• Most non-grandfathered health insurance plans are required by federal law to cover a breast pump at no cost to you.
• Coverage details vary by plan, so verifying your specific benefits before ordering is essential.
• A qualified DME supplier can handle the paperwork and ship your pump directly to your door.
Most expectant and new mothers in the United States are entitled to receive a breast pump through their health insurance plan at little to no out-of-pocket cost. Federal law has established this as a standard preventive benefit, though the process for claiming it requires a few deliberate steps.
Thanks to the Affordable Care Act (ACA), new or “ungrandfathered” health insurance plans must cover breastfeeding supports and supplies as a preventive benefit without imposing cost-sharing, such as deductibles, copayments, or coinsurance. If you want to get breast pump through insurance, working with an approved Durable Medical Equipment (DME) supplier simplifies the process considerably. Your health insurance plan must cover the cost of a breast pump, which may be either a rental unit or a new one you keep, and your plan may have guidelines on whether the covered pump is manual or electric and the length of any rental period.
Who Qualifies for Insurance-Covered Breast Pumps
The ACA requires most health insurance plans to cover breastfeeding support, counseling, and equipment, including breast pumps, without cost-sharing, meaning no copays, deductibles, or coinsurance for covered pumps. This requirement applies to most private insurance plans, including employer-sponsored and marketplace plans, Medicaid (though coverage varies by state), and TRICARE for military families.
There are important exceptions to be aware of:
• Grandfathered plans, established before March 2010, may not be required to provide coverage, so you should verify with your insurer.
• Medicaid plans in most states cover manual and electric breast pumps, but some require prior authorization, and since states control Medicaid plans, coverage may vary depending on where you live.
• In general, health insurance carriers only cover one breast pump per pregnancy, although you may have up to one year after giving birth to claim your insurance-covered breast pump.
• You will generally need a prescription to get a breast pump covered by insurance.
According to the
National Women’s Law Center’s ACA breastfeeding benefit guide, the law requires insurance plans to cover breast pumps, but it does not specify coverage of a certain type of pump.
What the Coverage Typically Includes
These services include breastfeeding equipment and counseling for pregnant and nursing women, and in the majority of cases, breast pumps are covered at 100%. Beyond the pump itself, additional benefits may be available:
|
Benefit |
Typical Coverage |
|
Standard electric breast pump |
Covered at 100% under most ACA plans |
|
Manual breast pump |
Covered; some plans offer only this type |
|
Milk storage bags |
May be covered depending on your plan |
|
Replacement parts and accessories |
Available under select plans |
|
Lactation counseling |
Covered for the duration of breastfeeding |
Additional benefits including milk storage bags, replacement part kits, and compression garments may also be available under your plan. It is important to check with your plan ahead of time to find out if it will only cover a certain type of pump, if there is a particular supplier you need to use, and the process for obtaining one.
How to Order Your Breast Pump Through Insurance
The ordering process is straightforward when you follow these steps in sequence:
1. Verify your coverage. Contact your insurance provider’s member services line and ask specifically about breast pump benefits under your plan.
2. Obtain a prescription. The process involves verifying your specific coverage, understanding which pumps qualify under your plan, and getting a prescription from your provider.
3. Choose an approved DME supplier. Coverage applies to one breast pump per pregnancy, provided at no cost when obtained through an in-network durable medical equipment supplier.
4. Select your pump model. A wide selection of insurance-covered breast pumps is available, including wearable, double electric, and hospital-grade options from brands such as Spectra, Eufy, MomCozy, Ameda, and Willow.
5. Receive delivery. Insurance-covered breast pumps come with expert guidance on choosing the right pump and doorstep delivery across the US, and teams also assist with insurance paperwork and offer ongoing customer support.
Begin the verification process around 28 to 30 weeks of pregnancy to allow adequate time for coverage confirmation and shipping before your due date.
Frequently Asked Questions
Can I get a breast pump before my baby is born? If you know you want to pump, you can contact your insurer before you give birth to get things sorted in time for your baby’s arrival.
What if my insurance denies coverage? If your insurance denies coverage despite not being a grandfathered plan, request a written explanation of denial, review your plan documents to confirm coverage requirements, and file an appeal with your insurance company citing ACA requirements. Contact your state insurance commissioner if appeals are unsuccessful.
Are used or refurbished pumps covered? All pumps from reputable suppliers are new and sealed in the manufacturer’s original packaging, as breast pumps are considered personal care items regulated by FDA approval and should not be shared with other mothers.
Does the ACA cover lactation consulting as well? In addition to electric breast pumps and equipment, your insurance may also provide coverage for lactation consultations with an IBCLC, allowing you to explore breast pump options with a lactation expert.
For expectant mothers ready to begin the process, Breastpumps.com provides insurance verification support, a curated selection of covered pump models, and free delivery across the United States. Confirming your eligibility early and working with a qualified DME supplier are the most reliable ways to secure your benefit without delays or unexpected costs.