Alyssa Lane
Since the passage of the Patient Protection and Affordable Care Act (ACA), insurers are required to cover breastfeeding support. This means that many new mothers are eligible for a free breast pump through their health insurance. The process for obtaining a breast pump through insurance can vary depending on the insurance plan. Some plans may only cover certain brands or require the use of a specific medical supply company. It is important to check with your insurance provider to understand what is covered and any requirements needed to obtain a breast pump. Additionally, a doctor's note or prescription may be needed to obtain a pump, especially if there are medical reasons for requiring one. Overall, obtaining a breast pump through insurance can be a great way for new mothers to access the tools they need to provide breast milk for their babies.
| Characteristics | Values |
|---|---|
| Legislation | The Patient Protection and Affordable Care Act (ACA) |
| Coverage | Varies depending on the health plan |
| Requirements | A doctor's note or prescription stating that a pump is medically necessary |
| Medicaid | Contact your provider to find out what's covered |
| Private medical insurance | May need to use a specific medical supply company (DME) |
| Delivery time | Within a few business days, depending on location |
| Warranty | 1-3 years |
| Customer support | Troubleshooting, replacement parts, and warranty claims |
| Hands-free options | Zomee Fit, Ardo Melia, Motif Aura Glow, Lansinoh Discreet Duo |
| Deluxe models | Spectra S1 |
| Wearable pumps | Willow Go, Elvie Stride |
| Accessories | Compression socks, maternity belts, blood pressure monitors, milk storage bags |
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What You'll Learn
Check your insurance eligibility for a breast pump
The first step to checking your insurance eligibility for a breast pump is to consult your insurance provider. The Patient Protection and Affordable Care Act (ACA) mandates that insurance providers cover breastfeeding support and supplies, including breast pumps, for lactating mothers. However, the extent of coverage can vary depending on your specific health plan. Some plans cover hospital-grade pumps, while others may only allow you to rent them or impose restrictions on the brands and suppliers you can use. If you have a "grandfathered" plan through your employer, it may not provide coverage for a breast pump at all.
Once you understand your insurance coverage, you can determine your eligibility for a breast pump. If your insurance plan does not typically cover electric pumps, you may still be eligible if you are pumping for medical reasons, such as having a preemie baby or facing latching difficulties, low milk production, or other nursing challenges. In such cases, you will need a doctor's note or prescription stating that an electric pump is medically necessary.
To simplify the process, you can engage the services of companies like Aeroflow Breastpumps, which help determine your coverage and benefits based on your specific insurance plan. They have a dedicated team of specialists who will verify your eligibility and guide you through the process of obtaining a breast pump covered by your insurance. All you need to do is provide your insurance information, and they will handle the necessary paperwork and claims with your insurance provider.
Additionally, if you have health insurance through your workplace, you may be eligible for fully covered electric or wearable breast pumps. Contact your insurance provider using the phone number on your health plan ID card or refer to the benefits section on your member account to understand your coverage and any specific requirements, such as a physician's prescription. Remember that reimbursement for a breast pump purchased at a retail store is typically not provided.
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Understand what type of pump is covered by your insurance
The type of pump covered by your insurance depends on several factors, including your insurance plan, provider, and location. It's important to carefully review your insurance plan documents or contact your insurance company directly to understand the specifics of your coverage. Here are some key points to consider:
- Standard Electric Breast Pumps: Most insurance plans typically cover standard electric breast pumps. These pumps are designed for regular use and can be powered by electricity or batteries. They are a common option for new mothers.
- Manual Breast Pumps: Manual pumps are operated by hand and do not require an electric power source. They are usually more affordable and portable but may require more effort to use compared to electric pumps. Some insurance plans may cover manual pumps, especially if they are deemed medically necessary.
- Hospital-Grade Breast Pumps: These pumps are designed for frequent and long-term use, often in cases where a baby is unable to breastfeed directly. Hospital-grade pumps are more powerful and efficient than standard electric pumps. They may be available for rent through insurance, sometimes requiring a prescription.
- Double Electric Breast Pumps: Double electric pumps have two flanges and allow mothers to express milk from both breasts simultaneously, saving time. Some insurance plans may cover these upgraded models, especially if recommended by a healthcare provider.
- Hands-free, Battery-operated, and Single-electric Pumps: There are also variations like hands-free, battery-operated, and single-electric pumps available. Your insurance coverage for these options may vary, and some plans might include them as part of their benefits.
- Medical Necessity and Healthcare Provider's Recommendation: The specific type of pump covered by your insurance may depend on medical necessity and the recommendation of your healthcare provider. Consult with your healthcare provider to determine if you require a specific type of pump and obtain a prescription if needed.
Remember, each insurance plan is unique, and it's always best to verify the specific details of your coverage. Contact your insurance provider or review your plan documents to understand the types of pumps covered, any requirements or limitations, and whether a prescription from your healthcare provider is necessary.
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Find out where to get your pump
The first step to getting your pump is to find out what your insurance covers and where you can get your pump from. Depending on your insurance, you may only be able to buy certain brands, and you may or may not be able to order them online.
If you're on Medicaid, reach out to your Medicaid provider to find out what's covered. If they can't provide a breast pump, you can get your pump through WIC (the Special Supplemental Nutrition Program for Women, Infants and Children). Some private medical insurance plans require you to get your breast pump from a specific medical supply company (sometimes called a "durable medical equipment" supplier, or DME) that's designated by your insurer. Make sure to call that supplier as soon as possible to see if they have the pump you want and how long it will take to get it.
If your insurance is provided by your employer, it may be a "grandfathered" plan, which is not required to provide a breast pump. However, you may still be able to get one if you're pumping for medical reasons, such as if your baby has Down syndrome or cerebral palsy, or if you have supply issues. You will need a doctor's note or prescription stating that an electric pump is medically necessary.
Once you know what your insurance covers, you can select your pump. Some websites, like breastpumps.com, will verify your insurance and handle the paperwork for you. They offer a variety of pumps, some of which are covered by insurance, while others may require an upgrade fee. Aeroflow Breastpumps also offers free breast pumps and accessories covered by insurance, as well as lactation courses. Acelleron Medical Products also offers free breast pumps and will verify your insurance and handle the paperwork for you.
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See if you need a doctor's note or prescription
If you want to order a pump through insurance, you will likely need a doctor's note or prescription. Breast pumps are medical devices, so insurance companies require an RX to put the order through. The specific requirements may vary depending on your insurance provider and health plan. Some insurance companies may require a prescription from your OB/GYN, while others may only need a doctor's note stating that the pump is medically necessary. For example, if you have a ""grandfathered" plan, you may need a doctor's note or prescription stating that an electric pump is medically necessary, such as if you have a preemie baby or are experiencing supply issues.
It is important to contact your insurance provider to understand their specific requirements and protocols. They may provide you with a list of medical supply companies from which you can obtain a pump. You can then contact the company directly to inquire about their process for obtaining a pump with insurance. Some companies may require you to obtain the prescription yourself and send it to them, while others may offer to contact your doctor on your behalf to request the prescription.
When obtaining the prescription, it is important to double-check with your insurance provider or the medical supply company about any specific information that needs to be included. For example, some companies may require your due date or the date your baby was delivered on the prescription. It is also important to note that you may not be reimbursed for a breast pump purchased at a retail store, so be sure to check with your insurance provider before making any purchases.
Additionally, depending on your insurance plan, you may only be able to buy certain brands of pumps and may or may not be able to order them online. Some insurance plans may require you to obtain your pump from a specific medical supply company designated by your insurer. Therefore, it is crucial to understand your insurance coverage and the requirements needed to obtain a pump through insurance.
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Contact your insurer to discuss your health plan
Contacting your insurer to discuss your health plan is an important step in ordering a pump through your insurance. The process can vary depending on your insurance provider and your specific health plan. Here are some steps you can take to discuss your health plan with your insurer and understand your coverage for a pump:
Firstly, locate the contact information for your insurance provider. You can usually find this information on your insurance card or on the insurer's website. Look for a customer service phone number, email address, or online chat option.
Once you have the contact information, reach out to your insurer. Explain that you want to discuss your health plan's coverage for a pump through your insurance. They will likely ask for your policy number or other identifying information to pull up your specific plan details.
Provide them with any necessary documentation or information they may need to verify your coverage. This could include your personal details, policy information, and any relevant medical history.
Ask about the specific brands or types of pumps that are covered under your plan. Some insurance plans have contracts with certain medical supply companies or durable medical equipment (DME) suppliers, so it's important to understand your options.
Inquire about the process for obtaining a pump. For example, find out if you need a prescription from your healthcare provider or if there are any specific forms or paperwork that need to be completed. Ask about delivery or pickup options as well.
If you have any specific needs or requirements for the pump, such as a particular feature or a hands-free option, discuss those with your insurer. They can help you understand if your plan covers those specific types of pumps or if there are any additional steps needed to obtain them.
Finally, don't hesitate to ask any questions you may have about the process, coverage limits, or anything else related to obtaining a pump through your insurance. Your insurer should be able to provide you with clear guidance and instructions on how to proceed.
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Frequently asked questions
You can order a pump through insurance by providing your location and insurance details on the website of the company you're ordering from. They will then handle the paperwork and deliver your eligible pump.
Some companies that offer breast pumps through insurance include Acelleron, BreastPumps.com, and UnitedHealthcare.
The Affordable Care Act requires most health insurance plans to cover breastfeeding services and supplies. However, coverage can vary depending on your specific health plan. It's best to check with your insurance provider to see if you're eligible.
Most orders are processed and shipped within a few business days after your insurance is verified and your pump is selected. Delivery times may vary based on your location.
