Overview
Under the Affordable Care Act (ACA), most U.S. health insurance plans fully cover breast pumps for new mothers. However, the process varies by insurer and program. This guide covers coverage details, prescriptions, pump selection, suppliers, ordering steps, and special considerations for Medicaid, Medicare, WIC, and TRICARE.
1. Insurance Coverage
ACA Benefits
The ACA mandates that private health insurance plans cover breastfeeding support and equipment, including a manual or electric breast pump. Coverage applies whether you obtain a pump before or after birth. However, insurers may set guidelines regarding:
- Ordering Timeline: Some insurers allow ordering during pregnancy, while others require waiting until after birth.
- Pump type: Manual or electric (they cannot require manual pumps first if an electric is medically needed).
- Rental vs. Purchase: Some plans cover rentals, while others provide a new personal-use pump.
Coverage by Major Insurers
| Insurer | Coverage Details |
|---|---|
| Aetna | Covers manual or standard electric pumps (not hospital-grade). Second set of pump supplies available if already breastfeeding from a previous pregnancy. Requires in-network durable medical equipment (DME) supplier. |
| Blue Cross Blue Shield (BCBS) | Varies by state, but generally covers a manual or double-electric pump per birth. Requires in-network supplier and doctor’s prescription. Hospital-grade pumps are usually not covered for personal use. |
| UnitedHealthcare (UHC) | Covers a personal-use double electric breast pump at no cost through in-network suppliers. Prescription required; retail store purchases are not reimbursed. |
| Cigna | Provides a free pump starting at 28 weeks of pregnancy. No prescription required for standard models. Covers a starter kit with accessories and offers upgrades at a discounted rate. |
| Kaiser Permanente | Covers a double-electric breast pump per birth at no cost. Requires ordering through their internal system or approved contractor. Some regions allow ordering before birth. |
| Humana | Covers one double-electric pump per pregnancy, often with a cost limit (e.g., $200). Models exceeding this may require an upgrade charge. |
How to Verify Coverage:
- Call Your Insurance Provider: Ask specifically about covered breast pump brands and models, whether a prescription is required, and which suppliers are in-network.
- Check Online Portals: Many insurers have online portals where members can check breast pump benefits and authorized suppliers.
- Ask Your OB/GYN or Midwife: Healthcare providers often have experience with insurance-covered breast pump claims and can offer guidance.
If coverage is denied, you have the right to appeal the decision by requesting an explanation in writing and seeking assistance from your healthcare provider or lactation consultant.
Types of Pumps Covered
- Manual Pumps: Hand-operated, covered but less efficient.
- Standard Electric Pumps: Double-electric models are the most common and fully covered.
- Hospital-Grade Pumps: Only covered as rentals if medically necessary.
- Wearable Pumps: Some insurers consider them luxury items and may require an upgrade fee.
2. Prescription Requirements
Do You Need a Prescription?
Most insurers require a doctor’s prescription for a breast pump. Some exceptions include Cigna, which does not require a script for a standard pump. Medicaid and state-based plans may have additional forms.
Many insurance providers require a prescription from your OB/GYN, midwife, or primary care provider before they approve your breast pump order.
How to Get a Prescription:
- Ask your doctor at a routine prenatal visit. You can request it around the third trimester or once your insurance confirms that you’re eligible.
- Your prescription may simply state “breast pump for nursing”, though some insurers may require additional details, such as the due date or type of pump (manual vs. electric).
- Some medical supply companies will request the prescription on your behalf. You just need to provide your doctor’s contact information.
- If you forget to get a prescription before birth, you can still get one postpartum. Most insurers cover a breast pump for up to one year after delivery.
If your insurance does not require a prescription, you can skip this step and move forward with ordering.
3. Choosing a Breast Pump
Popular Brands/Models
| Brand | Models |
|---|---|
| Medela | Pump in Style (MaxFlow) |
| Spectra | S1 (battery-powered), S2 (plug-in) |
| Lansinoh | Signature Pro, SmartPump 2.0 |
| Ameda | Mya Joy |
| Motif | Luna |
| Evenflo | Advanced |
Factors to Consider
- Portability: Battery-powered options like Spectra S1 or Medela Freestyle are ideal for travel.
- Suction Strength: Hospital-grade rentals are the strongest; Spectra and Medela offer strong personal-use options.
- Noise Level: Spectra and newer Medela models are quieter.
- Ease of Cleaning: Closed-system pumps (e.g., Spectra, Motif) require less maintenance than open-system pumps (e.g., older Medela models).
- Durability: Medela and Spectra are known for longevity.
4. In-Network Suppliers
Once you know your insurance’s options, you’ll likely need to order your pump from an in-network medical supplier rather than a retail store. These suppliers work directly with insurance companies to provide breast pumps at no cost.
| Supplier | Notes |
| Edgepark | A nationwide supplier offering all major breast pump brands. Handles insurance verification and direct billing. Shipping is typically free, and the approval process is straightforward. |
| Byram Healthcare | Provides insurance-covered breast pumps with a focus on reliable customer service. Offers a comparison guide to help moms select the best pump for their needs. Works with most insurers. |
| Aeroflow Breast Pumps | Fast insurance verification, easy online ordering, and upgrade options available. Known for excellent customer communication. Ships pumps quickly. |
| Yummy Mummy | Specializes in breast pumps and breastfeeding accessories. Works with many insurers, including Cigna, and prides itself on personalized customer service. |
| Lucina Care | Focuses on providing breast pumps through insurance, including Medicaid programs. Offers a variety of brands and models with helpful online ordering tools. |
Comparing Suppliers
Not all suppliers offer the same selection, even if they work with the same insurance company. One supplier may provide a particular pump at no cost, while another lists it as an upgrade with a fee. It’s worth checking multiple suppliers to compare options—many offer online eligibility tools that let you see what’s covered.
Troubleshooting Common Issues
- Approval Delays: If your pump approval is taking longer than expected, contact the supplier and your insurance provider to check on the status.
- Insurance Denial: If your request is denied, ask for a written explanation. You may need to submit an appeal.
- Limited Pump Selection: If your preferred model isn’t covered, check other suppliers or see if an upgrade option is available.
- Need a Pump Urgently? If your pump hasn’t arrived and you need one immediately, some hospitals and WIC offices provide short-term rental options.
Ordering Best Practices
- Choose only one supplier at a time. If you submit orders to multiple companies, it may create duplicate insurance claims, causing delays.
- Review each supplier’s available pumps and upgrade options. If you want a higher-end model, one supplier may have a better upgrade deal than another.
- Stick with your chosen supplier unless issues arise. If a problem occurs (e.g., delayed approval or insurance denial), you can switch to another supplier if necessary.
5. Ordering Process
Steps to Get a Free Pump
- Confirm Your Insurance Coverage – Check what pumps are covered and which suppliers are in-network.
- Visit the Supplier’s Website – Many suppliers (eg Aeroflow) have an online portal where you enter your insurance details and see available pumps.
- Choose a Pump – Compare different models. If an upgrade is needed, check pricing before proceeding.
- Submit Your Order – Provide insurance information, shipping address, and prescription (if required).
- Await Approval & Shipment – Processing takes 1-2 weeks. Once approved, the supplier ships the pump directly to your home.
Common Challenges & Solutions
- Delayed Approval: Call the supplier to check status.
- Denial of Coverage: Confirm eligibility; appeal if necessary.
- Already Purchased a Pump: You can still claim an insurance-covered pump but won’t be reimbursed for the previous one.
- Pump Malfunction: Contact the supplier or manufacturer; insurance may cover replacement parts.
6. Special Considerations
Medicaid
- Coverage varies by state, but electric pumps are usually covered.
- Must use a Medicaid-approved supplier.
- Some states require prior authorization.
Medicare
- Does not cover breast pumps, as pregnancy is not a covered event.
- Some Medicare Advantage plans may provide exceptions.
WIC (Women, Infants, and Children)
- Provides hospital-grade pump rentals for those in need.
- Can offer manual or electric pumps for working mothers or students.
TRICARE (Military Insurance)
- Covers one pump per birth event (manual or double-electric).
- Requires a prescription from a TRICARE-authorized provider.
- Covers supplies and accessories for up to 3 years postpartum.
Final Thoughts
Getting a breast pump through insurance is a straightforward process if you understand your coverage and follow the correct steps. Start early, choose the right pump, and work with an approved supplier for a hassle-free experience.
For further assistance, refer to your insurer’s website or a trusted supplier’s guide.