Alyssa Lane
Since the implementation of the Affordable Care Act, many new mothers are eligible for a free breast pump through their health insurance. This legislation intends to help every mother have the opportunity to provide her baby with breast milk. To get your insurance to pay for a breast pump, you must first tell them that you would like to get a personal-use breast pump. Then, depending on your insurance, you may only be able to buy certain brands, and may or may not be able to order them online. If you have a plan that does not normally pay for an electric pump, you may be able to get it if you're pumping for medical reasons or if you have supply issues with a doctor's note.
| Characteristics | Values |
|---|---|
| Legislation | The Patient Protection and Affordable Care Act (ACA) |
| What's covered | Breast pumps, milk storage bags, pregnancy support, education, supplies, compression socks, maternity belts, blood pressure monitors, replacement parts |
| Cost | Free |
| How to apply | Contact your insurance provider, select your pump, request a prescription from your doctor (if required) |
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What You'll Learn
Check your insurance coverage
Thanks to the Affordable Care Act, many new mothers are eligible for a free breast pump through their health insurance. The Act requires most health insurance plans to cover breastfeeding services and supplies. This legislation intends to help every mother have the opportunity to provide her baby with breast milk. However, since the ACA doesn't provide specific recommendations, coverage can vary depending on your health plan. While some cover hospital-grade pumps, others may only allow you to rent them, and some may not cover them at all. Therefore, it is important to check with your insurance provider to see what type of pump is covered.
If you are on Medicaid, reach out to your provider to find out what's covered. Most private insurance plans should cover a double-electric pump, which is more efficient as it allows you to pump both breasts at the same time. If your insurer doesn't normally pay for an electric pump, you may still be able to get one if you're pumping for medical reasons, such as if your baby has a condition that makes it difficult to nurse or if you have supply issues. In this case, you will need a doctor's note or prescription stating that an electric pump is medically necessary.
Ordering a breast pump through insurance can be a straightforward process, with some companies offering to verify your insurance coverage and take care of all the necessary steps to get your pump. You may also be eligible for additional insurance-covered items such as compression socks, maternity belts, blood pressure monitors, replacement parts, and milk storage bags.
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Choose a suitable breast pump
When choosing a suitable breast pump, there are several factors to consider. Firstly, decide between an electric or manual breast pump. Electric breast pumps are more powerful and efficient, allowing for faster milk expression. They can be double or single electric models, with the double option supporting expression from both breasts simultaneously. Electric pumps are usually more expensive and require an electrical outlet, which may be a consideration depending on your lifestyle and needs. On the other hand, manual breast pumps are significantly cheaper, with prices starting at around $15.
Battery-operated breast pumps offer a good middle ground between electric and manual pumps. They are portable and often considered hands-free, providing flexibility for busy mothers.
Another factor to consider is the suction power and speed of the pump. Different breast pumps offer various strength levels and speed settings to accommodate individual needs. The suction power, measured in mmHG, refers to the speed at which the vacuum is applied to the nipple during breastfeeding.
It is also important to ensure you are using the correct flange size, also known as a breast shield, for adequate suction, optimal milk production, and comfort.
Lastly, consider the brand and specific model of the breast pump. Aeroflow Breastpumps, for example, carries top-selling brands and currently offers the Medela Symphony, a hospital-grade pump available for rent with a prescription.
You can also attend webinars or consult with experts to help guide your decision based on your personal preferences and requirements.
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Order the pump
Ordering a breast pump through insurance can be a completely free process. The first step is to select the pump that fits your needs and lifestyle. The Affordable Care Act requires most health insurance plans to cover breastfeeding services and supplies, which means you could receive a top-brand breast pump at no cost.
Once you have selected the pump, you will need to complete an order form. The vendor will then verify your insurance coverage and request a prescription from your doctor if required. This is where it can get a little tricky, as coverage depends on your health plan. Some plans cover hospital-grade pumps, while others only allow you to rent them, and some don't cover them at all. If you have one of these "grandfathered" plans, you may still be able to get a pump if you're pumping for medical reasons or have supply issues. In this case, you will need a doctor's note or prescription stating that an electric pump is medically necessary.
It is worth noting that some companies offer additional support and resources, such as online breastfeeding education classes, lactation counselling, and virtual consults after you receive your pump. You may also be eligible for a breast milk storage bag resupply program.
Ordering a breast pump through insurance can be a straightforward process, and many vendors are available to guide you through the steps and handle the insurance-related work.
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Provide a doctor's note, if necessary
The requirement for a doctor's note depends on your insurance plan. Some plans require a prescription or medical documentation from your doctor, while others do not. If your insurance plan covers a hospital-grade breast pump rental, you will likely need a doctor's note or prescription stating that it is medically necessary. This prescription must include the signature of the mother's OBGYN and their NPI, the mother's full name and date of birth, the procedure code for a hospital-grade pump (EO604), and an indication of medical necessity with an ICD-10 diagnosis code.
If your insurance plan does not normally cover an electric pump, you may still be able to get one if you have a doctor's note stating that it is medically necessary. For example, if you or your baby has medical reasons that make it difficult to nurse, such as preterm birth, Down syndrome, or cerebral palsy, a doctor's note can help you obtain an electric pump through your insurance.
It is important to note that even if you do not have a prescription at the time of your order, you can still provide your doctor's information, and they will coordinate retrieving the prescription on your behalf. However, it is recommended to start the process early, as it may take a few days to two weeks for your pump to be approved and shipped.
To summarise, the need for a doctor's note depends on your specific insurance plan and the type of breast pump you require. If you are unsure, it is best to consult with your insurance provider and healthcare professional to determine the requirements and obtain the necessary documentation.
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Receive the pump
Receiving your breast pump depends on the type of insurance you have. If you have private insurance, you can choose from a curated selection of breast pumps covered by your insurance. You can then have the pump shipped to your door for free. If you are on Medicaid, reach out to your Medicaid provider to find out what's covered. You may only be able to buy certain brands, and may or may not be able to order them online.
If you are using Acelleron Medical Products, they will verify your insurance coverage and request a prescription from your doctor if required. They will then take care of the rest of the process for you. After you receive your pump, you can access free Lactation and Pump Education, as well as an Unbox Your Pump virtual consult.
If your insurance does not normally pay for an electric pump, you may still be able to get one if you are pumping for medical reasons. For example, if your baby is a preemie or has other medical conditions that make it difficult to nurse, or if you have supply issues. In this case, you will need a doctor's note or prescription stating that an electric pump is medically necessary.
Some companies, such as Aeroflow Breastpumps, also offer breast pump replacement supplies and milk storage bags through insurance. They also provide lactation courses to help you feel more confident feeding and caring for your baby.
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Frequently asked questions
Thanks to the Affordable Care Act, many new mothers are eligible for a free breast pump through their health insurance. The legislation intends to help every mother have the opportunity to provide her baby with breast milk.
Depending on your insurance plan, you may be covered for a hospital-grade pump, or you may only be able to rent one. You may also be covered for a double-electric pump, which is more efficient as it allows you to pump both breasts at the same time. Medicaid and most private insurance plans cover this type of pump.
You can contact your insurance provider to find out what breast pumps are covered by your plan. You may also be able to order directly from certain companies, such as Acelleron, which will verify your insurance coverage for you.
Depending on your insurance, you may only be able to buy certain brands, and may or may not be able to order them online. You may also be eligible for milk storage bags, compression socks, maternity belts, blood pressure monitors, and replacement parts through insurance.
