When you think of preventative care services offered by your health insurance, you probably think about things like no-cost annual physical and mammograms. You may not realize that a breast pump is another invaluable freebie.
Does health insurance cover a free breast pump?
Since the passage of the Patient Protection and Affordable Care Act (ACA) over a decade ago, insurers are now required to cover breastfeeding support. This legislation intends to help every mom have the opportunity to provide her baby with the ultimate in prevention: breast milk.
Of course, there's always a catch. Since the ACA doesn't provide specific recommendations, coverage can vary depending on your health plan. While some cover hospital-grade pumps, others exclude them, and still others only allow you to rent them.
There can be other hoops that you need to jump through, like only getting the pump from certain vendors, and chasing your OB/GYN down for a prescription. In addition, if your employer offers a "grandfathered" plan — and about 20 percent of employers still do — they may be able to get away with not providing one entirely.
But a good breast pump can really help you meet your breastfeeding goals, which in turn improves your health and your baby's. That's why pumps are considered a preventive service!
A breast pump also allows you to keep providing milk to your baby after you return to work or school, allowing you to breastfeed for longer. That's why it's so important to take advantage of this important, money-saving benefit if it's available to you.
How do you get a breast pump through your health insurance?
To get your insurance to pay for a breast pump, follow these four steps:
1. Call your insurance provider
Tell them you'd like to get a personal-use breast pump.
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2. Ask your insurance provider the following questions
- Do you cover the cost of buying or renting a breast pump?
- Are the costs covered with no cost-sharing?
- Do I need a doctor's prescription? If so, where and how should they send it?
- What kind of pump will you pay for? Ideally, you want a double-electric pump, which is more efficient and faster because it allows you to pump both breasts at the same time. (These should be covered by Medicaid and most private insurance plans.)
- Where can I get the breast pump? 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'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), a program run by the Food and Nutrition Service of the U.S. Department of Agriculture.[1]
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.[2] 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, since you'll want to have it as soon as your baby arrives or shortly after.
3. Ask your doctor to write a prescription if your insurance provider needs one
If you need the pump for a medical reason, the diagnosis must be included with the prescription. For example, your baby has trouble breastfeeding because she is a preemie.
The prescription should say "EO603, standard electric breast pump," for a standard personal use pump or "EO604, hospital-grade pump rental," if you need a hospital-grade one.
4. Turn in the prescription as directed by your insurance plan
Follow up if necessary, and ask when you can expect the pump to arrive.
What if your health insurance doesn't cover a free breast pump?
If for some reason your insurer doesn't normally pay for an electric pump — for example, you have one of those grandfathered plans — you may be able to get it if you're pumping for medical reasons, like if your baby is a preemie, or if she has other medical conditions that make it difficult for her to nurse (like Down syndrome or cerebral palsy), or if you have supply issues. You will just need a doctor's note or prescription stating that an electric pump is medically necessary.
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