnant. This provision has been crucial in expanding access to maternity care and essential health services for pregnant women across the United States.
Coverage for Low-Income Pregnant Women
Another key component of the ACA is the expansion of Medicaid eligibility to millions of low-income individuals, including pregnant women, to provide them with affordable health insurance plans. Before the ACA, Medicaid eligibility for pregnant women varied widely from state to state, leading to disparities in access to maternity care and essential health services.
The ACA expanded Medicaid eligibility to include pregnant women with household incomes up to 138% of the federal poverty level in states that chose to expand their Medicaid programs. This expansion has been instrumental in increasing access to prenatal care and other essential services for low-income pregnant women who were previously uninsured or underinsured.
Medicaid coverage for pregnant women typically includes comprehensive maternity care, including prenatal care, labor and delivery, and postpartum care. This ensures that even those with limited financial resources receive the care they need to have a healthy pregnancy and childbirth experience. Additionally, this Medicaid coverage for pregnant women is retroactive, meaning that eligible women receive health coverage for prenatal care and delivery services even if they were uninsured at the time of conception.
It is important to note that not all states have chosen to expand their Medicaid programs, leaving many low-income pregnant women without access to affordable medical care and health insurance coverage. You can check the status of your state’s action on Medicaid expansion here.
Pregnancy Assistance Fund (PAF)
In addition to expanding access to health care coverage, the ACA established the Pregnancy Assistance Fund (PAF) to support vulnerable pregnant and parenting women and their families. The PAF provides federal financing and grants to states and tribal entities to develop and implement programs offering supportive services to pregnant and parenting women, including case management, counseling, education, and support for pregnant and parenting teens.
The PAF aims to address the unique needs of pregnant and parenting women who may face challenges such as poverty, homelessness, substance abuse, or intimate partner violence. By providing funding for comprehensive support services, the PAF helps to ensure that pregnant and parenting women have access to the resources and support they need to have healthy pregnancies and positive parenting experiences.
This fund also promotes care coordination among health care providers, social service agencies, community organizations, and other stakeholders to coordinate care and services for pregnant and parenting women and their families. Through this care coordination, the PAF helps to maximize the impact of available resources and ensure that these individuals receive comprehensive, coordinated care that addresses their unique needs and circumstances.
Benefits for Postpartum Care
The postpartum period is a very important time for maternal health. During this period, women may experience physical, emotional, and social changes that require ongoing care and support. However, access to postpartum care and support services has historically been limited for many women, particularly those who are uninsured or underinsured.
Maternal Health Protections
The ACA extends coverage for postpartum people to ensure continued care and support for women after childbirth. Postpartum depression screenings, counseling, and support services are now covered without cost-sharing to ensure that women receive the support they need to address both their mental and physical health, which has led to a decrease in postpartum hospitalizations.
Additionally, contraceptive services and counseling are provided without cost-sharing under the ACA, enabling women to make informed decisions about family planning and contraceptive use after childbirth. The ACA helps to ensure that women have access to a full range of contraceptive options, including long-acting reversible contraceptives (LARCs) such as intrauterine devices (IUDs), oral contraceptive pills, and other contraceptive implants.
Returning to Work
The ACA also amended section 7 of the Fair Labor Standards Act (FLSA). The amendment includes an employer mandate stating that for up to one year following the birth of an employee’s child, employers are required to provide a reasonable amount of break time and space for nursing mothers to express milk as frequently as needed. Additionally, the space provided by the employer cannot be a bathroom. Pumping spaces must be shielded from view and free from intrusion by coworkers or the public.
This is a huge stride for working mama rights in the workplace! No more pumping in the bathroom or struggling to balance your lactation goals as you return to the office. And these changes are having a big impact on breastfeeding success for mamas in the United States!
Moms are not only continuing breastfeeding for longer but are also exclusively breastfeeding longer. According to the 2022 CDC Breastfeeding Report Card, breastfeeding increased from 81% in 2013 to 83% by 2020. And the number of babies exclusively breastfed for the first six months increased by 75% from 2010 by 2018. We love to see it!
Insurance Guidelines and Grandfathered Insurance Plans
Per the ACA, qualified health plans must provide breastfeeding support, counseling, and supplies at little to no cost for the duration of the time one chooses to breastfeed. Previously, breast pumps and breastfeeding services were costly and difficult for most people to afford, so this is especially exciting.
These breast pumps, per the health care reform, are covered under your preventive benefits, which means they will not be subject to deductibles, coinsurances, copays, or maximum out-of-pocket costs. You must be covered by the policy to be eligible for benefits—you cannot get a pump or breastfeeding coverage through your partner or child’s insurance if you are not personally covered.
Some plans are considered “grandfathered,” which means they are not always required to comply with the ACA’s health care reform. Legally, your insurance provider must notify you if you have a grandfathered plan. If you have a grandfathered plan, you may not be covered for services included by ACA under other marketplace plans.
Purchasing a Breast Pump
What does all this mean? Your insurance company may cover some or all of the costs of your breast pump, lactation classes, maternity support garments, and more! To find out what your plan covers, fill out our Qualify Through Insurance form and one of our specialists will contact you with more information regarding your specific situation.
If you are not currently covered for breastfeeding equipment and supplies by the ACA, you can still purchase a pump yourself. We offer a wide variety of top-brand pumps on our website and are happy to chat and help you decide which one is right for you and your goals.
If you have any questions about the Affordable Care Act or getting your breast pump through insurance, call our Breastpump Department today at 844-867-9890.
Information provided in blogs should not be used as a substitute for medical care or consultation.
References
https://www.mayoclinic.org/diseases-conditions/gestational-diabetes/symptoms-causes/syc-20355339
https://www.webmd.com/baby/anemia-in-pregnancy
https://www.healthcare.gov/medicaid-chip/medicaid-expansion-and-you/
https://opa.hhs.gov/grant-programs/archive/pregnancy-assistance-fund-paf-program-archive/about-paf
https://www.healthaffairs.org/doi/10.1377/hlthaff.2022.00819
https://my.clevelandclinic.org/health/treatments/24441-intrauterine-device-iud
https://www.dol.gov/agencies/whd/flsa
https://www.dol.gov/whd/regs/compliance/whdfs73.htm
https://www.ncbi.nlm.nih.gov/pubmed/29267066
https://www.cdc.gov/breastfeeding/data/reportcard.htm
https://www.healthcare.gov/coverage/breast-feeding-benefits/
https://www.healthcare.gov/health-care-law-protections/grandfathered-plans/
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