How Many Breast Pumps Will Insurance Cover?

Breast pumps are a vital tool for many new mothers, providing the ability to express milk for their babies, whether they’re breastfeeding or exclusively pumping. One of the questions many expectant mothers have is whether their insurance will cover the cost of a breast pump. The good news is that under the Affordable Care Act (ACA), most insurance plans are required to cover breast pumps, but the specifics of what’s covered can vary significantly. Let’s dive into the details of how many breast pumps insurance covers, what types of pumps are included, and how you can navigate the process.

Does Insurance Cover a Breast Pump?

Under the Affordable Care Act (ACA), most insurance plans are required to cover the cost of a breast pump, with no out-of-pocket expenses for the mother, but that doesn’t mean the process is always straightforward. The specifics can vary depending on your insurance provider and plan. Some plans will fully cover the cost of a breast pump, while others may require a co-pay or reimbursement process, where you pay upfront and get reimbursed later.

It’s important to note that coverage can also depend on the type of breast pump you need. For example, certain plans may cover a basic manual or electric pump, while others may offer more flexibility for choosing higher-end models. Always check with your provider to understand what’s included in your policy.

How Many Breast Pumps Will Insurance Cover?

The general rule of thumb is that insurance typically covers one breast pump per pregnancy. However, the number of pumps you can get may depend on your specific insurance plan and whether you need a replacement or are seeking an upgrade.

Replacement Pumps

Many insurance companies will cover the cost of replacement pumps if the original pump is no longer functioning properly or if it’s been a certain period since you last received one. Typically, you may be eligible for a new pump each pregnancy or every 3 to 5 years, but again, this depends on your insurer’s policy.

Hospital-Grade Pumps

Some insurance policies may also cover the cost of hospital-grade pumps, but this is less common. Hospital-grade pumps are often rented and are designed for women who are exclusively pumping or have special medical needs. These pumps are more powerful and efficient, but they may require additional paperwork, including a doctor’s note. You can check with your provider to find out if hospital-grade pumps are included in your plan and how to go about obtaining one.

Additional Pumps

If you need a second breast pump, some insurance plans may not cover an additional pump right away. However, you may be able to purchase one using Health Savings Accounts (HSA) or Flexible Spending Accounts (FSA), or through employer benefits. We’ll discuss these options in more detail later in this article.

Types of Breast Pumps Covered by Insurance

Insurance coverage for breast pumps varies depending on the type of pump. Here’s a breakdown of the types typically covered:

Manual Pumps

Manual breast pumps are hand-operated, require physical effort to express milk, and are usually the least expensive option. These pumps are often covered by insurance, but some plans may limit the number of manual pumps you can get. If you’re looking for a simple, portable solution, a manual pump might be sufficient, and it could be fully covered by insurance, depending on your plan.

Electric Pumps

Electric breast pumps, especially double electric pumps, are among the most popular types of pumps. These pumps use electricity or rechargeable batteries to power the pumping action, making the process faster and more efficient. Electric pumps tend to be more efficient than manual pumps and are often the preferred choice for mothers who need to pump frequently. Many insurance plans will cover at least one electric breast pump, but the quality and brand might be subject to specific restrictions.

Wearable/Hands-Free Pumps

Wearable or hands-free breast pumps, like the MomMed S21 wearable pump, are gaining popularity due to their convenience and discreet nature. These pumps fit into your bra, allowing you to pump while going about your day without being tethered to a wall. These pumps are ideal for busy moms, especially those who return to work or need to multitask while pumping. While insurance coverage for wearable pumps may be more limited, some plans may cover them depending on the brand and model.

Hospital-Grade Rentals

Hospital-grade breast pumps are high-performance pumps designed for frequent use, often recommended for women with specific medical needs, such as those who are exclusively pumping or have difficulty breastfeeding. These pumps are usually rented and may be covered by insurance, but this can depend on your insurer. Be sure to check if your plan includes rental coverage for hospital-grade pumps.

How to Check Your Insurance Coverage

Before you make any decisions, it’s essential to check your insurance coverage to understand exactly what is and isn’t covered. Here’s how to go about it:

Contact Your Insurance Provider

The first step is to contact your insurance provider directly to inquire about breast pump coverage. Ask them whether the pump is covered fully or if you’ll need to pay a portion of the cost. It’s also a good idea to ask if there are any specific brand or model restrictions.

Review Your Plan Details

Your insurance provider should provide you with details about your policy. Many plans include breast pump coverage as part of their maternity benefits, but the specifics can vary. Be sure to review your plan details to understand any co-pays, deductibles, or out-of-pocket expenses you may incur.

Ask About Brands and Suppliers

Different plans have different preferred suppliers. Ask your insurance provider about the brands and suppliers they work with to find out which breast pump models are available to you. You may be able to choose from several options, including popular models offer excellent functionality and comfort for moms who need reliable, effective pumps.

Confirm Upgrade Costs

If your insurance plan offers a basic breast pump but you’re interested in upgrading to a more advanced model, such as a wearable or hospital-grade pump, ask about upgrade costs. Some insurance plans may allow you to upgrade for an additional fee, while others may not cover upgrades at all.

Steps to Get a Breast Pump Through Insurance

Getting a breast pump through your insurance can be a straightforward process, but it requires a bit of planning. Here’s an expanded guide to ensure you don’t miss any steps:

Check Your Coverage

The first step is to confirm that your insurance covers breast pumps. This is a standard benefit under the Affordable Care Act (ACA), but the specifics can vary based on your plan. Some plans may fully cover a breast pump, while others might require co-pays or offer reimbursement after the purchase. It's crucial to review your policy details and call your insurance provider if you're unsure.

Get a Prescription from Your Doctor

In some cases, especially for more advanced or hospital-grade pumps, your insurance provider may require a prescription from your healthcare provider. Contact your doctor or OB-GYN to request a prescription if it's necessary for your plan. Make sure to inquire about the type of pump that’s most appropriate for your needs.

Choose a Breast Pump

Once your insurance coverage is confirmed and you have the prescription, it's time to choose the breast pump that suits you. You’ll need to decide between different types of pumps, such as a manual, electric, or wearable pump. If you’re looking for something efficient and hands-free, pumps like the MomMed breast pump are excellent choices. These models offer flexibility and efficiency, making them a great option for moms balancing work and childcare.

Order Through an Approved Provider

Many insurance plans work with approved suppliers for breast pump orders. These suppliers often include online retailers or local providers who will work directly with your insurance company. When placing your order, ensure that the supplier is listed as an approved provider to avoid complications with coverage.

Verify Delivery and Timing

Once you've selected your pump and placed the order, check in with your insurance provider and the supplier to confirm delivery details and timing. Some plans will ship the pump directly to you, while others might require you to pick it up from a local store or pharmacy. Be sure to order early, as some insurance policies may only allow you to get a breast pump a few weeks before your due date.

What If You Need a Second Breast Pump?

There are many situations where you might find it necessary to have a second breast pump. Whether it's for convenience, work, or if your original pump is no longer functioning well, it’s important to know your options.

Purchase a Second Pump Out of Pocket

If you’re unable to get a second pump through insurance, you can purchase an additional pump out of pocket. This can be particularly useful if you need a backup or a more portable option for certain situations. The MomMed S21 breast pump, for example, is a great portable, wearable option that can be used discreetly while on the go.

Use Your Health Savings Account (HSA) or Flexible Spending Account (FSA)

If your insurance doesn’t cover a second breast pump, Health Savings Accounts (HSA) and Flexible Spending Accounts (FSA) are excellent ways to purchase additional pumps or accessories. These accounts allow you to use pre-tax dollars, making it easier to manage the costs of a second pump. Check with your HSA or FSA provider to confirm which breast pumps are eligible for reimbursement.

Employer Benefits

Some employers offer benefits that help cover the cost of a second breast pump. If your employer provides assistance for new mothers, inquire with your HR department to see if a second pump is eligible for reimbursement or if they offer any discounts for breast pump purchases.

Consider Renting a Pump

If you don't want to purchase a second pump outright, you may also have the option to rent a hospital-grade pump. Hospital-grade pumps are more powerful and typically intended for mothers who need to pump multiple times a day or who have special medical needs. Some insurance plans offer rentals for these types of pumps, and you may be able to rent one as an alternative to buying a second pump.

Conlusion

In conclusion, while most insurance plans cover at least one breast pump per pregnancy, the specifics can vary based on your plan and provider. It’s important to review your plan details, ask the right questions, and make sure you’re choosing the best pump for your needs. Whether you’re looking for a manual, electric, or wearable pump, options like the MomMed S10 Pro and MomMed S21 can offer reliable, efficient pumping experiences that are covered by many insurance providers.