It takes some leg work, but you can use your provider to help get a free device.
By Chaunie Brusie Published: Jun 28, 2022 10:10 AM EDT Save Article
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After a pretty smooth experience breastfeeding my first four children, my last baby threw me for a loop (as they tend to do) when it came to nursing. Born five weeks early, she refused to nurse. Providing her with breast milk was important to me personally, so I committed myself to joining the world of exclusive pumping (EP).
After a few weeks of round-the-clock pumping with my traditional double electrical wall unit pump — one of the many types of breast pumps available — while I cared for my newborn, four other children who required rides back and forth to school every day and my husband worked outside of the home, I knew I needed help. I decided to look into purchasing the Elvie, a wireless, hands-free pump that would let me pump milk while taking care of the rest of my duties as a mom. The one problem? The Elvie was hella expensive. So I turned to my health insurance plan to see if I could get a breast pump through insurance — those who are experiencing the brunt of the formula shortage might be interested in the same — and here’s what I found out along the way.
Not only can you get a breast pump through your insurance, but legally, your health insurance plan has to cover it for free, without co-pays. All health insurance plans — including Medicaid — must cover breast pumps by law. The only exceptions are a few grandfathered plans, which do not have to offer the coverage, although many still do.
“Thanks to the Affordable Care Act (ACA), health insurance companies now provide coverage for a broad range of women’s health care services, including breast pumps and supplies, typically at no cost to you,” explains Natasha Cantrell, director of individual and family sales for eHealth.
Some breast pumps will be 100% free through your health insurance plan. However, there could be rules on what type of breast pump your insurance lets you get, such as manual vs. electric, or only certain brands. Additionally, some plans may only allow you to rent a pump, not keep it.
Other types of health insurance plans may allow you to purchase your own breast pump, then reimburse you up to an allotted amount. For instance, my insurance plan would have covered a traditional pump in full, but because I wanted the Elvie, I purchased the pump on my own, submitted the receipt to my insurance plan and they sent me a check for their allotted amount — which ended up being half of the cost I paid for the pump.
While that all probably sounds great, you’re probably wondering: How do you actually get a breast pump through insurance? There are a few steps you can take:
Every insurance plan will be different for what exactly it will cover, so you’ll want to check the specifics for your plan. If you have an online account or app, check the benefits guide under “pregnancy” or “breastfeeding.” I was able to find my information very easily in the online benefits guide. If you can’t find it online, you can also just call your insurance’s benefits number.
Some insurance plans may also reach out to you if you inform them of your pregnancy. For instance, after enrolling in her health insurance plan’s “pregnancy wellness” program, mother of five Gretchen Bossio, received a phone call from a benefits coordinator when she was 32 weeks pregnant to arrange for her breast pump. After confirming the pump she wanted was on the approved list, she was all set. “The pump arrived in the mail a week later,” says Bossio. “Super easy! I was so grateful!”
If you have commercial insurance, you may also be able to get a more expensive pump at a lower cost explains Jason Canzano, managing director of Acelleron. “In these instances, you can ‘upgrade’ by using your insurance to help subsidize the cost of a more expensive pump such a wearable breast pump or a pump that comes with bag and other extras,” he says. Essentially, the price of the pump drops by the amount the insurance company pays the breast pump provider and you would be responsible for the difference.
Again, every plan will be different, which is why it’s important to check with your specific plan about coverage rules. For instance, some plans may require a doctor’s order or preauthorization, some may cover only certain brands or types of pumps, and others will have you apply for a pump through a third-party site.
For instance, Erin Heger, a mom of two, found Edgepark, a third-party organization that partners with insurance companies, through Google. She plugged in her insurance information, picked out a Spectra 9, and that was that. “It was fully covered by insurance and the process was really easy,” she explains. “I got the pump shipped to me a few weeks later.”
Canzano adds that finding an in-network durable medical equipment (DME) breast pump provider can help parents through the process of applying for a pump. For instance, Acelleron verifies insurance information and can even request a prescription from your doctor on your behalf, so you don't have to call your insurance or your doctor. (If you already have a prescription, you’ll just upload it to the site.)
Using a third-party provider can also be helpful because you can apply for the pump at any time during your pregnancy once you have a prescription, although the company may not be able to physically ship the pump until the insurance plan approves it. For instance, you can submit your information in your second trimester so it’s done and off your to-do list, but if your insurance plan stipulates you can’t have the pump until you deliver, the company has to follow those rules.
Speaking of rules, sometimes, getting the breast pump through insurance can be as simple as filling out a form online, but it’s also important to be aware that some insurance plans may have specific rules about breast pumps. For instance, Katie Waite, who has five children, was eligible for a new pump with each pregnancy — providing they were 18 months apart — but discovered the hard way that her insurance plan also had a cruel caveat: she could not apply for the pump until after she delivered.
“When I was pregnant with my first and called my health insurance, the lady on the other end of the line told me I couldn’t order one until the baby was born, ‘just in case the baby didn’t make it,’ and well, that pretty reduced me to a puddle on the floor that week,” Waite notes. “I later called and complained and was told that this is not how I should have been told but it was the policy.”
Again, the rules for each insurance plan will vary, but Cantrell recommends contacting your insurance company for the details during your late second or third trimester. Typically, Canzano adds that most insurances cover one breast pump per pregnancy but there are some insurance and Medicaid plans that only allow one pump for a certain number of years and on a very rare occasion, only one pump per lifetime.
Unfortunately, some brands of breast pumps may not be covered fully by insurance, or covered at all. So if you have your eye on a specific type of pump, be sure to double check with your insurance provider if it’s covered. Alternatively, it’s worth looking into if they offer a reimbursement option you could take advantage of, like I did.
“Right now, wearable breast pumps made by Elvie and Willow are generating the most buzz despite rarely being covered by insurance due to their high price point,” Canzano says.
However, the good news is, many more affordable models of wearable breast pumps are being offered, so you may find a different option that works just as well for you. “Medela and Spectra breast pumps are probably the two most popular and known brands outside of the wearable category which make up the majority of the breast pump market,” he adds.
The most important step about getting a breast pump through your insurance is to check with your plan about what the coverage rules are, but there are also some other things that can be helpful to know.
Canzano notes that, in general, most plans allow you to apply for a pump for up to 12 months after your baby is born. Again, however, this can vary, so be sure to check.
While most Medicaid plans throughout the country cover a breast pump, Canzano adds that there are some state Medicaid plans that did not take federal money and thus do not have to follow the ACA Preventive Health Services guidelines.
“These plans typically only cover a breast pump if there is medical necessity, meaning the baby lacks the ability to initiate breastfeeding because of a medical condition like prematurity or oral defect,” he explains. Again, you’ll have to check with your specific plan to find out the rules.
Canzano explains that if you don’t have health insurance, your options are to:
Chaunie Brusie is a labor and delivery nurse turned writer; she specializes in health and parenting and her work has appeared everywhere from Glamour to The New York Times to Parents magazine. Her kids mostly think she drinks coffee all day (she does) and are really, really impressed that she can "type without looking at the computer." Chaunie lives with her husband and five young kids on a small farm in Michigan, in the middle of an actual hayfield.
