This blog was updated on 04/25/24
If you're expecting a baby and you live in the US, we've got good news – your health insurer will fund the costs of a breast pump.
There are many reasons you might want to use a breast pump: perhaps you're thinking ahead to returning to work and want to build up a milk stash; or maybe you're ensuring you and your partner can share feeding duties. If you know you want to pump, you can contact your insurer before you give birth, to get things sorted in time for your baby's arrival. This will give you time to ensure all the relevant paperwork is completed. Of course, you can still get a pump after birth, but bear in mind it may take a fair bit of admin!
Whatever your motivations for pumping, they're covered under the Affordable Care Act (ACA). It states that your insurance plan must cover the cost.
Great news! Well, yes – but there are a lot of specifics to consider. The ACA goes on to say that your individual plan may detail whether it covers a manual or electric pump, or whether it'll fund you renting or buying a pump. The only stipulation of the ACA is that your insurer funds a breast pump – what kind of pump, how long you can rent it for, and other finer details are all down to your specific insurance provider.
We've put together some advice for any US moms thinking about getting a breast pump through insurance, so you're armed with all the information you need.
Choosing the right breast pump
Not sure what kind of pump would best suit your needs? Have a look at our guide to manual, electric, and wearable breast pumps. Electric breast pumps do the hard work for you and allow you to express milk quickly while manual pumps are easy to use and an ideal choice if you want to express milk for one feed a day.
Pre-authorization form a doctor may be required by some insurers. Speaking to your healthcare provider and getting their breast pump recommendations can be a great help – not just for your insurer, but also for you. They'll be able to talk you through your feeding needs, and assist you in making the right choice.
If using a breast pump is a medical necessity – such as your baby being physically unable to feed, or due to your own health – it's especially important to speak to a healthcare professional. You may need a hospital-grade pump, and not all insurers cover these. At the very least, you'll likely need a prescription. Check out our blog on choosing a breast pump here for more information on which pumps best suit different circumstances.
Contacting your insurance provider
Once you've decided on the kind of breast pump you'd like, the next step is to speak to your insurance provider. Remember, each provider may differ in the kind of coverage they provide. Here's what to do once you're ready to get a breast pump.
Check your insurance coverage: First, review your health insurance policy to see what kind of breast pumps it will cover. This information should be in any paperwork relating to your plan, but if you're not sure, contact your insurer. Insurance providers are required to cover breastfeeding support and equipment under the Affordable Care Act (ACA), but the specifics vary from company to company.
Contact your insurance company: Sometimes, the easiest way to do things is to speak to a person. Call your insurance company's Member Services line to confirm your coverage and understand the process for obtaining a breast pump. They should provide you with information on which breast pump manufacturers and suppliers they work with, the type of pump you can get, whether you'll own or rent the pump, and any paperwork or documentation required. Midwife Lisa Paladino told Forbes that most insurers have a maternal health specialist on hand to help.
Get a prescription or pre-authorization: In many cases, you'll need a prescription from your healthcare provider to get a breast pump through insurance. This is especially likely to be the case if you need a hospital-grade pump. Your doctor will discuss your feeding plans and needs with you, and provide the required information to your insurer. Even if you don't need a prescription, many pump suppliers may ask for further details or medical information.
Choose a supplier: Your insurance company may have a list of approved suppliers for breast pumps. These might be specialist providers, or high-street stores, and many will have the option to order the pump online and select your insurer, so there are no up-front costs to claim back. Sometimes, if you are willing to pay the difference, you can upgrade your pump to a different model that isn't covered by your policy. To find out if this is possible, you'll need to ask your insurer.
Submit paperwork: Depending on your insurance company's requirements, you may need to fill out paperwork or provide documentation, such as your prescription, proof of pregnancy or childbirth, and insurance information. Submit these documents to your insurance company or chosen supplier as directed.
Receive your breast pump: Once your paperwork has been processed and approved, your breast pump will be shipped to you. Be sure to follow any instructions provided by your supplier for setup, use, and maintenance of the pump.
Follow up with your insurance company: If you encounter any issues or delays in with your breast pump, let your insurance company know, and they'll advise you on your options.
Grandfathered insurance plans
If your insurance plan was taken out before March 2010, you may be told that you can't get a breast pump. This is because the ACA came into effect on this date, and plans that pre-date it aren't required to comply. If you're on a grandfathered plan and want to change it, you'll need to check that you're eligible to switch providers. More information on that can be found on the official healthcare site.
If you're denied a breast pump by your insurer but you think this is incorrect – for example, you took out your plan after March 2010 – then you have the right to appeal.
When it comes to getting a breast pump through insurance, the best thing you can do is thorough research, before your baby arrives. If you've prepared the paperwork, seen your doctor, and researched the coverage your insurer offers, you'll know what to expect and what the process entails. Doing it early means your breast pump will be on hand as soon as your little one is born, in case you need it – so you can relax a little and enjoy your new baby.