Getting a Pump Through Insurance

How to Get a Free Breast Pump Through Insurance

Overview

If you’re expecting or recently had a baby, your health insurance likely covers a free breast pump. Thanks to the Affordable Care Act (ACA), most health plans, including Medicaid, provide this benefit at no cost to you. The process is straightforward, but the details may vary depending on your insurance provider.

Most new moms can get an electric or manual breast pump fully covered, though some insurers may have restrictions on timing, suppliers, or specific models. Below is a step-by-step guide to help you navigate the process, ensuring you receive the pump that best suits your needs.

1. Check Your Insurance Coverage

The first step is to verify what your specific insurance plan covers. Even though most plans provide a free breast pump, the details can vary. Some plans allow you to get your pump during pregnancy, while others require you to wait until after delivery.

Key Questions to Ask Your Insurance Provider:

  • What types of pumps are covered? (Manual or electric? Are wearable pumps like Willow or Elvie covered? Are there upgrade options?)
  • When can I order it? (Some plans allow you to get a pump in the third trimester, while others require you to wait until after the baby is born.)
  • Do I need a prescription? (Most insurers require a doctor’s note, but some, like Cigna or certain Medicaid plans, may not.)
  • Which suppliers are in-network? (Insurance companies partner with specific durable medical equipment (DME) suppliers. You must order from an approved provider to ensure full coverage.)
  • Can I upgrade my pump? (Some plans cover basic models, but you may be able to pay the difference for a premium pump.)

Checking these details ahead of time will save you time and frustration later. If your insurance provider has an online portal, you may find breast pump coverage details listed under maternity benefits.

2. Get a Doctor’s Prescription (If Needed)

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. Choose an In-Network Supplier

To receive your free breast pump, you must order from an approved medical equipment supplier that works with your insurance provider. These suppliers handle insurance billing directly, so you won’t have to pay out of pocket.

Here are some common in-network breast pump suppliers:

Each supplier offers different pump models and upgrade options. If you have a specific pump in mind, check with multiple suppliers to find the best fit. Some suppliers may also include free accessories like extra tubing or storage bags.

4. Pick Your Breast Pump

Not all pumps are the same, so it’s important to choose one that fits your lifestyle and needs. Most insurance plans cover a basic double-electric breast pump, but some allow for upgrades if you pay the difference.

Choosing the Right Pump:

  • Frequent pumping: If you plan to pump daily (e.g., for work), a double-electric pump (like the Spectra S1/S2 or Medela Pump in Style) is the most efficient.
  • On the go: A battery-powered pump like the Spectra S1 is portable and allows flexibility. Some insurers offer hands-free options, like the Willow or Elvie, but they often require an upgrade fee.
  • Occasional use: A manual pump may be enough if you only pump occasionally.

Most suppliers provide a list of covered pumps, so you can compare models before making a decision.

5. Place Your Order

Once you’ve chosen your supplier and breast pump, it’s time to place your order. This can usually be done online, by phone, or via fax.

What You’ll Need to Provide:

  • Your insurance details (Member ID, group number, etc.)
  • Your doctor’s prescription (if required)
  • Your due date or baby’s birth date
  • Your shipping address

After submitting your order, the supplier will verify your insurance coverage and confirm the order. Some suppliers may contact your doctor directly if they need more details for the prescription.

6. Receive Your Pump

Once your order is approved, the supplier will ship your pump for free. Shipping times vary, but most pumps arrive within one to two weeks.

Things to Keep in Mind:

  • Some insurance plans have timing restrictions, meaning they won’t ship the pump until 30 days before your due date or after delivery.
  • If you’re close to your due date and haven’t received your pump, contact the supplier for a status update.
  • Upon arrival, inspect your pump to make sure all parts are included and functioning properly.

7. Troubleshooting Tips

Sometimes there can be delays or issues with insurance approval. Here’s how to handle common problems:

  • Haven’t received approval yet? Contact the supplier—they may be waiting for insurance verification or your doctor’s prescription.
  • Insurance denied coverage? Double-check your plan details. Some older (“grandfathered”) plans may not be required to cover a pump, but most do.
  • Need it urgently? If you deliver early and don’t have your pump yet, hospitals often offer temporary rentals. Contact WIC or your hospital’s lactation consultant for emergency assistance.

If you’re on TRICARE (military insurance) or WIC (Women, Infants & Children program), you may also qualify for additional breast pump supplies, extra accessories, or lactation support.

Special Considerations: Medicaid, TRICARE, & WIC

Medicaid

  • Most state Medicaid programs cover electric breast pumps, but the process may vary.
  • Some states require prior authorization or limit the pump options.
  • Contact your Medicaid provider or check their website to see what’s covered.

TRICARE (Military Insurance)

  • Covers one breast pump per birth at no cost, plus supplies (bottles, tubing, storage bags) for up to 3 years postpartum.
  • Requires a prescription.
  • You can order from TRICARE-approved suppliers or purchase and request reimbursement.

WIC (Women, Infants, and Children Program)

  • WIC provides free breast pumps to those who qualify, especially if insurance doesn’t cover one.
  • They may offer hospital-grade pump rentals for NICU moms or those with supply issues.
  • Contact your local WIC office to check eligibility.

Final Tips

  • Order early! Many insurers allow orders around 28–36 weeks pregnant.
  • Compare suppliers. Different ones offer different pumps and perks.
  • Don’t hesitate to ask questions. Call your insurance or supplier if anything is unclear.
  • Keep your pump clean! Follow the manufacturer’s instructions for sterilizing parts.

By following these steps, you’ll be able to get a high-quality breast pump through your insurance hassle-free—saving money and helping you focus on your new baby!

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