A breast pump is a medical device used to express milk, allowing parents to provide nutrition when direct feeding is not possible. Acquiring this equipment often involves navigating health insurance policies to determine coverage and type. Understanding the rules governing this process is important, as coverage is generally tied to the event of a new pregnancy.
The Rule of Coverage Per Pregnancy
The primary question for many parents is whether they qualify for a new device with a subsequent child, and the answer is generally yes. Most private health insurance plans created or modified after March 2010 must cover breastfeeding supplies and support without cost-sharing. This requirement stems from federal guidelines mandating coverage for preventative services. The benefit is tied to the unique medical event of pregnancy and birth, not a lifetime allowance for a single device.
Because coverage is linked to the pregnancy, a new pump is typically available for each subsequent pregnancy. Health plans must cover the cost of a breast pump, which may be a rental unit or a new device the parent keeps. This provision ensures that parents have access to functional and hygienic equipment for the duration of breastfeeding, which may extend across multiple children.
Coverage guidelines specify that the pump must be obtained from an in-network supplier of Durable Medical Equipment (DME). The policy ensures parents rely on a functional and hygienic device for each child, eliminating the uncertainty of reusing older equipment with degraded motor strength or contamination risks. The federal mandate aims to remove financial barriers to necessary lactation support.
Types of Pumps Covered by Insurance
While a breast pump is covered, the specific type and model provided depend on the insurance plan’s contract. Plans generally cover a standard electric breast pump, often a double electric model for efficient milk expression. Insurance may also cover a manual pump for occasional use. The policy must cover a pump, but it can stipulate whether it is a new personal-use model or a rental.
Hospital-grade pumps, which feature stronger motors, are typically covered only as a rental for a limited time. These are reserved for situations involving prematurity, a baby in the neonatal intensive care unit, or documented supply issues. If a parent desires an upgrade—such as a wearable, hands-free, or premium portable model—they may pay an out-of-pocket difference. This “upgrade fee” covers the cost disparity between the standard covered pump and the desired model.
Coverage variations also exist concerning accessories and replacement parts. Some plans cover a specific number of replacement parts, such as tubing, valves, and membranes, while others may not. Parents should confirm whether the plan covers the pump purchase outright or requires a rental, and understand limitations on specific brands or models. Many insurers work with a select list of DME vendors, limiting brand choice unless an upgrade fee is paid.
Safety and Replacement Guidelines for Used Pumps
Reusing a breast pump from a previous pregnancy introduces specific hygienic and mechanical concerns. Personal-use pumps are classified as either “open-system” or “closed-system,” a design difference important for safety. An open-system pump lacks a barrier to prevent milk or moisture from entering the motor mechanism and internal tubing. This poses a risk for the growth of mold, bacteria, and viruses within parts that cannot be cleaned or sterilized.
A closed-system pump incorporates a physical barrier, such as a backflow protector, to separate the milk collection kit from the motor. While a closed system is safer for personal reuse, it is still crucial to replace all parts that contact milk, including the tubing, valves, and membranes. These components lose elasticity and sealing effectiveness over time, diminishing the pump’s suction and decreasing milk output. Furthermore, the motor’s suction strength naturally degrades with use and age, potentially making it less effective for maintaining milk supply.
Due to contamination risks in open-system models and difficulty assessing motor degradation, U.S. medical device regulations consider personal-use breast pumps to be single-user items. This means a pump should not be shared between different users. Hospital-grade rental pumps are an exception because they are designed as multiple-user devices, utilize a closed system, and are professionally sterilized and maintained between rentals.
The Steps to Obtain a Covered Pump
The process of acquiring an insurance-covered breast pump begins with verifying the specifics of the current health plan. This involves contacting the insurance provider or a specialized Durable Medical Equipment (DME) supplier to confirm coverage and available models. Most insurers require a prescription or referral from a healthcare provider, such as an obstetrician or midwife. This document formalizes the medical necessity of the device.
The prescription must typically be submitted to an in-network DME supplier, as retail purchases are rarely covered or reimbursed. The DME supplier handles the claim submission and coordinates the equipment delivery. Timing is a factor, as many insurance plans only allow the pump to be shipped within a specific window, such as 30 to 60 days before the due date.
Once coverage is confirmed and the prescription is received, the parent selects from the available covered pumps or chooses an upgraded model by paying the difference. The DME supplier submits the paperwork to the insurance company for authorization and ships the pump directly to the parent. This process ensures the equipment is obtained at the lowest possible cost, adhering to the plan’s medical benefits.