Does Medicare Cover Breast Pumps? How It Works
Navigate Medicare coverage for breast pumps. Discover eligibility, the acquisition process, and important financial considerations for beneficiaries.
Medicare, a federal health insurance program, provides coverage for various healthcare services and medical equipment for eligible individuals. Understanding how Medicare covers durable medical equipment, such as breast pumps, involves specific guidelines and requirements. This overview clarifies Medicare’s coverage provisions for breast pumps.
Understanding Medicare’s Breast Pump Coverage
Medicare Part B, which covers outpatient medical services and supplies, includes breast pumps as durable medical equipment (DME) when medically necessary. This coverage extends to beneficiaries under 65 who have received Social Security Disability benefits for at least 24 months, or those with End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS). A healthcare professional must determine the breast pump is medically necessary for home use and provide a prescription.
The types of breast pumps covered under Medicare Part B include manual and standard electric pumps. Coverage for hospital-grade electric breast pumps may also be available, often on a rental basis, if a medical condition necessitates their use. The type of pump covered depends on medical needs and plan guidelines. The prescription from a healthcare provider must state the medical reason for the pump and specify the type required.
To ensure coverage, the medical necessity for the breast pump must be well-documented in the patient’s records. This documentation includes details about the patient’s condition, such as being at least 32 weeks gestation, having recently given birth, or having a child 24 months of age or younger. The record should also indicate the potential for adequate milk production and the patient’s plan to provide breast milk. A face-to-face visit with the treating practitioner within six months of the order is also required.
Steps to Get Your Breast Pump
Obtaining a breast pump through Medicare begins with a prescription or order from a qualified healthcare professional. This essential document must outline the medical necessity for the pump, specifying the type required for home use. The healthcare provider who issues the prescription should have an affiliation with Medicare or be part of your Medicare Advantage plan’s network.
Once you have the necessary prescription, find a Medicare-approved supplier. Medicare only covers durable medical equipment obtained from suppliers enrolled in the program. You can ask your healthcare provider for a list of approved suppliers, or contact Medicare directly. It is important to confirm with the supplier that they accept Medicare before proceeding with your order.
After selecting a Medicare-approved supplier, submit your prescription. The supplier processes your order, verifying eligibility and coverage details with Medicare. They arrange for delivery of the pump to your home. Upon delivery, the supplier may provide initial instructions for setup and proper use.
Important Coverage Nuances
While Medicare Part B covers breast pumps, not all related items and services are included. Accessories such as extra bottles, tubing, carrying cases, and replacement parts are not covered under Original Medicare. These items are considered convenience items rather than medically necessary equipment.
Beneficiaries with Original Medicare Part B have cost-sharing responsibilities. After meeting the annual Part B deductible ($257 in 2025), Medicare pays 80% of the approved amount. The beneficiary is responsible for the remaining 20% coinsurance.
Medicare Advantage Plans (Part C), offered by private companies, must provide at least the same coverage as Original Medicare. Many Medicare Advantage plans offer additional benefits beyond Original Medicare, such as a broader selection of pump models, breastfeeding classes, or lactation consulting. Individuals enrolled in a Medicare Advantage plan should contact their plan provider to understand coverage details and network requirements for suppliers.
If a breast pump is required while an individual is an inpatient in a Medicare-approved hospital or skilled nursing facility, its cost is covered under Medicare Part A as part of inpatient services. If the breast pump is needed for home use after discharge, it falls under Medicare Part B coverage rules. If a beneficiary has other insurance in addition to Medicare, coordination of benefits rules apply, determining which insurance pays first.