Does Your Insurance Cover A Breast Pump? Here’s How To Check

Navigating the world of health insurance can feel overwhelming, especially when you’re expecting or have a new baby. One common question is whether your insurance plan will cover a breast pump, a crucial tool for many new mothers. The good news is that under the Affordable Care Act (ACA), most health insurance plans are required to cover breastfeeding support and supplies, including breast pumps. However, the specifics of what’s covered, the type of pump, and how you obtain it can vary significantly by plan. This guide will walk you through how to find out if your insurance covers a breast pump and what steps to take.

Quick answer

• Most health insurance plans are required to cover breast pumps as durable medical equipment.
• Coverage details, including the type of pump and acquisition method, vary by plan.
• You’ll typically need a prescription from your doctor to get a covered breast pump.
• Contacting your insurance provider directly is the most reliable way to confirm coverage.
• Specialized medical supply companies often work directly with insurers to provide pumps.

What to check first (before you buy or change coverage)

Before you get too far into researching breast pumps, it’s essential to understand your insurance coverage. This will save you time, money, and potential frustration.

Coverage needs

Consider your personal circumstances. Are you planning to breastfeed exclusively, or will you need a pump for returning to work or other situations? Your intended use might influence the type of pump that best suits your needs, and understanding what your insurance covers for different types is key. For example, some plans may cover a basic manual pump, while others might offer coverage for a more advanced double electric pump.

Deductibles and premiums

Your insurance plan’s deductible is the amount you pay out-of-pocket before your insurance starts covering costs. Your premium is your regular monthly payment for insurance. While breast pumps are often covered as a preventive service with no cost-sharing, it’s wise to understand if any part of your plan’s deductible or copay structure would apply. Check with your insurance provider to confirm if there are any out-of-pocket expenses associated with obtaining a breast pump under your specific plan.

Exclusions and limits (general)

Every insurance policy has exclusions – services or items that are not covered – and limits on what is covered. While breast pumps are generally covered, there might be limits on the type of pump (e.g., manual vs. electric, single vs. double) or the brand you can choose. Some plans might also have limits on accessories or replacement parts. Always ask for a detailed explanation of what is and isn’t covered for breast pumps.

Claim process

Understanding how to get a breast pump through insurance is crucial. Most plans require a prescription from your healthcare provider. You’ll then typically work with an in-network durable medical equipment (DME) provider or a specialized breast pump supplier that your insurance company partners with. Ask your insurance provider about their preferred network of suppliers and the process for submitting a claim or getting pre-authorization if needed.

Bundling and discounts (general)

While not directly related to breast pump coverage, it’s a good time to consider other aspects of your insurance. If you’re looking for a new plan or evaluating your current one, see if bundling services (like medical, dental, and vision) offers any advantages or discounts. Also, inquire about any wellness programs or discounts on related baby items that your insurer might offer. These can provide additional value beyond just the breast pump coverage.

Step-by-step (simple workflow)

Here’s a straightforward process to determine and obtain your insurance-covered breast pump.

1. What to do: Review your health insurance policy documents or visit your insurer’s website.

What “good” looks like: You find information specifically mentioning coverage for breast pumps, breastfeeding supplies, or durable medical equipment.
A common mistake and how to avoid it: Assuming coverage based on general ACA requirements without verifying your specific plan details. Avoid this by looking for explicit mentions of breast pump coverage in your policy.

2. What to do: Call your insurance provider’s customer service line.

What “good” looks like: You speak with a representative who can clearly explain your breast pump coverage, including any requirements like a prescription or preferred suppliers.
A common mistake and how to avoid it: Giving up after the first representative isn’t helpful. If you don’t get a clear answer, politely ask to speak with a supervisor or someone specializing in durable medical equipment coverage.

3. What to do: Ask specific questions about breast pump coverage.

What “good” looks like: You get answers to questions like: “Is a breast pump covered?” “What types of pumps are covered (manual, electric, double electric)?” “Are there specific brands or models I must choose from?” “Do I need a prescription?” “What is the process for obtaining one?”
A common mistake and how to avoid it: Not asking enough detailed questions, leading to surprises later. Make a list of questions beforehand and confirm the answers in writing or via email if possible.

4. What to do: Consult your OB-GYN or pediatrician.

What “good” looks like: Your doctor confirms the medical necessity for a breast pump and provides a prescription if required by your insurance.
A common mistake and how to avoid it: Forgetting to get the prescription or getting one that doesn’t meet your insurer’s requirements. Ensure the prescription includes all necessary medical codes and information.

5. What to do: Identify in-network durable medical equipment (DME) suppliers or specialized breast pump providers.

What “good” looks like: Your insurance company provides a list of approved providers or you confirm with a supplier that they work with your insurance.
A common mistake and how to avoid it: Choosing a supplier not in your network, which can lead to much higher out-of-pocket costs. Always verify network status with both your insurer and the supplier.

6. What to do: Contact the chosen supplier with your prescription and insurance information.

What “good” looks like: The supplier verifies your insurance coverage and explains the process for receiving your pump.
A common mistake and how to avoid it: Assuming the supplier has all the information. Be prepared to provide your insurance ID number, policy details, and your doctor’s prescription.

7. What to do: Confirm the specific breast pump model you will receive.

What “good” looks like: The model you are set to receive aligns with what your insurance covers and meets your needs.
A common mistake and how to avoid it: Accepting a pump without confirming its specifications. If you have specific needs (e.g., a double electric pump for efficiency), ensure the approved model meets them.

8. What to do: Understand the delivery or pickup process.

What “good” looks like: You know when and how you will receive your breast pump, and if there are any associated shipping fees.
A common mistake and how to avoid it: Not clarifying delivery timelines, especially if you need the pump by a certain date (e.g., when you return to work).

Common mistakes (and what happens if you ignore them)

Mistake	What it causes	Fix
Not verifying coverage before obtaining a pump	Paying the full retail price for a pump that would have been covered or partially covered by insurance.	Call your insurer and confirm coverage details, including the process and approved suppliers, before ordering or picking up any pump.
Assuming all pumps are covered equally	Receiving a basic manual pump when you needed or could have gotten a more advanced electric model.	Ask specific questions about the <em>type</em> of pump covered (manual, electric, double electric) and inquire about any upgrade options and associated costs.
Using an out-of-network supplier	Incurring significantly higher out-of-pocket costs, potentially paying the full price for the pump.	Always confirm with your insurance provider that the chosen supplier is in-network for durable medical equipment.
Not getting a valid prescription	The supplier or insurance company denying the claim, leaving you responsible for the full cost.	Ensure your doctor provides a prescription specifically for a breast pump, including all necessary medical codes and information required by your insurer.
Missing deadlines for pre-authorization	Delays in receiving your pump or outright denial of coverage if pre-authorization was required.	Ask your insurance provider if pre-authorization is needed and understand the timeline and process for submitting the necessary paperwork.
Not understanding accessory coverage	Having to pay out-of-pocket for essential accessories like extra valves, tubing, or collection bottles.	Inquire about coverage for essential accessories and replacement parts. Some plans cover them, while others may require separate purchases.
Relying solely on the pump supplier’s advice	The supplier may prioritize their own inventory or relationships over your specific insurance coverage.	Always cross-reference information with your insurance provider. The insurer is the ultimate authority on what your plan covers.
Not clarifying the return/exchange policy	Being stuck with a pump that doesn’t meet your needs or is defective, with no recourse for a refund or swap.	Before accepting the pump, understand the supplier’s and manufacturer’s return and exchange policies, especially if it’s not a perfect fit for your situation.
Not asking about replacement pumps	Being without a pump if yours malfunctions or is damaged and not knowing how to get a replacement covered.	Ask your insurance provider and supplier about the process for obtaining replacement parts or a new pump if the original becomes unusable.

Decision rules (simple if/then)

• If your insurance provider states that breast pumps are covered under the ACA, then you should proceed to asking for specifics about your plan’s coverage because ACA compliance doesn’t guarantee all plans cover the same models or have the same process.
• If your doctor recommends a specific type of breast pump (e.g., double electric), then confirm with your insurance that this specific type is covered before obtaining a prescription because your doctor’s recommendation might not align with your insurance’s coverage limits.
• If a supplier tells you they are “in-network,” then verify this information with your insurance provider directly because supplier claims about network status can sometimes be inaccurate.
• If your insurance plan has a deductible, then ask if obtaining a breast pump counts towards meeting that deductible because some preventive services are covered before the deductible is met.
• If you are offered an “upgrade” to a more expensive pump, then understand the exact out-of-pocket cost for that upgrade because your insurance will likely only cover the cost of the standard covered model.
• If you are given a prescription for a breast pump, then ensure it includes all required medical codes and information before submitting it to a supplier because incomplete prescriptions are a common reason for claim denials.
• If your insurance covers a specific list of breast pump brands or models, then choose from that list to maximize your coverage because deviating from the approved list may result in higher personal costs.
• If you are returning to work soon after giving birth, then start the process of obtaining your breast pump well in advance because there can be delays in prescription fulfillment and supplier processing.
• If your insurance requires pre-authorization for a breast pump, then initiate this process immediately and follow up regularly because failure to do so can result in denied coverage.
• If you receive a breast pump and it doesn’t meet your needs or has a defect, then immediately contact the supplier and review their return/exchange policy because you may have a limited window to address the issue.

FAQ

Q: Does every insurance plan cover a breast pump?

A: Under the Affordable Care Act, most health insurance plans are required to cover breast pumps and breastfeeding support. However, there can be variations in what specific models are covered and how you obtain them.

Q: What kind of breast pump will my insurance cover?

A: Coverage varies by plan. Some plans may cover basic manual pumps, while others will cover electric or double electric pumps. Some may offer a standard model for free and allow you to pay an upgrade fee for a more advanced one.

Q: Do I need a prescription to get a breast pump through insurance?

A: Yes, almost all insurance plans require a prescription from your healthcare provider (like your OB-GYN or pediatrician) to cover a breast pump.

Q: How do I get the breast pump from my insurance?

A: You typically work with an in-network durable medical equipment (DME) provider or a specialized breast pump supplier that your insurance company has partnered with. You’ll provide your prescription and insurance information to them.

Q: Can I choose any brand or model of breast pump?

A: Usually, you are limited to specific brands or models that your insurance company has contracted with or deemed medically necessary. Always confirm with your insurer.

Q: What if my insurance doesn’t cover the pump I want?

A: Your insurance will likely cover a specific model. If you want a different, more expensive model, you may be able to pay the difference out-of-pocket as an upgrade, but confirm this with your insurer and the supplier.

Q: How long does it take to get a breast pump through insurance?

A: The timeline can vary. It depends on how quickly you get a prescription, how long it takes your supplier to process the order, and shipping times. It’s best to start the process as early as possible, ideally in your third trimester.

Q: What if my breast pump breaks? Will insurance cover a replacement?

A: Coverage for replacement parts or a new pump depends on your specific policy and the reason for the malfunction. Inquire with your insurance provider and the supplier about their policies regarding broken or malfunctioning equipment.

What this page does NOT cover (and where to go next)

• Specific details on every insurance plan’s coverage for breast pumps.
• Reviews or recommendations for specific breast pump models.
• Information on international health insurance coverage for breast pumps.
• Detailed guidance on tax implications related to medical equipment.

Where to go next:

• Review your specific health insurance policy documents.
• Consult with your healthcare provider about your breastfeeding needs.
• Contact your insurance provider’s member services department directly.
• Research durable medical equipment (DME) suppliers in your network.