A breast pump is generally a covered benefit under your husband’s health insurance plan, provided you are enrolled as a dependent. Coverage is categorized as preventative care for women, meaning the policyholder’s gender does not determine eligibility. The focus is on the patient requiring the equipment—the pregnant or nursing mother covered by the plan. Most modern health plans are required to cover a breast pump with little to no out-of-pocket cost.
The Mandate for Coverage Under a Spouse’s Policy
Coverage under your husband’s insurance stems from a federal requirement for preventative services. The Affordable Care Act (ACA) mandates that most non-grandfathered health plans must cover women’s preventative services, including breastfeeding support, counseling, and equipment. This provision requires plans to cover a breast pump—either a rental or a purchase—without charging a copayment, deductible, or coinsurance.
The coverage is tied to the dependent’s medical needs, not the primary policyholder’s identity. Since you are the person who requires the breastfeeding equipment, the benefit applies directly to you as a covered member of the family plan. This ensures that the health benefit follows the patient.
While most employer-sponsored and Marketplace plans must comply, a small number of older “grandfathered” plans may be exempt from this mandate. Certain religious employers may also have an exception, although these instances are uncommon. If the plan offers comprehensive maternity benefits, breast pump coverage is highly likely to be included under preventative care.
Steps to Obtaining the Breast Pump
To obtain a breast pump, first call the insurance provider using the number on your husband’s insurance card. Verify the specific details of your plan’s benefit, including requirements for pre-authorization or a prescription. Confirming the timing is also important, as some policies allow ordering as early as the third trimester, while others require waiting until after the baby is born.
Most insurers require a prescription from an authorized healthcare provider before approving the pump. This prescription can typically be written by your OB-GYN, midwife, or the baby’s pediatrician. The prescription documents the medical necessity of the device for the covered patient.
Ordering the pump is usually managed through a Durable Medical Equipment (DME) supplier, not a pharmacy or doctor’s office. You must use an in-network DME supplier contracted with your husband’s insurance plan to ensure no-cost coverage. These specialized suppliers will often verify your benefits and handle the submission of required paperwork, including the prescription, on your behalf.
You may also need to provide your husband’s policy and your dependent information to the DME supplier. Starting this process early in your pregnancy is beneficial, allowing time to address potential delays before the baby arrives.
Understanding Coverage Type and Limitations
Insurance plans typically cover one breast pump per pregnancy. Most plans cover a standard personal-use electric breast pump, often a double electric model. Coverage for a manual, hand-operated pump may also be available, but it is less common as the primary option.
Hospital-grade pumps, designed for multiple users, are generally only covered for rental. This rental is usually reserved for specific medical indications, such as having a premature infant or a baby with a condition preventing direct nursing. Standard plans cover a purchased pump, but the rental option is typically limited to these special circumstances.
If you want a higher-end pump with extra features, such as a hands-free or wearable model, the insurance plan will cover the cost of a basic model (the allowed amount). If your chosen pump exceeds this allowed amount, you pay the difference as an “upgrade fee.”
Coverage often extends beyond the pump to include replacement supplies, though a separate order process is usually required. Policies frequently cover new tubing, flanges, breast shields, and collection bottles, which need periodic replacement due to wear or fit. Inquire about the frequency and process for ordering these replacement parts, as they maintain the pump’s performance and hygiene.