Planning on breastfeeding, but breast pump not covered by insurance? Here’s how to confirm for sure whether or not you have coverage, and some options for getting an affordable pump if you don’t.
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Do insurance companies cover breast pumps?
The Affordable Care Act requires insurance companies to provide a breast pump to new parents who plan to breastfeed free of charge, without a co-pay.
The Department of Health and Human Services issued the following guidance on what insurers are required to provide:
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).
How do you find out what breast pumps your insurance covers?
The easiest way to do this doesn’t involve talking to your insurance at all.
In most cases, you can work with a medical device company. They will contact your insurance, get a prescription from your doctor, and find out what you’re eligible for.
If you’re not sure whether or not you have coverage, you can fill out this form and find out.
Scenarios where you might not have breast pump coverage
There are a few different situations where you might not have insurance coverage you’d like for a breast pump:
1. Your insurance policy covers breast pumps, but not the one that you want
The Affordable Care Act doesn’t specify what type of pump must be covered.
2. You don’t have health insurance
If you’re without health insurance, you obviously won’t have breast pump coverage.
3. Your health insurance covers a new breast pump every X years, and you have multiple children in that timeframe.
I’ve heard from some people whose insurance only covered a new pump every 3 years, for example.
In this case, if you had two pregnancies and births within that 3 year period, you’d only qualify for a new pump with your first baby and not your second.
What to do when your breast pump is not covered by insurance
One option is obviously to pay out of pocket for your pump. In the next section, I’ll list a few affordable options that have gotten great reviews in our Facebook group.
First, though, here are some options that you can look into to try to save money.
Buy a pump second-hand
You may be able to buy a used closed system pump. Closed system breast pumps have a barrier between the pump parts and the tubing to prevent milk from getting into the motor.
(You’d want to buy your own breast pump parts to use with the pump itself.)
You also may be able to get a pump that has never been used from someone who maybe planned to breastfeed, but then didn’t end up using the pump.
Milkstash.co is a marketplace just for breastfeeding parents and a great place to look for a breast pump if you don’t have insurance coverage.
If you’re eligible for WIC, reach out to your WIC Clinic
They may be able to help you get or rent a pump.
See if you can upgrade your pump
If you fall into the category where you qualify for a pump but not the one that you want, find out if you can upgrade your pump.
Basically, what this means is that sometimes, if there is a price difference between the pump you want and the one that is covered, the medical device company that you work with will allow you to pay the difference.
As an example, let’s say that you want a Spectra S1 (which has a rechargeable battery), but your insurance only covers a Spectra S2 (which needs to be plugged into an outlet). The medical device company may allow you get an S1 for whatever the price difference between the two pumps is.
If you have an FSA or HSA, use it to buy a pump
Health flexible spending plans allow you to spend tax-free money on medical expenses.
Buying a new pump and paying out of pocket
This is the most obvious answer – if your pump isn’t covered, you may have to buy one yourself.
If you’re planning on exclusively pumping or pumping while at work, it’s a good idea to get a double electric breast pump.
Below are a few that are on the less expensive side that work well for many people in our Facebook group:
2. Spectra S2
3. Lansinoh Double Electric SmartPump 2.0
Have you struggled with getting a breast pump without insurance? Tell us about your experience in the comments!