Most health insurance plans are required to cover a breast pump at no cost to you under the Affordable Care Act. The catch is that every insurer handles the details differently: which brands qualify, whether you get a manual or electric pump, and where you can order from. Finding out exactly what your plan covers takes a few specific steps, and starting early gives you the most options.
What Insurance Is Required to Cover
The ACA requires all Marketplace plans and most employer-sponsored plans to cover breastfeeding support and equipment, including a breast pump, as a preventive benefit with no out-of-pocket cost. This means no copay, no deductible, and no coinsurance for the base-level pump your plan offers.
The one major exception is grandfathered health plans, which are plans that existed before the ACA took effect in 2010 and haven’t made significant changes since. If your employer’s plan is grandfathered, it may not be required to cover a pump at all. Your plan documents or benefits summary will state whether your plan is grandfathered, or you can ask your HR department directly.
Call Your Insurance Company First
The fastest way to find out what’s covered is to call the member services number on the back of your insurance card. Plans vary widely in what they’ll approve, so you need answers specific to your policy. Here’s what to ask:
- Manual or electric? Your plan may cover both, but many default to a standard electric double pump. Your doctor’s prescription needs to specify which type you’re getting, so it helps to know what’s covered before your appointment.
- Are there brand or model restrictions? Some insurers limit you to a list of approved brands, while others (like TRICARE) don’t restrict coverage to a specific manufacturer, brand, or model number. Getting this list upfront saves time.
- Can you upgrade and pay the difference? Many plans let you choose a higher-end pump and pay only the gap between your plan’s maximum benefit and the retail price. This is common for popular models that cost more than your plan’s standard allowance.
- Do you need to order through a specific supplier? Most insurers require you to use an in-network durable medical equipment (DME) supplier. Ordering from an out-of-network retailer could mean paying full price.
- Is a rental covered instead of a purchase? Hospital-grade pumps are typically covered as rentals rather than purchases, and usually require documentation of medical necessity from your provider.
- What documentation do you need? At minimum, you’ll need a prescription from your doctor or midwife. Ask whether it needs to include your due date, the pump type, and a diagnosis code.
When to Order Your Pump
Most expecting parents order their breast pump around 30 weeks of pregnancy, but you can technically place your order at any point during pregnancy or even up to a year after giving birth. The timing matters because insurers have different shipping rules. Some allow the pump to ship within 30 days of your due date, while others won’t ship until after delivery. A few suppliers will ship within weeks of your order regardless of your due date.
Starting the process around your second trimester gives you plenty of time to compare your options, get a prescription, and deal with any paperwork delays. If you wait until the last few weeks of pregnancy, you risk not having the pump in hand when you need it.
Using a DME Supplier to Simplify the Process
Rather than navigating insurance codes and claims yourself, many people order through a durable medical equipment supplier that specializes in breast pumps. These companies verify your insurance benefits, confirm which pumps are covered, and handle the billing directly. National suppliers that work with major insurers include Aeroflow, Byram Healthcare, Acelleron, Lucina Care, and Edwards Health Care Services, among others.
The process with most of these suppliers is straightforward: you enter your insurance information on their website, they check your benefits, and then show you which pumps are fully covered and which ones require an upgrade fee. Many also handle getting the prescription from your provider. This can save significant time compared to calling your insurance company, getting a list of approved pumps, finding a local DME provider, and coordinating the claim yourself.
One important note: always confirm that the supplier you choose is in-network with your specific plan. The supplier’s website will usually tell you, but a quick call to your insurer can verify it.
Getting a Prescription
You’ll need a prescription from your OB-GYN, midwife, or primary care provider before your insurance will process the order. The prescription should specify whether you need a manual or electric pump. Some insurers also want a due date or delivery date included. This is a routine request that providers handle regularly, so it’s usually as simple as asking at a prenatal visit or calling your provider’s office.
If you need a hospital-grade pump due to a medical situation like a premature birth or latch difficulties, your provider will need to include documentation of medical necessity. These pumps are significantly more powerful and expensive, so insurers treat them differently from standard personal-use pumps.
What If Your Pump Isn’t Fully Covered
If the pump you want costs more than your plan’s allowance, you have a few options. The upgrade path is the most common: you select the pump you want through a DME supplier, insurance covers its standard benefit amount, and you pay the remaining balance out of pocket. Depending on the pump, this upgrade fee can range from $30 to several hundred dollars.
You can also use funds from a health savings account (HSA) or flexible spending account (FSA) to cover upgrade costs or to purchase a pump independently. Breast pumps are considered eligible medical expenses under both account types.
If your plan is grandfathered and doesn’t cover a pump at all, purchasing one outright with HSA or FSA dollars is your best option for using pre-tax money. Some state Medicaid programs also cover breast pumps, so it’s worth checking if you’re enrolled.