Insurance Coverage of Breast Pumps

Allison Martin
Breast Pump

The Affordable Care Act requires healthcare insurance providers to include the coverage of breastfeeding supplies and lactation support into the plans offered to their members. Most companies made this policy effective on August 1, 2012.

How It Works

In most instances, women who are late in their pregnancy or postpartum can obtain a breast pump without having to remit a copayment, coinsurance or deductible if they are eligible for coverage. The typical procedure to claim your breast pump is as follows:

  1. Contact your provider to obtain a list of in-network or preferred durable medical equipment providers.
  2. Select a vendor and place an order. You may be asked to provide your doctor's contact information, due date or date of delivery, and disclose whether or not you are currently producing breast milk.
  3. Once your request is approved, the supplier will typically ship your breast pump and supplies directly to you.
  4. Follow-up with your insurance company to ensure that the DME provider submitted a claim for the pump and supplies. Also, inquire about any outstanding balance for which you may be responsible.

Most major providers also offer comprehensive lactation support and counseling along with a number of other beneficial pregnancy resources to support the mother during and after the pregnancy.

Restrictions

Because each plan's coverage for breast pumps and lactation support varies by provider, it is important to read the fine print to learn about the restrictions that may apply.

Prescriptions

Depending on the provider, you may need a prescription from your obstetrician to request a breast pump. Failure to do so may exclude you from coverage or result in the accrual of out-of-pocket costs.

Models

The types of breast pump models that are eligible for coverage vary by the provider. Hospital grade pumps are rarely permitted, and some insurance companies even exclude electric pumps from qualification. Be sure to check with your provider before placing an order to find out which type of breast pump you are eligible for.

Retail Store Pumps

Typically, breast pumps purchased from retailers are not eligible for reimbursement.

Number of Years Between Pregnancies

With the exception of rentals, most breast pumps stay with the covered member once they have received it. Because of this, some providers limit the number of breast pumps you can receive over the span in which you are covered. However, supplies are often replenished if you become pregnant prior to your eligibility date for a new breast pump.

Major Providers

Cost of Coverage Prescription Required? Restrictions Models Permitted Claims Processing Other Resources for Pregnant and Postpartum Mothers
Blue Cross Blue Shield Free no No reimbursement offered for retail store purchases

Cost-sharing may apply for out-of-network expenses
Inquire with provider for additional information Handled by the supplier Living Healthy Babies
Aetna Free or discounted rate no

No reimbursement offered for retail store purchases

Cost-sharing may apply for out-of-network expenses

Standard electric pump or manual pump once every three years Handled by the supplier Beginning Right Maternity Program
AvMed Free no

No reimbursement offered for retail store purchases

Cost-sharing may apply for out-of-network expenses

One pump per pregnancy from participating DME vendors (call for details) Handled by the supplier Appointments with lactation specialist permitted
Cigna Free yes

No reimbursement offered for retail store purchases

Cost-sharing may apply for out-of-network expenses

One pump per pregnancy that must be ordered from Care Centrix, Cigna's preferred DME provider Handled by Care Centrix Appointments with lactation specialist permitted

Other Important Considerations

It is important to note that the level of coverage varies depending on if your provider is commercial, private or a governmental program.

WIC and Medicaid Recipients

Participants in the WIC program qualify for breast pumps, breast shells, nursing supplements and lactation support services in the form of peer counseling and enhanced food packages.

On the other hand, the coverage for breast pumps if you are a Medicaid recipient varies by your state of residence because specific guidance for lactation services is not mentioned in Federal Medicaid Regulations. However, all states are encouraged to provide lactation resources and access to a manual or individual electric breast pump or a hospital-grade rental free of charge.

For additional assistance on how each of these programs work, contact or visit your local WIC or Medicaid office.

Out-of-Network Providers

If you choose to see an out-of-network provider, you will more than likely be responsible for co-payments if not the entire cost of lactation support services and supplies.

Questions to Ask Your Provider

To learn more about the specific details of your coverage, contact your insurance provider directly. When doing so, ask about the types and brands of pumps covered, out-of-network reimbursement policies, and details on the lactation consulting benefit.

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Insurance Coverage of Breast Pumps