What Breast Pumps Are Covered by Insurance? A Complete Guide for Moms

Breast pumps are essential tools for many new moms, whether they are exclusively pumping, balancing breastfeeding with work, or needing extra flexibility in their feeding routine. Thankfully, many health insurance plans cover breast pumps, making it easier for mothers to access high-quality pumps without the financial burden. But what exactly does insurance cover, and how can you get the best pump for your needs?

This comprehensive guide will walk you through what types of breast pumps are covered, how to check your insurance benefits, how to order a pump, and what to do if insurance doesn't cover the pump you want.

What Does Insurance Cover for Breast Pumps?

Understanding what your insurance covers is the first step in getting a breast pump through your plan. Coverage can vary based on your provider and policy, but most plans provide some level of support for new moms.

Under the Affordable Care Act (ACA)

Thanks to the Affordable Care Act (ACA), most health insurance plans are required to cover the cost of a breast pump and lactation support. However, the specific details—such as the type of pump covered, whether it's a rental or a personal pump, and when you can order it—can vary.

If your plan is ACA-compliant, you should be eligible for at least one breast pump per pregnancy at no cost. However, if you are covered by grandfathered health insurance plans (plans that existed before March 23, 2010, and have not been significantly changed since then), they may not offer this benefit.

General Coverage for Breast Pumps

Most insurance plans provide one of the following options:

• A manual or electric breast pump at no cost
  
• A hospital-grade rental for a certain period
  
• Partial coverage, requiring a co-pay or deductible payment
  

Some plans allow moms to choose from a selection of approved pumps, while others cover only basic models, requiring moms to pay extra for upgrades.

Types of Breast Pumps Covered by Insurance

Insurance policies typically cover different types of breast pumps, but the level of coverage varies. Understanding the different types of pumps available can help you choose the best one for your needs.

Manual Breast Pumps

Manual pumps are the most basic and lightweight option. They don’t require electricity and are usually compact, making them a good backup or travel-friendly option. Many insurance plans fully cover manual pumps, but they may not be ideal for moms who need to pump frequently.

Electric Breast Pumps

Most insurance plans cover electric breast pumps, which can be either single or double pumps. Single electric pumps allow you to pump one breast at a time, while double electric pumps let you pump both breasts simultaneously, saving time and increasing milk output.

Insurance will typically cover a standard electric breast pump, but premium models, like wearable pumps or those with extra features, may require an upgrade fee.

Wearable/Hands-Free Pumps

Wearable breast pumps, like the MomMed S21 wearable pump, offer a hands-free experience, allowing moms to pump discreetly while working or doing daily activities. These pumps fit inside a bra and do not require external tubes or wires.
Because of their convenience, insurance coverage for wearable pumps is less common. However, some insurance providers allow moms to pay an additional fee to upgrade to a wearable pump.

Hospital-Grade Pumps

Hospital-grade breast pumps are high-powered pumps often used for moms with low milk supply, premature babies, or medical conditions that make breastfeeding difficult. These pumps are typically rented through insurance rather than purchased, and rental periods may vary. Some plans cover partial rental costs, while others may provide full coverage.

How to Check What’s Covered by Your Insurance

Since every insurance plan has different policies, it’s important to check what’s covered before you choose a breast pump.

Review Your Plan Details

Start by reviewing your insurance policy documents or checking your insurer’s website to see if breast pump coverage is mentioned. Look for specific details about:

• Types of pumps covered (manual, electric, hospital-grade, wearable)
  
• Whether the pump is fully covered or requires a co-pay
  
• When you can order the pump (before or after birth)
  

Contact Your Insurance Provider

If the coverage details aren’t clear, call your insurance provider and ask questions like:

• What type of breast pump is covered?
  
• Do I need a prescription from my doctor?
  
• Do I have to order from a specific supplier?
  
• Are there any costs associated with upgrading my pump?
  

Check for Deductibles or Co-Pays

Some insurance plans cover only a portion of the pump's cost, meaning you may need to pay a deductible or co-pay. Be sure to clarify any out-of-pocket costs before making a decision.

Approved Suppliers

Most insurance providers require you to order from approved suppliers. These suppliers work with insurance companies to provide covered breast pumps. Some well-known suppliers include:

• Aeroflow Breastpumps
  
• Edgepark
  
• Byram Healthcare
  

You’ll need to order through one of these suppliers to ensure your pump is covered.

How to Order a Breast Pump Through Insurance

Once you've confirmed that your insurance plan covers a breast pump, the next step is to navigate the process of ordering it. While it may seem overwhelming, the process can be relatively straightforward if you follow the necessary steps. Here's a step-by-step guide to ensure that you get the breast pump you need, hassle-free.

Get a Prescription

Most insurance companies require a prescription from your healthcare provider before you can order a breast pump. The prescription should typically state that you need a pump for medical or breastfeeding purposes. You can request a prescription from your OB-GYN, midwife, or pediatrician. Be sure to clarify with your doctor what information the prescription needs to include. If you are already postpartum, your pediatrician may also be able to provide the necessary prescription.

Choose a Covered Pump

Once you have the prescription, you'll need to select the breast pump you want. Many insurance plans have a list of approved suppliers and pumps that they cover. However, it's important to know that some insurance providers may offer you a selection of basic models, while others may provide more options for advanced or upgraded pumps. Remember to consider your needs: whether you're looking for a portable breast pump for on-the-go, a double pump to save time, or a quiet and efficient pump to help with milk production.

Order Through an In-Network Supplier

Insurance companies typically have a network of approved suppliers or partners that they work with to fulfill orders for covered breast pumps. These suppliers usually include both online and brick-and-mortar stores, so you’ll have options on how to place your order. Some well-known suppliers, such as Aeroflow Breastpumps or Edgepark, offer user-friendly websites where you can place your order online. If you’re ordering from a third-party supplier outside the network, it’s possible your insurance won’t cover the full cost, or you may be required to pay a higher co-pay.

Confirm Coverage and Payment

Before placing your order, confirm your insurance benefits directly with the supplier. Double-check to see if your insurance covers the entire cost of the pump or if you’ll need to pay a co-pay or deductible. It's important to understand the breakdown of any costs to avoid surprises later. Ask the supplier for an itemized bill or payment schedule that clearly states the amount your insurance covers versus what you'll be responsible for paying out-of-pocket.

If you're upgrading to a premium model or need additional accessories, such as breast milk storage bags, extra flange inserts, or replacement parts, these may not be covered fully by your insurance. Make sure you're aware of any additional costs for these extras.

Can You Upgrade Your Pump?

Some moms prefer a more advanced pump than what’s fully covered by insurance. Many insurance companies allow upgrades for an additional fee.

What’s Considered an Upgrade?

An upgrade typically means choosing a pump that’s more advanced than the standard model offered by your insurance. For example, you may want to opt for a double electric pump if your plan only covers a single electric pump. Upgrades may also include features like quieter operation, faster pumping, or additional comfort features.

Upgrade Options

To upgrade, you will typically need to cover the difference in cost between the covered pump and your desired model. Some suppliers will let you pay this difference directly, while others may offer a payment plan. Be sure to clarify this with your supplier before making a decision. Keep in mind that your insurance may only cover the cost of the basic model, and you’ll be responsible for the extra cost if you choose to upgrade.

It's also a good idea to ask if the upgraded pump will still be covered by your insurance in the long run, as some policies have restrictions on which models are eligible for full coverage in subsequent years.

What If Insurance Doesn’t Cover a Pump?

If your insurance plan doesn’t cover a breast pump or only provides partial coverage, there are still options to get an affordable pump.

Use HSA or FSA Funds

If you have a Health Savings Account (HSA) or Flexible Spending Account (FSA), you can use these tax-advantaged accounts to purchase a breast pump. Both HSA and FSA funds are often eligible for use on medical expenses, and many breast pumps qualify as eligible purchases. The advantage is that you can use pre-tax dollars, which can save you money on your purchase.

Shop for Discounts

Even if your insurance doesn’t fully cover a breast pump, there are still ways to save money. Many breast pump suppliers offer discounts, especially if you're buying a second pump or upgrading to a more advanced model. For example, MomMed’s S21 wearable pump and S10 Pro breast pump are known for their advanced features and efficient pumping, but they are also affordably priced compared to some other premium options on the market. Shopping around for deals and comparing prices between suppliers can help you find a good pump within your budget.

Consider Rent-to-Own Options

Some suppliers offer rent-to-own programs for high-end or hospital-grade pumps. This can be a good option if you need a powerful pump for a short-term need, such as when you’re exclusively pumping or if your milk supply is low and you need a hospital-grade option to boost it. These programs allow you to rent the pump for a set period, and at the end of the rental period, you may have the option to purchase it outright.

Look for Assistance Programs

If you're facing financial hardship or if your insurance doesn’t provide the coverage you need, you may be eligible for a breast pump assistance program. Many nonprofit organizations and charities offer free or discounted breast pumps to those who qualify. These programs often cater to low-income families or women who are having difficulty affording essential baby supplies.

Conclusion

Getting a breast pump through insurance can be a simple and cost-effective way to support your breastfeeding journey. While most insurance plans cover at least one manual or electric pump, upgrading to a wearable or hands-free pump like the MomMed S21 may require an out-of-pocket cost. Be sure to check with your insurance provider, explore your options, and take advantage of HSA/FSA funds or discount programs if needed. With the right pump, you can enjoy a smooth and convenient breastfeeding experience.