Most health insurance plans cover the cost of a breast pump with no out-of-pocket expense, and you can typically start the ordering process during your third trimester of pregnancy. The exact timing depends on your specific insurer, but many plans allow you to place an order around 30 days before your due date, and some let you order even earlier.
What Insurance Is Required to Cover
Under the Affordable Care Act, health insurance plans must cover breastfeeding support, counseling, and equipment for the duration of breastfeeding. This applies to Marketplace plans and most employer-sponsored plans. Coverage includes the cost of a breast pump at no charge to you, with no copay or deductible.
The one major exception is grandfathered health plans, which are plans that existed before the ACA took effect in 2010 and haven’t made major changes since. If your plan is grandfathered, it isn’t required to cover a breast pump. You can find out by calling the number on the back of your insurance card or checking your plan documents.
When You Can Place Your Order
Timing varies by insurer, but here’s the general pattern:
- Third trimester (around 28 weeks): Most plans allow you to begin the ordering process once you’re in your third trimester. This is a good time to call your insurer and confirm your specific plan’s timeline.
- 30 days before your due date: Many insurance companies and equipment suppliers ship pumps about 30 days before your expected delivery date. Even if you place your order earlier, the pump may not arrive until this window.
- After birth: Some plans won’t ship the pump until after your baby is born. If your insurer has this policy, the pump typically arrives within a few days of delivery.
- Up to one year postpartum: If you missed the window during pregnancy, most insurers still allow you to order a pump for up to a year after delivery.
Starting the process early gives you the best chance of having your pump in hand before you need it. Even if your insurer won’t ship until after delivery, getting the paperwork and order set up ahead of time means less hassle during those first days with a newborn.
Manual vs. Electric: What’s Actually Covered
The ACA requires insurers to cover a breast pump, but it doesn’t specify what kind. That decision is left to the insurance company. Some plans cover a double electric pump as the standard benefit. Others will only provide a manual pump unless your doctor writes a letter explaining why an electric pump is medically necessary.
This is one of the biggest sources of frustration for new parents. A manual pump works fine for occasional use, but if you’re pumping multiple times a day (especially if you’re returning to work), a double electric pump saves significant time. Before you order, call your insurer and ask specifically whether they cover an electric pump. If the standard benefit is a manual pump, ask your OB or midwife about requesting an electric one based on medical necessity. Plans generally cover one pump per pregnancy, so it’s worth getting this right the first time.
How to Order Through Insurance
There are two main routes to getting your pump. The first is through a durable medical equipment (DME) supplier that works with your insurance. These are companies that specialize in filling insurance orders for medical devices. You can find in-network suppliers by searching your insurer’s provider directory for “durable medical equipment” or calling member services. Several online DME companies also handle the entire process digitally: you enter your insurance information, they verify your benefits, and ship the pump to your door.
The second route is through your healthcare provider’s office. Your OB or midwife can submit an order directly to a DME supplier on your behalf. In most cases, no prior authorization is needed for a standard breast pump. The supplier will confirm your due date and insurance details, then mail the pump to you.
Some insurers require a prescription or physician’s order, while others don’t. Either way, having your provider involved can speed things up, especially if you need documentation for an electric pump upgrade.
What to Do If Your Insurance Doesn’t Cover It
If you have a grandfathered plan or a coverage gap, the WIC program provides breast pumps at no cost to eligible participants. WIC pumps are issued after the baby is born, once a breastfeeding need is identified. Local WIC agencies assess your situation and can provide a pump even if you already received one from another source that doesn’t meet your needs.
WIC eligibility is based on income (generally up to 185% of the federal poverty level), and you must have an active certification in the program. Contact your local WIC office during pregnancy to get enrolled so the process moves quickly after delivery.
Tips for a Smooth Process
Call your insurance company early, ideally in your second trimester, just to understand the rules. Ask these specific questions: When can I order? Do you cover an electric pump or only manual? Do I need a prescription? Which DME suppliers are in-network? Is there a list of approved pump brands?
Many parents are surprised to learn their plan covers a specific list of pump models rather than offering a dollar amount toward any pump. Knowing your options ahead of time lets you research which model works best for you. If the covered models don’t meet your needs, some DME suppliers offer upgrade programs where insurance covers the base cost and you pay the difference for a higher-end pump out of pocket.