If you’re in the US, 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 easily get a free breast pump through insurance!
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How to Get a Breast Pump through Insurance
I thought that getting a pump through insurance would be a giant hassle – who wants to deal with the red tape of an insurance company? I almost didn’t even bother.
But it’s actually really easy!
I would recommend skipping dealing with your insurance company altogether and go right to a medical device company that provides breast pumps. Aeroflow Breastpumps is who I recommend.
All you have to do is fill out this form, and they take it from there – they contact your insurance, see what you qualify for, and help you pick out a pump.
What if your insurance doesn’t cover the pump that you want? In some cases you can upgrade and pay the difference. For example, if you want a Spectra S1 for the battery pack but your insurance only covers an S2, you may be able to just pay for the difference in the cost of the two pumps. More info on different breast pumps here.
If Aeroflow doesn’t work in your insurance and you don’t know where to start, call your insurance company and find out which company they use. The process will likely be very similar.
Breast Pump 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 2019, 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.
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, as mentioned above. 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.
When Breast Pumps through Insurance Are Available
Per Medela’s survey, most policies (89%) provide the pump after the baby’s delivery.
I would still try to place the order and do everything you can while you are pregnant, even if they won’t provide it until after the baby is born. It will be nice to have the option to pump as soon as possible (even if you don’t use it), and when you have a newborn, this won’t be at the top of your to do list.
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.
As I noted above, it was really easy – I found out on my insurance company’s website which medical device provider they worked with, and went to the 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. I didn’t have to speak with anyone on the phone or follow up or anything!
Here’s what I received:
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