Most health insurance plans in the U.S. are required to cover a breast pump at no cost to you. Under the Affordable Care Act, all non-grandfathered health plans must provide breastfeeding equipment, counseling, and support for the duration of breastfeeding. The specific pump you’ll receive depends on your insurer, your plan’s rules, and whether you’re willing to pay an upgrade fee out of pocket.
What the Law Actually Requires
The ACA mandates that health insurance plans cover the purchase or rental of a breast pump as part of preventive care for pregnant and nursing women. This applies to all Marketplace plans and most employer-sponsored plans. The key phrase is “no cost sharing,” meaning no copay, no deductible, and no coinsurance for the covered pump.
The major exception is grandfathered plans. These are plans that existed before the ACA took effect in 2010 and haven’t made significant changes since. If you’re on a grandfathered plan, your insurer is not required to cover a breast pump at all. You can check whether your plan is grandfathered by calling the number on your insurance card or looking at your plan documents.
Pumps Typically Covered at No Cost
Most insurers fully cover a standard double electric breast pump. This is the workhorse category: plugs into a wall, uses two flanges at once, and gets the job done efficiently. Popular models in this tier include the Medela Pump in Style and the Spectra S2. Many plans also cover a manual pump at no cost, though most people opt for the electric option.
The exact models available to you vary by insurer and even by plan within the same insurer. Aetna, for example, considers a manual or standard electric pump medically necessary during pregnancy or any time after delivery, and covers a replacement pump for each subsequent pregnancy. Other major insurers follow a similar structure, though the specific brand list differs.
What’s generally not covered at zero cost: wearable pumps (like the Willow or Elvie) and hospital-grade pumps for home purchase. These fall into different categories that most insurers treat separately.
Wearable Pumps and Upgrade Fees
If you want a wearable, hands-free pump instead of a standard electric model, you’ll likely pay an upgrade fee. This is the difference between what your insurance covers (the cost of a standard pump) and the retail price of the premium pump you’re choosing instead.
These upgrade fees typically range from $75 to $200, depending on the pump model and the durable medical equipment (DME) supplier you order through. Some insurers set a specific dollar allowance for wearable pumps. One common structure is full coverage for standard pumps with a $500 cap for wearable models, leaving you to cover anything above that amount. The fees can vary significantly between suppliers, so it’s worth checking more than one before you buy. Some parents have found that the same pump carries different upgrade fees at different suppliers, and a few suppliers may cover certain wearable models fully under specific plans.
Hospital-Grade Pump Rentals
Hospital-grade pumps are more powerful than personal-use models and cost several thousand dollars to buy outright. Insurance generally will not cover purchasing one for home use. However, most plans will cover a rental if you meet specific medical criteria.
Common qualifying situations include having a premature infant (39 weeks or earlier), a baby with feeding difficulties due to a neurological or physical condition, separation from your baby due to illness, being on medication that compromises milk supply, or having multiples. If any of these apply, your provider can submit documentation to your insurer to authorize a rental for as long as it’s medically needed.
How to Order Your Pump
You’ll need a prescription from your OB-GYN or midwife. Most insurers require this before they’ll authorize coverage. The American College of Obstetricians and Gynecologists recommends using your last month of pregnancy to research your options, get your prescription, and place your order.
There are three main ways to get your pump:
- Through a DME supplier: Companies like Aeroflow, Byram Healthcare, and Edgepark specialize in processing breast pump orders through insurance. You enter your insurance details on their website, they verify your benefits, and they show you which pumps are fully covered and which carry an upgrade fee.
- Through your insurer’s preferred supplier: Some plans require you to use a specific supplier. Call your insurance company first to ask.
- Buy and get reimbursed: A few plans allow you to purchase a pump yourself and submit the receipt. This is less common and usually has stricter limits on which pumps qualify.
Some plans require pre-authorization before you order. Others let you order anytime during pregnancy or after delivery. Calling your insurer to ask about timing requirements, preferred suppliers, and covered models before you order saves a lot of frustration.
What Comes With the Pump
Insurance-covered pumps typically come as a kit that includes the pump itself, flanges (breast shields), bottles, tubing, and a power adapter. After that initial kit, replacement accessory coverage varies. TRICARE, for reference, covers two replacement bottles every 12 months and one set of two breast shields per birth. Private insurers each set their own replacement policies. Carrying cases and travel bags are generally not covered.
If the flanges that come with your pump don’t fit well, you may need a different size. Some plans cover replacement flanges, but many people end up buying these out of pocket since sizing is personal and sometimes requires trying multiple options.
Medicaid Coverage
Medicaid covers breast pumps, but the details vary by state. Some states are more generous than others in terms of which models are available and how often you can get a new one. Illinois, for example, updated its policy in January 2024 to allow one electric breast pump per year without prior approval, up from one every five years. Other states may still have longer replacement timelines or require prior authorization for every pump.
If you’re on Medicaid, contact your state’s Medicaid office or your managed care plan directly to find out which pumps are covered and what documentation you need. The process often moves slower than private insurance, so starting early in your third trimester is a good idea.
Getting the Most From Your Coverage
A few practical tips that can save you money and hassle. First, don’t assume the first DME supplier you check has the best deal. Upgrade fees for the same pump can differ by $100 or more between suppliers. Second, confirm whether your plan covers one pump per pregnancy or one pump per a set number of years. Many plans, like Aetna’s, cover a new pump with each pregnancy, which matters if you’re planning to have more children. Third, if you want a wearable pump but the upgrade fee is steep, consider getting your free standard electric pump through insurance and purchasing a wearable separately during a sale. Some parents find this combination actually costs less than the upgrade fee alone.