Most health insurance plans are required to cover a breast pump at no cost to you, but the specific pump you can get, when you can order it, and how you order it vary by plan. Finding out exactly what your plan covers takes a few targeted steps, starting with your insurance company’s member services line or online portal.
What the Law Requires
Under the Affordable Care Act, health insurance plans must provide breastfeeding support, counseling, and equipment for the duration of breastfeeding, with no co-pay or cost-sharing. This applies to Marketplace plans and nearly all employer-sponsored plans. The one exception is grandfathered plans, meaning plans that existed before the ACA took effect in 2010 and haven’t made significant changes since. Very few plans still hold grandfathered status, but if yours does, it is not required to cover a breast pump.
Even though coverage is legally required, the law doesn’t specify which type or brand of pump your insurer must provide. That’s why two people with different insurance companies can have very different experiences.
How to Check Your Specific Coverage
The fastest way to find out what your plan covers is to call the member services number on the back of your insurance card. When you call, ask these specific questions:
- What types of breast pumps are covered? Many plans cover a personal-use double electric pump at no cost. Manual pumps, hospital-grade multi-user pumps, and newer hands-free pumps are frequently excluded or only partially covered. UnitedHealthcare, for example, typically covers a double electric pump but not manual, hospital-grade, or hands-free models.
- Do I need a prescription? Most insurers require one. Your OB-GYN, midwife, or primary care provider can write it. Ask your insurance company exactly what information needs to be on the prescription so you don’t have to go back for corrections.
- When can I order? Some plans let you order during pregnancy (often 30 days or more before your due date), while others require you to wait until after delivery. Knowing this helps you plan ahead.
- Do I have to use a specific supplier? Most plans require you to order through an in-network durable medical equipment (DME) provider. Ask for a list of approved vendors.
- How many pumps can I get? The standard is one breast pump per 12-month period. If you have another baby later, you can typically get a new one.
- Which brands and models are fully covered? Your plan will have a list of pumps available at zero cost. Ask for this list specifically so you can compare before choosing.
You can also log into your insurance company’s member portal or app. Many insurers now have a dedicated breastfeeding benefits page that lists covered pumps, approved vendors, and ordering instructions.
Ordering Through a DME Provider
Insurance companies don’t ship you a breast pump directly. Instead, they work with durable medical equipment suppliers who handle the order and bill your insurance. These companies specialize in processing insurance claims for breast pumps, so they can often verify your benefits for you and tell you exactly which pumps are covered at no cost under your plan.
National DME suppliers that work with many major insurers include Aeroflow, Byram Healthcare, Acelleron, and several others. Some are listed directly on your insurer’s website. You can typically go to one of these suppliers’ websites, enter your insurance information, and see which pumps are available to you within minutes. This is often easier than calling your insurance company and asking them to read off a list of covered models.
The process generally works like this: you provide your insurance details and a prescription, the DME company verifies your benefits, you choose from the pumps your plan covers, and the supplier ships it to you. No claim forms to fill out on your end.
Upgrading Beyond What’s Covered
Most plans fully cover a basic double electric pump, but if you want a higher-end model (a newer hands-free pump, for instance), many DME suppliers offer an upgrade option. Your insurance covers its standard amount, and you pay the difference out of pocket. This upgrade cost can range from $30 to $200 or more depending on the model.
Before paying for an upgrade, it’s worth checking whether the features you want actually exist on one of the fully covered options. The list of zero-cost pumps has expanded significantly in recent years, and some plans now fully cover models that would have required an upgrade payment a few years ago.
What to Do if You’re on Medicaid
Medicaid covers breast pumps in every state, but the details vary significantly depending on where you live. Some state Medicaid programs cover only manual pumps, while others cover double electric models. The approved brands, ordering process, and whether you need prior authorization all differ by state.
Your best starting point is to call the number on your Medicaid card and ask what breast pump equipment is covered. You can also contact your state Medicaid office directly or ask your prenatal care provider, since many OB offices are familiar with the local process and can point you to the right supplier.
If You Already Bought a Pump
If you purchased a breast pump out of pocket before checking your benefits, you may be able to submit a claim for reimbursement, but this gets complicated. Many insurers only reimburse purchases made through approved DME suppliers, and buying from a retail store or directly from a manufacturer may not qualify. If you went this route, call your insurance company with your receipt and ask about their reimbursement process. Be prepared for the possibility that you’ll only be reimbursed up to the amount your plan would have paid for its standard covered pump, or that the claim may be denied entirely if you didn’t use an in-network supplier.
The simplest path is always to verify your coverage before purchasing. Even if you’re in a hurry, a quick call to your insurer or a visit to a DME provider’s website can save you hundreds of dollars.