How Many Breast Pumps Can You Get Through Insurance?
Navigate health insurance coverage for breast pumps. Understand your benefits, specific plan details, and the steps to obtain your pump.
Accessing a breast pump through health insurance can significantly assist new and expectant parents. The Affordable Care Act (ACA) established provisions requiring most health insurance plans to cover breastfeeding support, supplies, and counseling. While this mandate ensures broad coverage, specific details can differ depending on the individual insurance plan and provider.
Insurance Coverage Basics for Breast Pumps
The Affordable Care Act (ACA) plays a fundamental role in ensuring access to breast pumps. Under the ACA, most health insurance plans are required to provide coverage for breastfeeding support, supplies, and counseling without cost-sharing, meaning no co-pays or deductibles for these services.
Eligibility for this benefit generally extends to pregnant or nursing individuals enrolled in an ACA-compliant health plan. Plans existing before the ACA, known as “grandfathered plans,” may not be subject to these requirements. While coverage is mandated, the exact terms can vary among insurance providers and plans. These variations can include whether a pump is rented or purchased, the types of pumps covered, and the network of approved suppliers. Durable Medical Equipment (DME) suppliers often facilitate the provision of these pumps, working directly with insurance companies.
Specific Coverage Details and Limitations
Most insurance plans typically cover one breast pump per pregnancy. This means that for each new pregnancy, individuals are generally eligible for a new breast pump, even if they have received one for a previous child. Some plans may offer flexibility for additional pumps if a pump malfunctions or if there’s a medical necessity for a different type.
The timing for obtaining a breast pump can also vary by plan, though it’s often available during pregnancy or shortly after birth. Some policies permit shipment within a few weeks or months of the due date, while others may require proof of birth before the pump is released. Insurance coverage extends to various types of breast pumps, including manual, standard electric, and double electric models. Coverage for hospital-grade pumps, which are often rental units, may require medical necessity justification, such as for a premature baby or an infant with feeding difficulties.
Coverage for replacement parts and other breastfeeding accessories, such as tubing, flanges, and milk collection bottles, can also differ by plan. While the ACA requires coverage for breastfeeding supplies, whether these components are included at no cost often depends on the specific policy. Some plans cover the purchase of a breast pump outright, while others may only cover the rental of a hospital-grade pump for a limited period.
Navigating the Process to Get Your Pump
Initiating the process to acquire a breast pump through insurance begins with understanding your specific plan’s benefits. Contact your insurance provider directly to inquire about coverage details, including any requirements like pre-authorization or a prescription. They can also provide a list of approved Durable Medical Equipment (DME) providers or breast pump suppliers within their network.
Obtaining a prescription from a healthcare provider such as a doctor, midwife, or nurse practitioner is a common requirement for insurance coverage. This prescription serves as medical documentation, and for hospital-grade pumps or specific medical needs, it should include relevant diagnoses. Once you have clarified your coverage and obtained a prescription, the next step involves selecting an in-network DME supplier or breast pump provider. Many insurance companies partner with specific suppliers or offer online portals to facilitate this choice.
After choosing a supplier, you will typically submit the necessary documentation, including your prescription and insurance information. This submission can often be done through an online portal, via phone, or by mail. The supplier then verifies your coverage with your insurance company and processes the order. Once approved, the breast pump is shipped directly to your address, often with free shipping.