Insurance Covered Breast Pump

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I have seen so many moms register for breast pumps, but did you know you might be able to get one for free? If you live in the U.S., you qualify to get a free pump through your insurance under the Affordable Care Act (ACA). This post is intended to help you navigate this process and explain how it all works.

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Although this sounds amazing, there are a few catches to this law. First, if you have had the same healthcare plan since before 2010, they are grandfathered in and do not HAVE to provide you with a free pump. However, just because they are not required to by law, does not mean that they will not still cover a pump. The best way to determine this is to give your provider a call to find out. The second catch is that your provider does not have to cover any specific pump, or even a double electric; any manual pump is sufficient under the ACA. The following guide should help you determine how to figure out what limitations they will set.

Call up your Insurance:

This is always tedious, and nobody likes sitting on the phone with insurance. This is exactly why some companies will handle it for you (more on this later). If you call the number on the back of your insurance card, let them know you are expecting and that you would like more information on how to receive a covered breast pump. They should give you all the necessary information, but here are some questions to ask in case they leave anything out.

Questions:

1. What kind of pump is covered.
   1. Double electric, Single electric, manual, etc.
2. What specific pump is covered?
   1. Not only will they put limitations on the brand, but also the specific model of pump. My insurance had one pump from 4 different brands that were covered.
3. Is this pump for purchase or will you be reimbursed for a rental?
   1. It doesn’t necessarily have to be one or the other. My insurance covered a double electric pump for purchase AND a hospital grade rental pump for the first few weeks until my milk was established.
   2. If they only cover a rental, you will want to find out how long that rental pump is covered for.
4. What dollar amount will be covered?
   1. Some companies will cover up to a certain cost vs. a specific pump. Find out the total amount covered so you can determine which pumps are within your budget.
5. When can you get your pump?
   1. Some insurance companies will let you purchase at any point in your pregnancy, while others will make you wait until after you have had the baby.
6. Do you have to purchase your pump through a specific company?
   1. Some insurances will require you to purchase your pump at a specific company for it to be covered. Others will allow you to purchase any (eg. Amazon) and just submit your receipt for reimbursement.
7. Do you cover parts or accessories?
   1. Along with your pump, you will need tubing, flanges, bottles, any other accessories for your pump.
8. Do you need a prescription?
   1. Some insurance companies will need a prescription from your doctor. This was super easy and my OB had a prewritten letter that he signed and gave to me for submission. Other insurance companies may not need a prescription but might ask for proof of prenatal care.

Using a 3rd party company

Some companies will do all the work for you so you do not have to deal with insurance at all. When signing up with these companies, you should have to insert your insurance information to see if they are in-network. Not all insurance companies work with these 3rd party suppliers so just double check!

I personally used Aeroflow through one of my insurance providers and it was so easy! After logging on and creating an account, the site prompts you to enter insurance information. A representative is typically in contact after it is determined what the insurance is going to cover. When you log on to your account, it shows you all of the different pump options you have. Next to that, it lists what the out-of-pocket cost will be. I had a few pumps listed as free or I could get an upgraded pump for a small fee. For example, a Spectra S2 was covered, but the Spectra S1 was extra, and so was the S2 bundle that came with a pumping bag.

Once you decide on a pump, they will reach out to your healthcare provider to request a prescription (if required). Aeroflow will let you know when you are eligible to receive your pump and will mail it out within the approved time period set by your insurance.

Three of the most common companies I have heard of are Aeroflow, Edgepark, and Byram. However, I have not used Edgepark or Byram so I cannot comment on either of those companies.

Note: I have heard from some people that they had to pay more for a pump through these companies compared to buying at a retailer. My suggestion is to sign-up and see what your options are. If they are charging you for a pump or the pump you really want is not listed for free, do some comparisons so you get the best value. I fortunately did not have to do any comparisons; as the pump I wanted was 100% covered.

Outside of the US

If you are in a different country, call and check with your insurance provider before purchasing a pump. For instance, many insurance companies in Canada cover a pump but may also require a prescription. There are also specific laws that may require them to cover a pump. A good example of this is a law set for residents of Ontario. If Baby is born premature, insurance companies are required to cover a pump.

I know this process seems like a bit of work, but if it saves you a few hundred dollars on a breast pump it is totally worth it! Hopefully this helped you, and feel free to share with any other expecting moms you may know to save them some money as well!