Do insurance companies really cover breast pumps?

    Yes! Most insurance companies are now required to cover the cost of your breast pump and other breastfeeding services or needs! This is not some untrue rumor.  The Affordable Care Act (ACA) was signed into law in 2010. There are many parts of the ACA, but one of the most valuable is that ACA requires health plans to cover breastfeeding support and supplies. Many health plans began implementing this coverage on or after August 1, 2012. The coverage could potentially save breast-feeding women hundreds of dollars. But there is considerable variation in what sort of pumps are covered, and how they are covered. The law’s recommendations aren’t specific, so coverage varies from health plan to health plan. Some cover purchase of manual pumps only; others exclude hospital-grade pumps, often used soon after birth to help mothers establish adequate milk flow (although some plans cover such pumps if a doctor deems one medically necessary). Most plans require women to obtain the pumps from designated vendors, which may or may not offer the model a woman prefers; that means women usually can’t buy a pump at retail and submit a receipt for reimbursement.

“There is a lot of confusion,” said Judy Waxman, vice president for health and reproductive rights at the National Women’s Law Center, which is urging the federal Department of Health and Human Services to issue more detailed recommendations. “Everybody’s winging it.”

    I have been making posts about this frequently on my  breastfeeding mama talk page  because I want to make sure everyone knows. I think it is wonderful that the insurance companies are finally recognizing how beneficial breastmilk is to a baby’s health. To me if anything breastmilk should be considered “preventative care” just like how most insurance plans cover vaccines for preventative care the same should go for breastfeeding supplies. But honestly I could careless what category they put it on I’m just thrilled breastmilk is finally getting the recognition it deserves. I also think that it may motivate someone to breastfeed maybe if they see that an insurance company is willing to cover a breast pump that it means breast milk really is beneficial to their baby’s health. I know when I was a new mom I couldn’t afford a breast pump. My husband was just starting out on his job I of course had to quit mine and money was just something we didn’t have a lot of. The thought that I may have got a nice high tech pump at no cost to me could have changed my whole breastfeeding experience! That is what I’m hoping to do with anybody reading this. Here is a picture of a pump a member posted to the breastfeeding mama talk page and what she wrote along with the picture.

Breastfeeding mama talk member: “Thanks to this group (breastfeeding mama talk) I got my pump with no charge I had no idea my insurance would cover it!!!” When I asked her if I could share this she also said, “Yeah and  I saved 299.99.”

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I feel it is my duty as a lactivist to make sure everybody knows about this wonderful coverage. Only downfall is that I have heard woman say that their specific provider or plan unfortunately did not and do not cover it. But I say it can’t hurt to make that phone call to your insurance company just so you know and the worst that could happen is they say no. I’m wanting to look more into the insurance companies to find out why some do cover it and why some do not and if in the future ALL insurance companies and plans will be required to cover it. Maybe it can even be a stipulation for you when you are electing what plan will best suit you and your family.

Here is another woman who shared her 100% covered breast pump on my breastfeeding mama talk facebook page.

Breastfeeding mama talk member: “My hospital grade pump just arrived today completely covered by my insurance.”

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Make that call to your insurance provider today it takes five minutes to do whether your pregnant or not or whether your nursing or not it is still good to know what you could get covered for in the future. If you do have any information please comment below. Tell me what insurance company, plan, and whether it’s PPO or HMO. I want to gather up as much information as I can about this. Some plans actually require certain things before they approve a pump to be covered and they may not want to disclose that to you but that is what I’m here for! A woman in Canada said that for her insurance company Under her plan the purchase of a Breast Pump is eligible at 100 percent as long as deemed medically necessary and prescribed by a Medical Doctor (M.D.). The reasonable and customary maximum is $300.00 and is allowed once every 60 months.’ This is from Sunlife Insurance in Ontario, Canada. So there may be some loop holes you may have to go through first depending on your provider. Please share this because many people do not know this and I think this is something everyone should know about. Even men should know this info. because if it does go by a certain plan they could look into it before making any elections for coverage.

~Kristy (creator of breastfeeding mama talk)

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33 thoughts on “Do insurance companies really cover breast pumps?

    • So it seems like Tri care is a popular insurance company that doesn’t cover pumps unfortunately. This info. is good for me to know that way when I post about this in the future I can add that Tri care may be one of the providers not covering the pumps, that way I don’t get peoples hopes up for nothing. Have you tried any other places, like WIC? ~Kristy

      • WIC gives you a manual if they have some. I was surprised when I saw this, then I saw that Tricare doesn’t cover and became sad lol. I loved the pump from the hospital.

  1. I have Kaiser and a manual hand pump was all that was covered until I raised hell that my daughter was failure to thrive. I couldn’t think of a better reason to deem a pump being medically necessary. They gave me one for 30 days after making me and the ped jump through hoops. I wish I qualified for WIC but lets not start that rant…

  2. I have health net and my doctor prescribed me a double electric! Problem was that the insurance company took forever to approve it and find a medical supply store that I ended buying my own. Finally after a month and a half they sent me one. I returned it to the supply store in hopes that I can get reimbursed for the one I bought. Can anyone help me with that?

    • Yeah this is so new unfortunately and I don’t think insurance companies are liking this new rule. So some are trying to do whatever they can to get out of covering it. Just like with any other medical service or need they make you jump in through hoops for. 😦 ~Kristy

  3. I have Aetna Insurance and live in TN. My insurance covers my breast pump 100% with no up-front cost. I simply order through the vendor’s website (I have a large selection to choose from) and give them my insurance information and everything is taken care of. I can order a new one every 36 months as well.

  4. United healthcare PPO

    100% covered but must go through 1 of 2 vendors. Only pump covered was the Ameda Purely Yours with no extra accessories and only covers 1 in the lifetime of the mother.

    But better than spending full price!

    • Well the first step would be to call the direct contact number you have for your insurance provider. Simply ask them if they cover breast pumps and ask for all the stipulations in which they will cover it. Some insurance companies have requirements before they will approve coverage on one. All you have to do is call and ask. 😀 ~Kristy

  5. Hello my son is 6 months oLd and i would like to know if the insurance i have does it cover the pump i have blue shield blue cross PPO … ThaNk yOuu

  6. I have BCBS HMO and they cover pumps 100 percent with no copay! That includes manual, electric and hospital grade. Just have to go through a vendor they give me and get a referral from my OB.

  7. I have Sagamore insurance and my hospital grade Medela advanced personal double pump was covered. After deductible, obviously. But I had to have a prescription from my doc deeming it medically necessary. My little girl has a lip tie and has trouble latching.

  8. Aetna EPO (HMO) covers a Madela, or Ameda pump through special vendors once every 3- 5 years unless you can prove the pump is broken. You must get a Rx 60 days before or after birth and order from the approved vendor.

  9. I love this group on Facebook. There is so much support, not only from the admins but, from each Facebook member. I have gained more confidence in NIP and every feeding is another step to creating a cultural norm.

    Stephanie

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