Under the Affordable Care Act, insurance companies are required to cover a breast pump and supplies at no cost to pregnant or breastfeeding members. The problem is that the Affordable Care Act does not specify which kind of breast pumps must be covered by insurance, nor does it specify the price range. As a result, breast pump coverage varies significantly depending on your insurance.
Contact Your Insurance Company
Because there are no standard criteria, the best approach to learn more about your coverage is to call your insurance carrier.
Lisa Paladino, a certified nurse midwife and worldwide board-certified lactation consultant in private practice in Staten Island, New York, advises her patients to contact their insurance carrier by the third trimester.
Most insurance companies, according to Paladino’s experience, have a specialized maternal child specialist who can explain the process and the coverage you’re entitled to. However, call the Member Services phone number on the back of your insurance card to get started.
Ask the Right Questions
Gather your questions before making the call. Here’s a rundown of what you should expect from the representative to get you started:
- What are the different varieties of breast pumps that you cover? Some insurers provide up to nine options, including double-electric, single-electric, battery-operated, and manual types. Some insurance firms, on the other hand, only provide one or two possibilities.
- I’m looking for a place to buy a pump. Most insurance companies require you to get your pump from a provider who is part of their network. In most cases, there are multiple possibilities, so ask for a list. In-network providers are frequently online-only durable medical equipment (DME) companies like Yummy Mummy or Aeroflow Breast Pumps. “These vendors have a lot of experience working with insurance companies,” Paladino says. “They know what pumps your insurance covers, and they have all the documents and documentation you’ll need.” You also don’t have to pay anything up ahead. It could be a simple procedure.” Retailers like Walmart and Target may be included in your insurance company’s in-network providers. These shops also offer an online ordering option for your pump. Choose one and browse to their website after you know which providers are in-network. On the homepages of most of these firms (including Walmart and Target), you can choose your insurance company and state. It will display you all the pumps that your insurance covers once you’ve input your information.
- Is it possible for me to upgrade my breast pump? If you’re ready to pay a fraction of the expense, several insurance companies and DME suppliers will allow you upgrade to a more expensive pump. The website will indicate the pumps that are considered upgrades if this is an option. The pumps will say $0.00 if they are completely covered. If you desire that pump, the improvements will include a price value that represents your half of the cost. The availability of this option varies by insurance company.
- Is a prescription required? To acquire your pump, you may need a prescription and/or pre-authorization. Inquire about this policy so you’re not running at the last minute to seek it from your midwife or obstetrician. Even if you don’t require a prescription, the DME (or another provider) may need to double-check some details with your doctor before shipping your pump. Again, each insurance company’s procedure is different.
- Do you provide coverage for hospital-grade pumps? A hospital-grade pump is a higher-powered electric pump than a personal double-electric pump. “Most insurance companies don’t pay these pumps unless it’s a medical necessity,” adds Paladino, such as if the baby was born tongue-tied or with a low birth weight, or if the mother has a low milk production. Your doctor or midwife will need to write a prescription and submit a diagnosis code in these circumstances.
- Will I be required to pay for a hospital-grade breast pump? These pumps are quite expensive, costing up to $2,000 each. If you qualify, the insurance will cover a rented property rather than one you own. It’s possible that you’ll have to buy your own collection kit, which contains the tubes, valves, breast shields, and bottles you’ll need to use the pump. Before your coverage kicks in, you may have to pay a deductible and a co-payment. The DME coverage in your plan determines your expenditures. While you’re on the phone with them, the insurance representative should be able to check up this information.
Consider Various Breast Pumps
If your insurance provider offers a variety of pumps, you’ll have to pick which one is ideal for you. Here’s a quick rundown.
- Pumps with two electric motors: “According to Nicole Drury, a certified La Leche League leader in Northampton, Massachusetts, “electric pumps are designed to simulate the way a baby feeds, initially with quick, short pushes to establish a let down and then with a longer pull.” “Because it allows you to pump both breasts at once, the double-electric pump is the most efficient. “However, some ladies don’t enjoy this setup and feel as if they’re attached to a machine,” she explains.
- Single-electric breast pumps: With this kind, you can only pump one breast at a time, which takes longer. However, some mothers prefer the option of pumping one breast while allowing the infant to suckle on the other.
- Breast pumps that run on batteries: These pumps are great for when you’re on the go. “If you’re traveling and don’t have certain access to an electrical outlet,” Drury says, “you might pump in the car.” “If portability is more essential to you than speed, this pump might be appropriate for you.”
- Pump by hand: “This low-tech method appeals to certain ladies,” adds Drury. “They’re quite portable, and I know a lot of parents who swear they can get a lot of milk pumping done manually, with good suction and a long draw.”
How to Get Your Pump
The time it takes to obtain your pump varies. When it comes to when your breast pump can be shipped, each insurance provider has its own set of rules. You can get it after you give birth if you don’t get it while you’re pregnant. However, if at all possible, Paladino recommends getting it during your third trimester. She explains, “It’s one less thing to worry about.”
When should I order my breast pump through insurance?
Around week 30, we discovered that the majority of moms order a breast pump. During your pregnancy, you can order a breast pump at any moment. We recommend starting the process before your third trimester to give us enough time to finalize the details before your baby arrives.
If you’ve already given birth and only recently discovered that a breast pump is a covered benefit through your insurance, you’re still eligible for a breast pump up to one year after giving birth.
Keep in mind that each insurance company has its own set of rules for when your breast pump can be delivered. As a result, it’s possible that your pump won’t arrive until 30 days before your due date, or even after you’ve given birth in some cases.
How fast can you get breast pump through insurance?
Your breast pump will be delivered as soon as your insurance allows. Each insurance plan has its own set of criteria for when you can get your breast pump. These periods might be anywhere from 30 days prior to your due date to the day you give birth, your due date, or another date set by your provider.
Can you pick your breast pump through insurance?
Yes, in most circumstances, a prescription is required to obtain a breast pump through insurance. Because breast pumps are considered medical devices, a prescription is required whether you order directly via your insurer or through a source like Pumps for Mom. Pumps for Mom simplifies the process.
Is Spectra or Medela better?
I strongly suggest the Spectra over the Medela. After using both (and a variety of other pumps), I recommend the Spectra if you have the option. Overall, it is more efficient and offers superior features.
The Medela is a reliable pump that does its job well. But, in my opinion, it isn’t as good as some of the others.
Remember, both of these pumps are functional at the end of the day! With either pump, you will be able to express milk effectively, which is the primary purpose.
However, I’ve found that the Spectra gives me less of a headache and makes pumping a little more bearable. That’s why I believe we’re all here.
Should I buy breast pump before baby arrives?
When is the best time to buy a breast pump? This is a question we get a lot from women. It might be tough to know whether you need a breast pump and whether you should buy one ahead of time or wait until after the baby is born, especially for first-time moms expecting their first child. What is the solution? Well, the choice is entirely yours! However, we can provide you with some food for thought!
How do I get my breast pump through insurance anthem?
What are my options for getting a breast pump via Anthem? Most moms will need to schedule an appointment with their obstetrician after confirming that their insurance plan covers breast pumps, as many insurance policies require a prescription to pay the expense.
Does insurance cover Spectra S2?
Looking for a fantastic late-night breast pump? A quiet motor and a night light are included with the Spectra S2 breast pump. As a result, it’s ideal for late-night pumping sessions, making life a little easier for moms. When you’re near your kid or have a pleasant, comforting reminder of your tiny bundle of joy, it’s sometimes easier to express milk. The last thing you want is for a noisy, clumsy breast pump to wake up your sleeping infant. So take advantage of this well-liked and well-reviewed silent breast pump. For more information on the Spectra S2, you can always contact The Breastfeeding Shop.
Can you get a free breast pump through TRICARE?
For new moms, including mothers who adopt a child and plan to breastfeed, TRICARE provides breast pumps, breast pump supplies, and breastfeeding counseling at no cost. For more information, please check the following questions and answers.
How do I get a breast pump through Mainecare?
Our procedure is simple.
- We double-check everything. We check your insurance coverage and ask your doctor for a prescription.
Most health insurance policies are required by the Affordable Care Act to cover breastfeeding services and supplies. That means you might be eligible for free replacement parts for your breast pump.
You may require repair or spare pumping parts over time or after frequent pumping. These items, which may include tubing, flanges, and milk collection bottles, will aid in your pumping and breastfeeding endeavors.
The insurance provider and plan that each person has determines whether or not they are covered for accessories. To make your request, please fill out the form below, and a member of our customer service team will contact you.