Breast Pump Insurance Coverage: Everything You Need to Know

For many new moms, a breast pump is an essential tool for keeping their baby healthy and happy, especially if they plan to return to work or just need a break from breastfeeding. However, breast pumps can be expensive, and not all insurance plans cover them. In this article, we will take a look at breast pump insurance coverage and what you need to know to get the best coverage for your needs.

What is Breast Pump Insurance Coverage?

Under the Affordable Care Act (ACA), breastfeeding support, supplies, and counseling are considered preventive care and must be covered by most insurance plans without cost-sharing. This means that insurance plans are required to cover the cost of a breast pump, either rental or purchase, for nursing mothers.

However, there are some exceptions to this rule. Grandfathered plans that were in existence before the ACA was passed may not be required to cover breast pumps. Also, some plans may have specific coverage requirements, such as only covering certain types of pumps or limiting the amount of coverage.

How Do I Know if My Insurance Plan Covers Breast Pumps?

To find out if your insurance plan covers breast pumps, you should contact your insurance provider directly. You can also check your plan documents or call the customer service number on your insurance card.

Some insurance plans may require a prescription from your doctor for a breast pump, while others may not. It is important to understand your plan’s requirements so that you can get the coverage you need.

What Types of Breast Pumps are Covered by Insurance?

Under the ACA, insurance plans must cover either a rental or purchase of a breast pump. This can include electric or manual pumps, as well as hospital-grade pumps if medically necessary.

However, some plans may have specific requirements for the type of pump that is covered. For example, some plans may only cover a manual pump if an electric pump is not medically necessary.

How Much Coverage Will I Receive?

The amount of coverage you receive for a breast pump will vary based on your insurance plan. Some plans may cover the full cost of a pump, while others may only cover a portion of the cost or require you to meet a deductible or co-pay.

It is important to understand your plan’s coverage limits and requirements so that you can plan accordingly.

Do I Need to Purchase a Breast Pump from a Specific Provider?

Most insurance plans do not require you to purchase a breast pump from a specific provider. However, some plans may have a list of preferred providers that offer discounted or free pumps. It is important to check with your insurance provider to see if they have any specific requirements for purchasing a breast pump.

How to Get Breast Pump Insurance Coverage

Contact Your Insurance Provider

The first step to getting breast pump insurance coverage is to contact your insurance provider. You can call the customer service number on your insurance card or visit their website to find out what type of coverage is available under your plan.

Get a Prescription from Your Doctor

Some insurance plans may require a prescription from your doctor for a breast pump. If so, you will need to speak to your doctor to obtain a prescription before you can get coverage for a pump.

Choose a Breast Pump

Once you have determined what type of coverage is available under your plan, you can choose a breast pump that meets your needs. You can purchase a pump from a retailer or supplier, or you may be able to rent a pump through your insurance provider.

Submit a Claim to Your Insurance Provider

After you have purchased or rented a breast pump, you will need to submit a claim to your insurance provider for reimbursement. You will need to provide proof of purchase or rental, as well as any other documentation required by your plan.

Frequently Asked Questions

Are Breast Pump Accessories Covered by Insurance?

Under the ACA, breast pump accessories, such as bottles, tubing, and storage bags, are not required to be covered by insurance. However, some insurance plans may cover these items as part of their breast pump coverage. It is important to check with your insurance provider to see what is covered under your plan.

Can I Get Coverage for a Second Breast Pump?

Some insurance plans may cover the cost of a second breast pump if the first one is lost, stolen, or damaged. However, this will vary based on your plan. It is important to check with your insurance provider to see if a second breast pump is covered and what the requirements are.

Do I Need a Prescription for a Breast Pump?

While not all insurance plans require a prescription for a breast pump, some do. It is important to check with your insurance provider to see what the requirements are for your plan.

Can I Rent a Breast Pump?

Under the ACA, insurance plans must cover either a rental or purchase of a breast pump. Some plans may have specific requirements for renting a pump, such as only covering a rental for a certain amount of time or requiring a prescription from your doctor.

What if My Insurance Plan Doesn’t Cover Breast Pumps?

If your insurance plan does not cover breast pumps, there are still options available to you. Some states have laws that require insurance plans to cover breast pumps, and some employers may offer coverage as part of their employee benefits package. You can also purchase a breast pump out of pocket.

In conclusion, breast pump insurance coverage is an important consideration for new moms. Understanding your insurance plan’s requirements and limitations can help you get the best coverage for your needs. Contacting your insurance provider, getting a prescription from your doctor, choosing a breast pump, and submitting a claim are the key steps to getting coverage. Remember that if your insurance plan doesn’t cover breast pumps, there are still options available to you.