Most health insurance plans in the U.S. are required to cover a breast pump at no cost to you. The Affordable Care Act classifies breastfeeding support and supplies as preventive care, which means your plan must provide a pump without copays, deductibles, or coinsurance. Getting one takes a few specific steps: confirming your coverage, getting a prescription, and ordering through an approved supplier.
What Insurance Plans Must Cover
The ACA mandate applies to Marketplace plans and virtually all other health insurance plans, with one exception: grandfathered plans. A grandfathered plan is one that existed before March 23, 2010, and hasn’t made certain significant changes since then. If you’re unsure whether your plan qualifies, call the number on your insurance card and ask directly. Most employer-sponsored plans created or substantially modified after 2010 are required to comply.
Medicaid also covers breast pumps, though the specifics vary by state. In New York, for example, Medicaid covers pumps throughout pregnancy and up to 12 months postpartum, and members qualify for a new pump with each pregnancy. Your state’s Medicaid program may cover manual pumps, personal-use double-electric pumps, or even hospital-grade rentals depending on medical need.
Which Pump Types Are Typically Covered
Insurance plans generally cover three categories of breast pumps, though not every plan covers all three at no cost:
- Manual pumps: Handheld devices suitable for occasional or daily use, depending on your schedule.
- Double-electric pumps (personal use): Designed for parents returning to work or school who plan to pump regularly. These are single-user devices and should not be shared.
- Hospital-grade electric pumps: Higher-powered pumps intended for situations where a baby can’t breastfeed directly or when milk supply needs extra support. These are typically rented rather than owned, and they’re safe for multiple users because each person gets their own pumping kit.
Most plans will fully cover at least one double-electric pump model. If you want a specific brand or a wearable pump, you’ll likely pay an upgrade fee out of pocket. More on that below.
Step by Step: How to Order
The process is straightforward, but skipping a step can mean paying out of pocket unnecessarily.
1. Call Your Insurance Company
Start by calling the member services number on your insurance card. Ask three things: which pump brands and models are covered at no cost, whether you need to order through a specific supplier, and how early in your pregnancy you can place the order. Some plans allow ordering in the third trimester, while others won’t ship until closer to your due date or after delivery. TRICARE, for instance, extends coverage starting at the 27th week of pregnancy.
2. Get a Prescription
You’ll need a prescription or written order from your healthcare provider. Your OB, midwife, or primary care doctor can write this. The supplier will verify the prescription before shipping, so have it ready before you place your order. Some suppliers will contact your provider’s office directly if you give them the name and phone number.
3. Order Through an Approved Supplier
This is where people most often run into problems. You will not be reimbursed for a breast pump purchased at a retail store. You must order through a durable medical equipment (DME) provider that’s in your insurance network. Your insurer can give you a list of approved suppliers, or you can use one of the large national breast pump suppliers like Aeroflow or Byram Healthcare, which work with many insurance plans. These companies will typically verify your benefits for you if you enter your insurance information on their website.
Upgrade Fees and How to Minimize Them
Every plan covers at least one pump model at zero cost, but it may not be the one you want. If you prefer a different brand or a wearable pump, the supplier will charge an upgrade fee for the difference. These fees vary wildly depending on the supplier, ranging from under $10 to $200 for the same pump.
The Spectra S1, one of the most popular pumps, illustrates this well. One parent reported a $9.95 upgrade fee through one supplier while Aeroflow and Byram quoted $60 to $100 for the same model. Another paid $75 through Byram with Kaiser insurance, while someone else paid $30 elsewhere. The price difference comes down to which supplier you use and what deal they’ve negotiated with your insurer.
Before paying an upgrade fee, check multiple suppliers. Enter your insurance details on two or three different sites and compare what they charge for the pump you want. A few minutes of comparison shopping can save you $50 to $150.
When to Start the Process
Most parents order their pump during the third trimester, around 30 to 34 weeks. Starting early gives you time to deal with any insurance hiccups, prescription delays, or shipping times. Some suppliers take a week or two to verify benefits and process the order, and you want the pump in hand before the baby arrives.
That said, you can also order after delivery. Coverage doesn’t expire the moment your baby is born. If you’re on Medicaid, coverage typically extends through the postpartum period, up to 12 months in states like New York. If you adopted an infant and plan to breastfeed, you’re eligible as well under many plans including TRICARE.
Medicaid: What’s Different
If you’re on Medicaid, the process depends on whether you’re in a managed care plan or fee-for-service (straight Medicaid). Managed care enrollees should contact their plan directly to find out which suppliers to use. Fee-for-service enrollees can get manual or personal-use double-electric pumps through any pharmacy or DME vendor that accepts Medicaid.
Hospital-grade pump rentals require meeting additional medical criteria, and your provider will need to document the need. If you qualify, Medicaid covers the rental cost. Fee-for-service enrollees in New York, for instance, can call the Medicaid Helpline at (800) 541-2831 for help arranging a rental. Other states have similar processes but different contact points, so check with your state’s Medicaid office.
Common Mistakes That Delay Your Pump
The biggest mistake is buying a pump at a retail store and expecting reimbursement. Insurers require you to go through their approved DME channels. If you buy from Target or Amazon first, you’re paying out of pocket.
The second most common issue is not getting a prescription ahead of time. Some providers will write one at a routine prenatal visit if you ask, so bring it up early rather than making a separate appointment later. The third is assuming your plan doesn’t cover a pump without actually calling to check. Even if your employer has a grandfathered plan, it’s worth confirming, because many grandfathered plans have voluntarily added this benefit anyway.
Finally, don’t assume you’re limited to one pump per lifetime. Many plans cover a new pump for each pregnancy, and replacement parts like flanges, valves, and tubing may also be covered during the period you’re breastfeeding. Ask your insurer specifically about replacement parts when you call, because worn parts can reduce pump effectiveness over time.