How Often Can You Get a Breast Pump Through Insurance?
Maximize your breast pump benefits. Learn about insurance coverage frequency and the straightforward process to obtain your pump.
The Affordable Care Act (ACA) significantly expanded access to healthcare services, including coverage for breastfeeding equipment. This legislation generally mandates that most health insurance plans provide support for nursing parents. Understanding the specifics of this coverage can help individuals navigate their benefits effectively.
Understanding Coverage Frequency
Most health insurance plans cover the cost of one breast pump per pregnancy. This means that a new breast pump may be obtained for each new pregnancy, rather than on an annual basis or per child in cases of multiple births. While this is the general rule, individual plan details can influence the specific timing of when a pump can be acquired. Some plans allow ordering several weeks before the baby’s due date, while others may require waiting until closer to delivery or even postpartum.
The eligibility period for obtaining a breast pump often extends for up to one year postpartum. Certain older health insurance plans, known as “grandfathered” plans, may not be subject to these ACA mandates and might have different coverage rules or require cost-sharing. Therefore, verifying benefits directly with the insurance provider is a necessary step to confirm eligibility and any specific limitations.
Process for Obtaining a Breast Pump
Obtaining a breast pump through insurance begins with contacting your health insurance provider’s member services department. This initial contact allows individuals to understand their specific plan’s benefits, identify any preferred medical equipment suppliers, and clarify requirements for documentation.
A prescription or referral from a healthcare provider, such as a doctor or midwife, is almost always a requirement for insurance coverage of a breast pump. This prescription typically needs to be submitted to a Durable Medical Equipment (DME) supplier or a breast pump provider that works directly with insurance plans. Many DME suppliers offer online portals or assistance in obtaining the necessary prescription directly from the healthcare provider.
Once coverage is verified and the prescription is in place, the individual can proceed with ordering the pump through an in-network DME supplier. These suppliers handle the direct billing to the insurance company and arrange for the delivery of the breast pump to the individual’s home.
Types of Breast Pumps Covered
Insurance coverage generally includes standard electric breast pumps. These typically include double-electric models, which are efficient for regular milk expression. While most plans cover these common types, the specific brands or models available may depend on the insurance plan’s agreements with various manufacturers and suppliers.
Manual breast pumps are also often covered, providing a portable and affordable option, though they require more physical effort. Hospital-grade electric breast pumps are usually only covered under specific medical circumstances, such as a baby in the neonatal intensive care unit (NICU) or other medical needs that necessitate a higher-powered pump. In such cases, these may be provided as rental units.
Beyond the pump itself, insurance plans may also cover breast pump supplies and replacement parts. These can include items such as tubing, flanges, collection bottles, and breast milk storage bags. Coverage for these accessories can vary by plan, so it is advisable to confirm with the insurance provider or the DME supplier what additional supplies are included in the benefit.