Understanding ACA Breast Pump Coverage
Since the passage of the Affordable Care Act (ACA) in 2010, most health insurance plans in the United States are required to cover breast pumps as part of comprehensive lactation support services. This landmark legislation, specifically the Women's Health Amendment, recognizes breastfeeding support as essential preventive care for new mothers and their babies.
Under the ACA mandate, insurance companies must provide coverage for breastfeeding support, counseling, and equipment for the duration of breastfeeding. This includes one breast pump per pregnancy, which can be either a manual or electric model, provided at no cost to you—meaning no copay, coinsurance, or deductible applies when obtained through an in-network durable medical equipment (DME) supplier.
The coverage typically includes a standard double electric breast pump, which is the most common type recommended for working mothers and those who pump regularly. Many insurance plans now offer multiple pump options at different tiers, allowing you to choose from basic manual pumps, standard electric models, or premium pumps with advanced features. Some insurers have even begun covering wearable breast pumps, recognizing the increasing demand for hands-free, discreet pumping solutions.
It's important to understand that while the ACA mandates coverage, the specific details—including which pump models are covered, whether you need a prescription, when you can order the pump, and which DME suppliers are in-network—vary significantly by insurance provider and individual plan. Additionally, certain grandfathered health plans (those established before March 23, 2010, that haven't significantly changed) may be exempt from this requirement.
The primary goal of this coverage is to remove financial barriers to breastfeeding by ensuring that all mothers have access to the equipment necessary to successfully pump breast milk. Research consistently shows that access to quality breast pumps increases breastfeeding duration and exclusivity, which provides significant health benefits for both mother and baby. By understanding your insurance coverage and how to access this benefit, you can obtain a high-quality breast pump at no cost and set yourself up for breastfeeding success.
For most mothers, this benefit represents a savings of $150-400 or more, depending on the pump model. Taking advantage of your insurance coverage is one of the most valuable prenatal preparations you can make, ensuring you have the right equipment ready when you need it most—whether that's immediately after birth, when returning to work, or when building a milk supply.
How Insurance Coverage Works
Affordable Care Act Requirements
The ACA requires non-grandfathered health insurance plans to cover breastfeeding support and supplies without cost-sharing when provided by in-network suppliers. This means that when you obtain your breast pump through an approved DME supplier or retailer that has contracted with your insurance company, you should not have to pay a copay, meet a deductible, or pay coinsurance for the pump itself.
The law applies to individual and group health plans, including employer-sponsored insurance, Health Insurance Marketplace plans, and most Medicaid programs. The coverage must include breastfeeding support, counseling, and equipment for the duration of breastfeeding, not just for a limited time period. However, self-funded employer plans and certain religious organization plans may have exemptions.
What's Typically Covered
Most insurance plans cover a comprehensive range of breast pump options to meet different needs:
- Double Electric Pumps: Standard models like Spectra S2 Plus, Medela Pump in Style Advanced, and Lansinoh Signature Pro are the most commonly covered pumps, ideal for daily use and returning to work
- Single Electric Pumps: Some plans offer single electric pumps for occasional pumping needs, though double pumps are more commonly recommended
- Manual Pumps: Hand-operated pumps like Medela Harmony or Lansinoh Manual are covered by most plans as a lower-tier option or backup pump
- Hospital-Grade Pumps: Rental coverage for hospital-grade pumps may be available for medical necessity cases such as premature birth, NICU stays, low milk supply, or multiple births
- Wearable Pumps: Increasingly, plans are adding wearable pumps like Elvie, Willow, or Momcozy to their covered options, either at standard coverage or as premium upgrades
Coverage timing also varies: some insurers allow ordering during the third trimester (typically 30-32 weeks), while others require waiting until after delivery. Some plans permit ordering up to 30-60 days postpartum. The benefit generally renews with each pregnancy, allowing you to get a new pump for subsequent children.
What's Not Covered
While the ACA mandates broad coverage for breast pumps, there are important limitations to understand:
- Out-of-Network Suppliers: If you purchase a pump from a retailer or supplier not contracted with your insurance, you'll likely pay full price with no reimbursement
- Replacement Parts: Most plans don't cover ongoing replacement of consumable parts like flanges, valves, membranes, tubing, or bottles—these typically cost $20-60 per replacement set
- Second Pump Same Pregnancy: Insurance typically covers one pump per pregnancy, not multiple pumps (unless medically necessary for multiples)
- Premium Upgrades: If you choose a pump that costs more than your plan's allowance, you'll pay the difference out-of-pocket
- Pumps Purchased Before Coverage Verification: Buying a pump before confirming coverage or without going through proper channels usually results in no reimbursement
- Accessories and Extras: Additional items like pumping bras, storage bags, coolers, and supplemental flanges aren't typically covered under pump benefits
Deductibles and Copays
Under the ACA, preventive services—including breast pumps—must be covered without any cost-sharing when obtained through in-network providers. This means:
- No Deductible: You don't need to meet your annual deductible before the pump is covered
- No Copay: There should be no copayment required at the time of obtaining the pump
- No Coinsurance: You shouldn't pay a percentage of the pump cost
However, these zero-cost protections only apply when using in-network DME suppliers and selecting from your plan's covered pump options. If you choose to upgrade to a premium model or use an out-of-network supplier, you may face cost-sharing. Always verify coverage details with your insurance company and chosen DME supplier before ordering to avoid unexpected charges.
Step-by-Step Guide to Getting Your Pump Through Insurance
Obtaining your breast pump through insurance is straightforward when you follow the proper steps. Here's a comprehensive guide to ensure a smooth process:
Step 1: Verify Your Coverage (Around 28-30 Weeks Pregnant)
Start by contacting your insurance company's customer service or checking your member portal online. Ask these specific questions:
- Does my plan cover breast pumps under the ACA preventive services benefit?
- When can I order my breast pump (during pregnancy or after delivery)?
- Do I need a prescription or Letter of Medical Necessity from my healthcare provider?
- Which DME suppliers are in-network with my plan?
- What breast pump models and brands are covered?
- Are there multiple tier options (basic, standard, premium)?
- Can I upgrade to a higher-tier pump by paying the difference?
- Is there any cost-sharing (copay, deductible, or coinsurance) that applies?
Document the representative's name, date of call, and reference number for your records. Request written confirmation of coverage details if possible.
Step 2: Choose an Approved DME Supplier (30-32 Weeks Pregnant)
Once you know which DME suppliers are in-network, research your options. Major suppliers include:
- Aeroflow Breastpumps: Large selection, helpful customer service, online portal for easy ordering
- Edgepark Medical Supplies: Extensive insurance network, offers accessories and replacement parts
- Byram Healthcare: Comprehensive pump selection, dedicated breastfeeding specialists
- 180 Medical: Personal care coordinators, assistance with insurance verification
- Yummy Mummy: Boutique DME supplier with premium options
Many DME suppliers offer online coverage verification tools where you can enter your insurance information and immediately see which pumps are available under your plan. This can save time and help you compare options across multiple suppliers.
Step 3: Obtain Prescription if Required (30-34 Weeks Pregnant)
While many insurers no longer require a formal prescription, some still do. If your plan requires one, contact your OB-GYN, midwife, or primary care provider and request a breast pump prescription. The prescription should include:
- Your full name and date of birth
- Diagnosis code: Z39.1 (care and examination immediately after delivery) or similar
- Order for "breast pump, electric, double" or specific model if required
- Provider's signature, NPI number, and date
Most DME suppliers can also contact your provider directly to obtain the necessary documentation on your behalf, streamlining the process.
Step 4: Select Your Breast Pump (32-36 Weeks Pregnant)
Review the pump options available under your insurance coverage. Consider your specific needs:
- Daily/Work Use: Choose a powerful double electric pump with good battery life like Spectra S1 Plus or Medela Freestyle Flex
- Hands-Free Convenience: Consider wearable options like Elvie Stride or Momcozy M5 if covered
- Exclusive Pumping: Opt for hospital-grade or high-suction models like Spectra S2 Plus or Medela Pump in Style
- Occasional Use: A standard electric or manual pump may be sufficient
Read reviews, compare features, and consult with your lactation consultant about which pump best fits your pumping goals and lifestyle. Don't hesitate to call the DME supplier's customer service to discuss options—they're experienced in helping mothers make the right choice.
Step 5: Complete the Order (34-36 Weeks Pregnant)
Once you've selected your pump, complete the ordering process through your chosen DME supplier. You'll typically need to provide:
- Insurance card (front and back copy)
- Your contact information and shipping address
- Expected due date or delivery date
- Healthcare provider information (for prescription if needed)
- Payment information (if upgrading to premium model)
Most suppliers process orders within 7-10 business days after verifying your insurance coverage. They'll contact you to confirm your pump selection and estimated shipping date.
Step 6: Receive and Inspect Your Pump (Before or Shortly After Delivery)
When your breast pump arrives, carefully inspect the package to ensure all components are included:
- Pump motor/base unit
- Flanges (breast shields) in appropriate sizes
- Bottles or milk collection containers
- Tubing and connectors
- Valves and membranes
- Power adapter and/or batteries
- Carrying case or storage bag
- User manual and warranty information
Test the pump to ensure it's working properly before your baby arrives. Read the instruction manual thoroughly and familiarize yourself with assembly, cleaning, and operation. If anything is missing or defective, contact the DME supplier immediately for replacement.
Step 7: Register Your Pump and Keep Documentation
Register your breast pump with the manufacturer to activate the warranty (typically 1-2 years). Save all documentation including:
- Order confirmation and receipt from DME supplier
- Insurance Explanation of Benefits (EOB) statement
- Manufacturer warranty information
- User manual and assembly instructions
This documentation will be essential if you need warranty service, replacement parts, or have questions about coverage later.
Pro Tip from an IBCLC
Don't wait until the last minute! Start the insurance verification and ordering process around 30 weeks of pregnancy. Some DME suppliers experience high volume in certain months, and insurance processing can take time. Having your pump ready before delivery gives you peace of mind and ensures you're prepared if baby arrives early or if you need to pump in the hospital.
Major Insurance Providers & Their Breast Pump Policies
While all major insurance companies must comply with ACA requirements, their specific policies, covered pump options, and processes vary. Here's what you need to know about the largest providers:
Aetna
Aetna typically covers one breast pump per pregnancy through contracted DME suppliers. Most plans offer a choice between standard electric pumps (Spectra S2, Medela Pump in Style) at no cost or upgrade options to premium models. Ordering is usually allowed starting at 30 days before your due date. Aetna generally requires verification of pregnancy but not a formal prescription. Members can use the Aeroflow Breastpumps portal specifically designed for Aetna customers for easy ordering.
Blue Cross Blue Shield (BCBS)
BCBS coverage varies significantly by state and plan type, as BCBS operates as a federation of independent companies. Most BCBS plans cover double electric pumps through approved DME suppliers at 100% with no cost-sharing. Some plans offer tiered options with basic, standard, and premium selections. Ordering windows typically begin at 30-90 days before delivery. Check with your specific state BCBS plan for exact coverage details and approved supplier lists.
Cigna
Cigna covers breast pumps as preventive care with no cost-sharing when using in-network DME suppliers. Coverage typically includes one standard electric pump per pregnancy, with upgrade options available for premium models. Cigna has partnered with several major DME suppliers including Edgepark and Byram Healthcare. Members can typically order pumps during the third trimester (after 27-30 weeks). A prescription may be required depending on your specific plan.
UnitedHealthcare (UHC)
UnitedHealthcare provides comprehensive breast pump coverage under most plans, offering multiple pump options across different quality tiers. Members can typically choose from manual, standard electric, or premium electric pumps. UHC has an extensive network of DME suppliers and an online portal for coverage verification. Ordering is generally allowed from 30 days before due date through 365 days postpartum. Some UHC plans now include wearable pumps in their covered options.
Humana
Humana covers one breast pump per pregnancy through authorized DME suppliers. Coverage typically includes standard double electric pumps at no cost, with options to upgrade to premium models by paying the difference. Humana members can usually order pumps starting at 60 days before the expected due date. A prescription from your healthcare provider may be required. Check Humana's DME supplier directory for in-network options in your area.
Anthem
Anthem (now Elevance Health) provides breast pump coverage as part of preventive care benefits. Coverage includes one pump per pregnancy, typically a standard electric double pump from brands like Spectra, Medela, or Lansinoh. Anthem members can order through contracted DME suppliers starting at approximately 30 days before delivery. Some Anthem plans offer multiple tier selections, allowing you to choose based on features and needs.
Kaiser Permanente
Kaiser Permanente members typically order breast pumps directly through Kaiser's medical equipment services rather than third-party DME suppliers. Coverage includes standard electric pumps, and ordering is usually permitted after 34 weeks of pregnancy or following delivery. Kaiser offers pump education classes and lactation consultant support as part of comprehensive maternity care. Contact your local Kaiser facility for specific pump options and ordering procedures.
Medicaid
Medicaid coverage for breast pumps varies by state, as each state administers its own Medicaid program within federal guidelines. Most state Medicaid programs cover breast pumps through approved DME suppliers, typically offering standard electric double pumps. Some states provide extensive coverage including hospital-grade pumps and accessories, while others offer more limited options. Prescriptions are usually required for Medicaid breast pump coverage. Contact your state's Medicaid office or managed care plan for specific coverage details.
Important Note
Insurance policies and coverage details change frequently. Always verify your specific coverage directly with your insurance provider and DME supplier before ordering. The information provided here represents general guidelines and may not apply to your particular plan.
Best Breast Pumps Typically Covered by Insurance
While coverage varies by insurance plan, these pumps are most commonly available through insurance DME suppliers and represent excellent quality options across different price points and feature sets.
Spectra S2 Plus - Best Overall Insurance-Covered Pump
The Spectra S2 Plus is the most frequently recommended insurance-covered breast pump among lactation consultants and consistently tops the list of DME supplier offerings. This hospital-strength double electric pump features a closed system design that prevents milk backflow and contamination, making it exceptionally hygienic.
Key features include adjustable suction (level 1-5), customizable cycle speeds (38-54 cycles per minute), a soothing nightlight for overnight pumping, and remarkably quiet operation (under 45 decibels). The letdown massage mode mimics natural nursing to stimulate milk flow, while the expression mode provides efficient milk removal. The pump is AC-powered only (no battery), making it ideal for home or office use with a power outlet.
Insurance coverage: Nearly all major insurers cover the S2 Plus as a standard-tier option at no cost. Retail value is approximately $160-200, representing significant savings when obtained through insurance. The pump comes with two 24mm flanges, bottles, tubing, and a carrying tote. Additional flange sizes (19-36mm) are available for purchase separately.
Best for: Mothers who pump primarily at home, exclusive pumpers, those seeking hospital-grade suction without battery needs. Read full Spectra S2 Plus review.
Medela Pump in Style Advanced - Most Recognized Brand
The Medela Pump in Style Advanced is one of the most well-known breast pumps and is widely covered by insurance providers. Medela's 2-Phase Expression technology mimics a baby's natural nursing rhythm with a faster, lighter stimulation phase followed by a slower, stronger expression phase for maximum milk flow.
This portable double electric pump features adjustable suction and speed controls, allowing you to customize comfort and efficiency. The pump includes a rechargeable battery pack (in most versions), making it versatile for pumping on-the-go. It comes with a stylish shoulder bag that includes cooler compartment and ice pack for milk storage. The pump uses an open system design, requiring regular cleaning of tubing.
Insurance coverage: Commonly covered by most major insurance plans, though some insurers offer it as a mid-tier option. Retail value ranges from $200-300 depending on the model (Advanced vs. Max Flow versions). Replacement parts are widely available from multiple retailers.
Best for: Working mothers who need portability, those familiar with the Medela brand from hospital use, mothers who value established brand reputation and extensive parts availability. Read full Medela Pump in Style review.
Lansinoh Signature Pro - Best Budget-Friendly Option
The Lansinoh Signature Pro offers impressive features at a lower price point, making it an excellent value option frequently covered by insurance. This double electric pump features three pumping styles (massage, letdown, and expression) with eight adjustable suction levels for personalized comfort and efficiency.
The pump includes both AC adapter and battery pack, providing flexibility for home or travel use. Its closed system design prevents milk from entering the tubing, ensuring hygiene and easy cleaning. The LCD display shows pumping mode, suction level, and timer. It's notably lightweight (under 1.5 lbs without batteries) and compact, fitting easily into bags for travel.
Insurance coverage: Frequently offered as a standard or basic-tier option by most insurance providers, often at no cost. Retail value is approximately $130-170, making it a cost-effective choice. The pump includes everything needed to start pumping: flanges, bottles, tubing, cooler bag with ice pack, and storage tote.
Best for: Budget-conscious mothers, those seeking good features without premium price, first-time pumpers, occasional to moderate pumping needs. Read full Lansinoh Signature Pro review.
Ameda Purely Yours - Excellent for Exclusive Pumpers
The Ameda Purely Yours is a workhorse pump particularly well-suited for exclusive pumping or frequent daily use. It features hospital-performance suction with independently adjustable speed and suction controls on each side, allowing you to customize pumping for each breast individually—a unique feature in this price range.
The pump uses a hygienic closed system with proven airlock protection to prevent milk backflow. It includes a rechargeable battery pack for portability and can also run on AC power. The wide-neck bottles are compatible with standard bottle nipples, eliminating the need for transfer. The pump is lightweight (1.3 lbs) and relatively quiet for comfortable pumping anywhere.
Insurance coverage: Widely covered by most major insurance providers as a standard or mid-tier option. Retail value is approximately $150-180. Replacement parts are affordable and readily available through multiple online retailers and DME suppliers.
Best for: Exclusive pumpers, mothers needing independent breast control, those with different output between breasts, travel and work use.
Motif Luna - Rising Star in Insurance Coverage
The Motif Luna is increasingly appearing in insurance DME supplier catalogs as a covered option. This sleek, modern pump offers three expression modes (massage, letdown, and maxflow) with 16 suction levels for precise customization. The closed system design with overflow protection prevents contamination.
Features include a rechargeable lithium-ion battery providing multiple pumping sessions per charge, LED display with timer and mode indicators, and whisper-quiet operation. The pump is remarkably lightweight and compact, with a minimalist design that's easy to transport. It comes with soft silicone flanges in multiple sizes for better comfort and fit.
Insurance coverage: Growing availability through insurance coverage, particularly with UnitedHealthcare, Aetna, and some BCBS plans. Retail value is approximately $180-220. The brand is gaining positive reviews for performance and value.
Best for: Tech-savvy mothers, those seeking modern design, pumpers wanting extensive customization options, portable pumping needs.
| Pump Model | Insurance Availability | Retail Price | Battery | Best For |
|---|---|---|---|---|
| Spectra S2 Plus | Widely covered | $160-200 | No (AC only) | Home use, exclusive pumping |
| Medela Pump in Style | Very common | $200-300 | Yes | Working moms, portability |
| Lansinoh Signature Pro | Widely covered | $130-170 | Yes | Budget, first-time users |
| Ameda Purely Yours | Common | $150-180 | Yes | Exclusive pumping, control |
| Motif Luna | Growing availability | $180-220 | Yes | Modern design, customization |
Remember, your insurance plan may offer different pump selections than listed here, including additional brands or newer models. Always verify which specific pumps are covered under your plan before making a decision. Consult with a lactation consultant if you're unsure which pump best meets your individual needs.
DME Suppliers & Where to Order
Durable Medical Equipment (DME) suppliers are specialized companies authorized by insurance providers to distribute medical equipment including breast pumps. Using an in-network DME supplier is essential to ensure your pump is covered at no cost under your insurance benefit.
Top DME Suppliers for Breast Pumps
Aeroflow Breastpumps
Aeroflow is one of the largest and most popular DME suppliers specializing in breast pumps. They have insurance contracts with virtually all major providers and many regional insurers. Their strengths include an easy-to-use online portal where you can check coverage, view available pumps, and place orders entirely online. Customer service specialists help you select the right pump based on your needs and insurance coverage. Aeroflow offers extensive educational resources, pump comparison tools, and excellent customer reviews. They also carry replacement parts and accessories.
Website: aeroflowbreastpumps.com | Insurance Network: Extensive (500+ plans) | Ordering: Online and phone
Edgepark Medical Supplies
Edgepark is a comprehensive medical supply company with a dedicated breastfeeding division. They're in-network with most major insurance providers and offer a wide selection of breast pump brands and models. Edgepark's advantages include bulk purchasing power allowing them to stock even hard-to-find pumps, convenient auto-ship programs for replacement parts, and knowledgeable product specialists. They also carry nursing supplies, milk storage solutions, and breastfeeding accessories.
Website: edgepark.com | Insurance Network: Very comprehensive | Ordering: Online, phone, fax
Byram Healthcare
Byram Healthcare is a well-established DME supplier with over 45 years of experience. Their breast pump program includes certified breastfeeding specialists who provide personalized support in selecting the right pump for your situation. Byram offers pump comparison tools, educational videos, and ongoing customer support for troubleshooting and questions. They maintain partnerships with major insurance providers and process claims efficiently. Their website features live chat support for immediate assistance.
Website: byramhealthcare.com | Insurance Network: Major insurers | Ordering: Online and phone
180 Medical
180 Medical provides personalized care coordination for breast pump orders. Each customer is assigned a dedicated care coordinator who handles insurance verification, pump selection, and all paperwork. This white-glove service is particularly helpful for those navigating complex insurance situations or who prefer hands-on support. 180 Medical is in-network with many major insurers and emphasizes customer service and education.
Website: 180medical.com | Insurance Network: Growing (major providers) | Ordering: Phone-based with coordinator
Yummy Mummy
Yummy Mummy is a boutique DME supplier focusing on premium breast pump options and exceptional customer experience. While they carry standard insurance-covered pumps, they specialize in helping mothers access wearable and high-end pump options through insurance, often facilitating upgrade programs. Their customer service is highly rated for responsiveness and breastfeeding knowledge. They're in-network with many major insurers though their network may be smaller than larger suppliers.
Website: yummymummystore.com | Insurance Network: Major insurers | Ordering: Online and phone
How to Choose the Right DME Supplier
When selecting a DME supplier, consider these factors:
- Insurance Network: Verify the supplier is in-network with your specific plan
- Pump Selection: Ensure they carry the pump models you're interested in
- Customer Service: Read reviews about responsiveness and helpfulness
- Ordering Process: Determine if online ordering, phone support, or personal coordination fits your preference
- Additional Services: Check if they offer replacement parts, accessories, or educational resources
- Processing Time: Ask about typical processing and shipping timeframes
Tip
Many DME suppliers offer online coverage checkers where you simply enter your insurance information and immediately see which pumps are available under your plan at no cost. This is the fastest way to verify coverage and compare options across multiple suppliers.
Upgrade Options & Premium Pumps
While insurance covers a standard breast pump at no cost, many mothers choose to upgrade to premium models by paying the difference out-of-pocket. This allows you to access advanced features, wearable technology, or higher-end brands while still benefiting from your insurance coverage.
How Upgrades Work
Most DME suppliers offer tiered pump selections: basic (usually manual), standard (double electric), and premium (advanced electric or wearable). Your insurance typically covers the full cost of standard-tier pumps. If you prefer a premium model, you pay only the difference between the insurance allowance and the retail price.
For example, if your insurance covers $200 toward a breast pump and you want a $450 wearable pump, you would pay $250 out-of-pocket. This upgrade fee is typically paid directly to the DME supplier at the time of ordering, using a credit card, HSA, or FSA card.
Popular Upgrade Options
Spectra S1 Plus (Battery-Powered Version)
If insurance covers the Spectra S2 Plus (AC-only) but you need portability, upgrading to the S1 Plus adds a rechargeable battery for pumping anywhere. The upgrade cost is typically $40-80. This gives you all the benefits of the hospital-grade S2 with the added freedom of battery operation, making it ideal for work, travel, or pumping without access to outlets.
Medela Freestyle Flex or Sonata
Upgrading from the standard Pump in Style to Medela's more compact Freestyle Flex or app-connected Sonata provides enhanced portability, Bluetooth connectivity, and personalized pumping programs. Upgrade costs range from $80-150 depending on your insurance allowance. These premium Medela models offer smart features and modern design while maintaining the brand's proven 2-Phase Expression technology.
Wearable Pumps (Elvie, Willow, Momcozy)
Wearable pumps are increasingly available as upgrade options, typically requiring $200-400 in additional payment beyond insurance coverage. Popular options include:
- Elvie Stride: Hands-free with separate pump unit, quieter operation, upgrade typically $200-300
- Willow 3.0: All-in-one wearable with spill-proof design, upgrade typically $300-400
- Momcozy M5: Budget wearable option with good suction, upgrade typically $100-200
These wearables allow completely hands-free pumping inside your bra, ideal for working mothers who need discretion and mobility. See our wearable vs traditional pump comparison for detailed analysis.
Is Upgrading Worth It?
Consider upgrading if:
- You'll be pumping frequently at work and need portability (battery power or wearable)
- Hands-free pumping would significantly improve your quality of life and productivity
- You want smart features like app connectivity, pumping tracking, or personalized programs
- You're willing to invest in premium features for enhanced convenience and comfort
Skip upgrading if:
- You'll primarily pump at home with access to power outlets
- Budget is a significant concern and the standard pump meets your basic needs
- You're a first-time pumper unsure of your long-term pumping requirements
- The standard covered pump has all the features you need
Using HSA/FSA Funds for Upgrades
Breast pump upgrade costs are eligible for payment with Health Savings Account (HSA) or Flexible Spending Account (FSA) funds. This allows you to use pre-tax dollars for the upgrade difference, effectively providing a 20-30% discount (depending on your tax bracket). Simply use your HSA/FSA card when paying the DME supplier's upgrade fee. No prescription is required for HSA/FSA purchases.
Frequently Asked Questions About Insurance Coverage
Does insurance cover breast pumps?
Yes, under the Affordable Care Act (ACA), most health insurance plans are required to cover one breast pump per pregnancy at no cost to you. This includes both manual and electric pumps from approved medical equipment suppliers. Coverage is provided as a preventive health benefit under the Women's Health Amendment, which mandates coverage for breastfeeding support and supplies.
When can I order my breast pump through insurance?
Most insurance companies allow you to order a breast pump during your third trimester, typically starting at 30-32 weeks of pregnancy. Some insurers allow ordering immediately after birth, while others permit ordering up to 30-60 days postpartum. Contact your insurance provider or DME supplier early (around 28 weeks) to understand your specific coverage timeline and avoid delays.
Do I need a prescription for an insurance-covered breast pump?
Requirements vary by insurance provider. Many insurers and DME suppliers no longer require a written prescription, only verification of pregnancy and delivery date from your healthcare provider. However, some plans still require a formal prescription or Letter of Medical Necessity from your doctor or midwife. Check with your insurance company or DME supplier to confirm their specific requirements before ordering.
What breast pumps are typically covered by insurance?
Insurance plans typically cover standard double electric pumps like the Spectra S2 Plus, Medela Pump in Style Advanced, Lansinoh Signature Pro, and Ameda Purely Yours. Manual pumps like the Medela Harmony are also usually covered. Some insurers offer multiple tiers with basic, standard, and premium options. Wearable pumps like Elvie or Willow may be available as premium upgrades with an out-of-pocket cost difference.
Can I upgrade to a better breast pump if it's not fully covered?
Yes, most insurance plans and DME suppliers offer upgrade options where you pay the difference between the covered amount and the retail price of a premium pump. For example, if your insurance covers $200 and you want a $400 Spectra S1 Plus (with battery), you would pay the $200 difference. This allows you to access higher-end features like rechargeable batteries, hospital-grade suction, or wearable technology while still utilizing your insurance benefit.
Which insurance companies cover breast pumps?
All major insurance providers cover breast pumps under the ACA mandate, including Aetna, Blue Cross Blue Shield, Cigna, UnitedHealthcare, Humana, Anthem, Kaiser Permanente, and Medicaid. Coverage specifics vary by plan type (HMO, PPO, EPO) and state. Employer-sponsored plans, individual marketplace plans, and most Medicaid programs include this benefit. Grandfathered plans (established before March 2010) may not be required to provide coverage.
What is a DME supplier and where do I order my pump?
DME (Durable Medical Equipment) suppliers are companies authorized by insurance providers to distribute medical equipment including breast pumps. Major DME suppliers include Aeroflow, Edgepark, Byram Healthcare, and 180 Medical. These suppliers verify your insurance coverage, help you select from covered pumps, handle claims processing, and ship the pump directly to your home. Your insurance company can provide a list of approved in-network DME suppliers.
Can I get a second breast pump through insurance?
Generally, insurance covers one breast pump per pregnancy. If you have twins or multiples, some insurers may cover a hospital-grade pump or allow for enhanced coverage. For subsequent pregnancies, you are typically eligible for a new pump. If your first pump breaks or malfunctions within the warranty period, contact the manufacturer for replacement. Some DME suppliers offer loaner programs during repairs.
Does insurance cover breast pump replacement parts?
Coverage for replacement parts varies significantly by insurance plan. Most plans do not cover replacement parts like flanges, valves, tubing, or bottles after the initial pump is provided. These parts typically need to be purchased out-of-pocket and cost $20-60 for complete replacement sets. Some plans may cover parts if medically necessary or if the pump is defective. HSA or FSA funds can be used to purchase replacement parts tax-free.
What if my insurance denies coverage for a breast pump?
If coverage is denied, first verify the reason: it may be due to timing (ordering too early), lack of documentation, or grandfathered plan status. Request a detailed explanation of benefits (EOB) and appeal the denial in writing with supporting documentation from your healthcare provider explaining medical necessity. Contact your state insurance commissioner if appeals are unsuccessful. Self-funded employer plans have different appeal processes. Consider purchasing a pump directly or using HSA/FSA funds if appeals fail.
Are wearable breast pumps covered by insurance?
Coverage for wearable pumps (Elvie, Willow, Momcozy) varies by insurance provider and plan. Some insurers now include wearable pumps in their standard coverage, while others offer them as premium upgrades requiring you to pay the cost difference ($200-400). A few plans may cover wearables only with a Letter of Medical Necessity citing specific medical need (such as returning to work, exclusive pumping, or supply issues). Contact your DME supplier to check if wearable options are available under your plan.
Can I use my HSA or FSA for a breast pump?
Yes, breast pumps and related supplies (flanges, bottles, milk storage bags, nursing pads) are HSA and FSA eligible expenses. You can use these pre-tax funds to purchase a pump if insurance doesn't cover it, to pay for upgrade costs, or to buy replacement parts and accessories. No prescription is required for HSA/FSA purchases. This provides significant savings (20-30% depending on your tax bracket) on out-of-pocket breastfeeding expenses.