Most health insurance plans cover a double-electric breast pump at no cost to you. Under the Affordable Care Act, non-grandfathered plans must cover breast pumps as preventive care with zero cost-sharing. The specific brands and models available depend on your insurer and the supplier you order through, but standard double-electric pumps from major manufacturers are typically included. Wearable and hospital-grade pumps may also be covered, though some come with an out-of-pocket upgrade fee.
What the ACA Requires
The ACA classifies breast pumps under women’s preventive services, which means insurers must cover them without copays, deductibles, or coinsurance. This applies to plans purchased on the marketplace, employer-sponsored plans, and most individual plans. The one major exception is grandfathered health plans, which are plans that existed before the ACA took effect in 2010 and haven’t made significant changes since. Grandfathered plans are exempt from the preventive services requirement, so they may not cover a pump at all or may require you to pay part of the cost.
If you’re unsure whether your plan is grandfathered, check your Summary of Benefits and Coverage or call the member services number on your insurance card. Most plans have updated enough by now to lose grandfathered status, but it’s worth confirming before you assume full coverage.
Types of Pumps Typically Covered
Insurance plans generally cover three categories of breast pumps, though not every plan covers all three.
- Manual pumps: Hand-operated, portable, and useful for occasional pumping. These are the least expensive and almost always fully covered.
- Double-electric pumps: The most commonly covered type. These are personal-use pumps designed for parents who pump regularly, especially those returning to work or school. Major insurers like UnitedHealthcare cover a personal-use double-electric pump at no cost under most benefit plans.
- Hospital-grade electric pumps: These are heavy-duty, multi-user pumps intended for situations where a baby can’t breastfeed directly or a parent needs extra help establishing milk supply. They’re typically rented rather than purchased, and coverage usually requires a specific medical reason.
Wearable pumps from brands like Elvie, Willow, and Eufy have become increasingly popular, and many insurers now include at least some wearable options. UnitedHealthcare, for example, began covering many wearable pumps through its Optum store for employer-sponsored plans. However, wearable pumps often fall into a gray area: your plan may set a coverage limit (such as $500 for wearable pumps) and require you to pay the difference if the pump costs more.
Upgrade Fees and How to Avoid Them
When you order through a durable medical equipment (DME) supplier, you’ll often see certain pumps listed as “fully covered” and others listed with an upgrade fee. These fees range widely. For a pump like the Spectra S1, one supplier might charge a $10 upgrade while another charges $100 for the exact same pump under the same insurance plan.
This price difference happens because DME suppliers set their own upgrade fees on top of what insurance reimburses. The pump itself hasn’t changed, just the supplier’s markup. Shopping around between suppliers can save you $50 to $200. Parents on forums regularly report finding the same pump fully covered at one supplier that another supplier charged $75 to $200 for.
Another option: call your insurance company directly and ask what the allowable amount is for breast pumps. Some plans allow you to purchase a pump yourself and submit a reimbursement claim. One parent found that her insurance allowed $450 per pregnancy for pumps and equipment, while the pump she wanted only cost $230. By self-submitting, she avoided an unnecessary $100 upgrade fee from a supplier.
How to Order Through Insurance
The process involves a few steps, but most DME suppliers handle the insurance verification for you once you provide your information.
First, you’ll need a prescription from your OB, midwife, or primary care provider. Most insurers require one before they’ll approve coverage. The prescription typically includes your provider’s information, a diagnosis code, and the expected length of need. In New York’s Medicaid program, for example, coverage will be denied without a prescription on file.
Next, choose a DME supplier that’s in-network with your plan. Major national suppliers include Aeroflow, Byram Healthcare, Edgepark, Acelleron, and several breast-pump-specific companies like Pumping Essentials and Lucina Care. Most of these suppliers have websites where you can enter your insurance information and instantly see which pumps are covered at no cost and which carry an upgrade fee. Your insurer’s website or member services line can also provide a list of approved suppliers.
Timing matters. Insurance guidelines vary on when they’ll ship a pump. Some plans allow ordering and shipping as soon as you have a prescription, while others won’t ship until 30 days before your due date. In rare cases, proof of birth is required first, meaning the pump arrives after delivery. To avoid cutting it close, start the process before your third trimester. This gives you time to handle any paperwork delays or shipping issues before the baby arrives.
Medicaid Coverage
Medicaid covers breast pumps in all states, but the specifics vary by state. New York’s program is a useful example of how comprehensive coverage can be: it covers manual pumps, double-electric pumps, and hospital-grade rentals throughout pregnancy and up to 12 months postpartum. Members qualify for a new pump with each pregnancy.
Hospital-grade pump rentals through Medicaid require meeting specific criteria, usually related to the baby’s inability to breastfeed directly or a medical complication affecting milk supply. Your provider determines which type of pump is appropriate and writes the prescription accordingly.
Other states may have shorter coverage windows or more limited model selections. Contact your state’s Medicaid office or check their website for the exact terms. The prescription requirement is universal across state programs.
TRICARE Coverage
TRICARE covers breast pumps, supplies, and breastfeeding counseling starting at 27 weeks of pregnancy (the beginning of the third trimester). If your baby arrives before 27 weeks, coverage begins at birth. TRICARE also extends coverage to eligible beneficiaries who legally adopt an infant and plan to breastfeed. You’ll need a prescription from your provider specifying the type of pump and length of need.
Replacement Parts and Supplies
Breast pump parts wear out with regular use. Valves, membranes, tubing, and breast shields all need periodic replacement to maintain suction and hygiene. Whether insurance covers these replacement parts depends entirely on your plan. Some insurers bundle a set of replacement parts with the initial pump order, while others cover ongoing supplies separately.
Check with your insurer about what’s included. If replacement parts aren’t covered, they’re relatively inexpensive to buy directly, usually $5 to $20 per piece depending on the brand. Many DME suppliers also sell replacement kits that are compatible with the most common pump models.