Mother who has breast pump insurance coverage through ACA

If you find yourself asking, “Will my insurance cover my breast pump?” then you’re in the right place. Unfortunately, it seems like anything having to deal with insurance companies can be complicated and confusing, even when it comes to breast pumps.

However, that’s why we’re here to help by quickly guiding you through the breast pump insurance coverage.

Breast Pump Insurance Coverage and the ACA

Will My Insurance Cover My Breast Pump?

The answer to this question is a vague yes. Insurance will cover a breast pump for you, but it might be different from the one you want. Under the Affordable Care Act, breast pumps are 100% covered for all insurance plans that begin after August 1, 2012.

At first glance, this seems great, because what mom doesn’t want a free breast pump?  Both purchases and rentals are covered! However, upon digging deeper you’ll find that many insurance providers have restrictions on what they’ll cover.

Many have a set reimbursement limit that may not fully cover the cost of the double electric breast pump you really want. There are brand limitations and vary guidelines for how long you can rent your pump.

On top of that, you need to decide which pump you want from an array of options and may need a prescription from your doctor.

Mother researching breast pump insurance coverage through the ACA

How To Figure Out What Your Insurance Will Cover

It can be helpful to first meet with your doctor to discover your individual breast pumping needs, so they can recommend the right pump for you. Then bust out your insurance card and call the number on the back to ask a few questions.

Ask what paperwork you need to fill out to receive your pump, ask what types of pumps or brands are covered, and most importantly, ask how much they will cover so you can narrow your options down.

Then ask if they offer an upgrade option. Some insurance companies will allow you to use the amount they’ll cover towards a more expensive pump if you agree to pay for the rest.

Ask if you can get the breast pump from the store and if they will reimburse you for it, or if you’ll need to order it online. Many insurance companies will recommend you to a durable medical equipment (DME) provider.

If your provider only covers manual pumps unless you have a medical necessity for an electric pump or a hospital grade ask what documentation is needed and work with your doctor to see if you qualify.

Some insurance companies also cover breast pump resupply parts and will cover replacement parts, so it’s important to ask about what is covered specifically in case something breaks. Be sure to refer to your breast pump warranty too.

Another important question to ask is when you can get your breast pump. Some insurance policies allow you to get it right away, while others require you to wait until a few weeks before your due date, and some require you to wait until your baby is born!

Save Time With Motif

As an expecting mother, you’re busy. You may not have time to make multiple phone calls or to research your breast pump options. Avoid the hassle by using our insurance qualification form to discover your options.

All content published on the Motif Medical site is created for informational purposes only. This information should not substitute as medical advice, diagnosis, or treatment. Always consult your doctor or qualified health professional with any questions regarding the health of you or your baby.