You may have heard that breast pumps are covered by your health insurance. If you’re pregnant and planning to breastfeed, here’s how to get a breast pump through insurance.
Coverage Requirements under the Affordable Care Act
Like most things related to health care and insurance in the United States, the details of the requirements for insurance companies to cover breast pumps are really confusing. To illustrate how difficult it is, I tried to find the actual text of the provisions covered by the law in the Affordable Care Act. Since it is 955 pages long, I did a search for “breast,” which comes up 44 times in the law. Two of these refer to allowing breastfeeding mothers to take reasonable breaks to pump at work. The other 42 references are in regard to breast cancer.
So where does the law actually state what insurance companies must provide? This is the closest that I can come to finding it:
Comprehensive lactation support and counseling, by a trained provider during pregnancy and/or in the postpartum period, and costs for renting breastfeeding equipment.
Additionally, the Health and Human Services department has issued guidance on what is required:
Your health insurance plan must cover the cost of a breast pump. It may be either a rental unit or a new one you’ll keep. Your plan may have guidelines on whether the covered pump is manual or electric, the length of the rental, and when you’ll receive it (before or after birth).
The only situation where this rule does not apply is if you have a grandfathered plan. Grandfathered plans are plans that were in place on March 23, 2010 and have not changed substantially since then. (By now, in 2018, it’s unlikely that you have a grandfathered plan, but it’s still worth checking.) Your insurance company must notify you if you have a grandfathered plan. The rules do not vary by state, so the insurance company needs to cover a pump regardless of where you live.
The insurance company is not allowed to charge you a deductible or co-pay for your breast pump.
How to Get a Breast Pump through Insurance
The first step is to call your insurance company and find out what they cover – a rental pump (and how long the rental can last) or a new pump, an electric pump and or a manual pump. Here are some good questions to ask when you call.
Then, once you find out what your coverage is, how do you actually get the pump? Do you just pick out what you want and send your insurance company a receipt?
In most cases, no. Many insurance companies will require you to go through a medical device company. Aeroflow is a good example of this – you can go to this page and see if they take your insurance and then what pumps you would qualify for. You do not have to pay for the pump, that should be handled between the insurance company and the medical device company.
If your insurance isn’t on Aeroflow’s list and you don’t know where to start, call your insurance company and find out who they work with.
Choice in Breast Pumps through Insurance
Again, the amount of choice that you’ll have depends on your insurance company – some offer choices and some do not. Medela did a survey of insurance companies as to what they offer, and here are some details:
- 77% cover hospital grade pump rental, but most of them require pre-authorization and a prescription. You can get this from your OB or baby’s pediatrician. As noted above, the insurance company determines how long the rental pump is covered.
- 60% of insurance plans will allow an upgrade. If your plan offers a basic pump and the one that you want is more expensive, they’ll allow you to get the more expensive one and just pay the difference.
The upgrade option is a great for exclusive pumpers if your plan only covers a manual pump. Ideally, you want to have a double electric pump, and this way you wouldn’t have to pay for the full cost of the pump out of pocket.
When Breast Pumps through Insurance Are Available
Per Medela’s survey, most policies (89%) provide the pump after the baby’s delivery.
This is kind of a bummer if you need it when you get home from the hospital – I used mine right away to try to stimulate milk production. Also, I was way too out of it at that point between sleep deprivation and hormones to be dealing with my insurance company. If you can, it’s probably a good idea to work out the details with your insurance company before you have the baby so you can get it as soon as you have the baby, and so you don’t have to figure it out when you’re dealing with all of the post-partum stuff.
Getting a Breast Pump From Insurance: My Experience
With my third baby, I was able to get my own breast pump through insurance when I was eight months pregnant. It was really easy – I found out on my insurance company’s website which medical device provider they worked with, and went to the medical device provider’s website. After I specified my insurance company, the medical device company told me which pumps I could choose. I picked a Medela Pump in Style, and placed the order.
After that, I got an email from the company saying they would verify my coverage with my insurance company and my pregnancy with my doctor. And about three weeks after that, my pump arrived.
Included was the pump, tubing, two bottles, two sets of pump parts, and some Medela breast pads.
I felt really lucky to get this pump through insurance and have the process be so easy. Because I had already bought a breast pump for my first child, I was able to leave that pump at home and leave this one at work, which made commuting much easier.
Feel free to share your experience and any tips you have for how to get a breast pump through insurance below!References
- 111th Congress. “Compilation of Patient Protection and Affordable Care Act.” https://housedocs.house.gov/energycommerce/ppacacon.pdf
- Health Resources and Services Administration. “Women’s Preventative Services Guidelines.” https://www.hrsa.gov/womens-guidelines/index.html
- Healthcare.gov. “Breastfeeding Benefits.” https://www.healthcare.gov/coverage/breast-feeding-benefits/
- Healthcare.gov. “Grandfathered health insurance plans.” https://www.healthcare.gov/health-care-law-protections/grandfathered-plans/
- Medela. “Coverage Questions You Should Ask Your Insurance Company.” https://www.medelabreastfeedingus.com/tips-and-solutions/138/coverage-questions-you-should-ask-your-insurance-company
- Medela. “What Does My Insurance Company Cover?” https://www.medelabreastfeedingus.com/tips-and-solutions/166/what-does-my-insurance-company-cover#Infographic