Getting a breast pump doesn’t have to be expensive – most insurance plans cover it under the Affordable Care Act. This essential tool gives you more options for feeding your baby, whether you’re returning to work or just need some flexibility in your schedule. Our guide shows you the steps to get your pump through insurance, from checking your coverage to selecting the right model. We’ve laid out clear instructions to help you take care of this practical need before your baby arrives.
Breast Pump Coverage Under the ACA: Your Legal Rights
The ACA has clear rules about breast pump coverage – and knowing these rules helps you get the right equipment through your insurance.
Required Benefits from Your Insurance
Your insurance must provide breastfeeding equipment at no cost, with no copay or deductible charges. This includes:
● A breast pump (either to own or rent)
● Basic pump supplies like tubing and flanges
● Access to lactation support services
● Breastfeeding counseling: up to 6 sessions per pregnancy
What to Ask Your Insurance Provider
Your coverage details depend on your specific plan. Call your insurance and ask:
Which breast pump brands and models are covered?
Do you cover electric pumps or only manual ones?
When can I order my pump – before or after delivery?
Which medical supply companies can I use?
Will you cover a replacement if my pump breaks?
Do I need a prescription from my doctor?
Write down:
● Date and time of your call
● Name of the representative
● Reference number for your conversation
● Specific details about covered items
Common Coverage Exclusions
These plans often don’t include breast pump coverage:
● Grandfathered plans from before March 23, 2010
● Short-term health insurance
● Some religiously-affiliated employer plans
If your plan doesn’t cover pumps, check:
● Your state’s Medicaid program
● Local WIC (Women, Infants, and Children) offices
● Hospital lending programs
● Your employer’s HR department for alternative benefits
Your insurance provider must give you clear answers about your coverage. A quick call now saves time and prevents surprises when you need your pump. Contact them today to learn your specific benefits.
Why Breast Pumps Matter for Parents Today
Once you know your insurance coverage for a breast pump, you’ll want to understand its benefits for you and your baby. A good breast pump makes a big difference in how you manage feeding, especially if you’re planning to breastfeed for several months.
Keep Your Milk Supply Steady and Track Feeding
Breast pumps help you maintain your milk supply and keep track of how much your baby eats. When you pump regularly, you can store breast milk and avoid common problems like painful engorgement. If you have trouble with too much or too little milk, pumping helps you adjust your production.
Store Milk Before Going Back to Work
When you return to work, a breast pump keeps breastfeeding possible. You can pump during breaks and save milk for your baby’s caregiver to use. Many parents start pumping a few weeks before work to store extra milk. This way, your baby gets breast milk even when you’re at work.
Let Partners Help with Feeding
A breast pump gives you more options for daily life. Your partner can feed the baby while you sleep, or you can leave stored milk when you have appointments. This helps during medical needs too – like when your baby has trouble nursing or during hospital stays. You can go to events or exercise knowing your baby has milk ready.
How to Get Your Breast Pump Through Insurance
Now that you know your coverage benefits, here’s the step-by-step process to actually get your pump.
Contact an Approved Medical Supplier
Your first task is reaching out to a medical supplier that works with your insurance. They’ll need your insurance information and member ID, along with your doctor’s contact details. Make sure to tell them your due date and provide a reliable shipping address where you can receive your pump.
Ask Your Doctor for a Prescription
The prescription from your doctor should detail your specific needs. It must include basic information like your name, date of birth, and due date. Your doctor should also specify what type of pump you need – manual or electric – and note how long you’ll need it. If you have any special circumstances, like returning to work soon after birth, ask your doctor to include these details.
Pick the Right Pump for Your Needs
When choosing from your insurance’s approved list, think about your daily routine. Consider where you’ll pump most often – at work, home, or both. Think about your workplace setup and whether you need a quiet pump. If you travel often, you might want a portable option. Some parents prefer a double pump to save time, while others find a single pump works better for their needs.
Best Time to Order Your Breast Pump
After selecting your pump model, timing your order correctly ensures you’ll have it when you need it.
Start the Process in Your Third Trimester
Most insurance companies let you order your pump when you’re 30-36 weeks pregnant. Starting early gives you time to handle any insurance issues or delays. Your doctor can write the prescription during a regular prenatal visit in your third trimester. This also leaves time to contact a different supplier if your first choice is out of stock.
Plan for Shipping and Delivery
Medical suppliers usually process orders within 3-5 business days after receiving your prescription and insurance approval. Standard shipping takes another 5-7 days. Order at least a month before your due date to avoid rush delivery fees. Some parents order even earlier if they want time to familiarize themselves with the pump before the baby arrives.
Request Rush Delivery if Needed
If you’re close to your due date or have a medical need for the pump right away, tell your supplier. Many can rush orders or offer temporary solutions. Your doctor can note urgent needs on your prescription, which often helps speed up the process. Some suppliers also offer in-store pickup options if they have local branches.
How to Handle Insurance Problems When Getting Your Pump
Even with proper planning, you might face some insurance challenges. Here’s how to solve common problems.
Address Insurance Claim Denials
If your insurance denies your breast pump claim, first ask for the denial reason in writing. Common reasons include missing prescription details or choosing an unapproved supplier. Call your insurance directly and ask what specific documents they need. Often, a detailed prescription from your doctor noting medical necessity will resolve the issue. Keep notes of every call, including the date, representative’s name, and what was discussed.
Fix Common Coverage Problems
Your insurance might say they only cover manual pumps when you need an electric one, or limit you to certain brands. Ask your doctor to write a letter explaining why you need a specific type of pump. For example, if you’re returning to work, your doctor can explain why an electric pump is necessary. Some insurers will expand coverage with proper medical documentation.
Find Help Beyond Insurance
When insurance options aren’t working, check other resources. Your state’s Medicaid program might offer additional coverage. Local WIC offices often have breast pump programs. Some hospitals have pump rental programs at reduced costs. Many employers also offer separate lactation benefits outside of health insurance. Contact your company’s HR department to learn about workplace programs.
Call Your Insurance About Your Breast Pump!
Insurance makes getting a breast pump much easier under the ACA. Check your coverage, talk to your doctor, and work with a supplier to get the right pump. If you have problems, remember there are solutions and resources to help. Don’t wait – call your insurance today to learn about your breast pump benefits. This simple step will help you feed your baby on your schedule.
