Most health insurance plans are required to cover the cost of a breast pump at no charge to you. The Affordable Care Act mandates that plans provide breastfeeding equipment, counseling, and support for the duration of breastfeeding, with no copay or deductible. Getting your pump typically involves a few straightforward steps: confirming your coverage details, getting a prescription, and placing an order through an approved supplier.
What Insurance Is Required to Cover
Federal law requires Marketplace plans and most employer-sponsored plans to cover the cost of a breast pump. This can be either a new pump you keep or a rental unit. Your plan decides whether it covers a manual pump, a standard double electric pump, or both, and it sets the rules on timing, including whether you can receive the pump before or after delivery.
Plans often follow your doctor’s recommendation on what type of pump is medically appropriate. If your provider recommends a double electric pump, your insurer will typically cover one. Some plans also cover upgrades to higher-end or wearable models, though you may need to pay the price difference out of pocket. The one major exception to this coverage requirement is grandfathered health plans, which are plans that existed before the ACA took effect in 2010 and haven’t made significant changes since. Grandfathered plans are not required to offer free preventive care benefits, including breast pumps. If you’re unsure whether your plan is grandfathered, your benefits summary or a quick call to your insurer will clarify.
Step 1: Call Your Insurance Company
Before you do anything else, call the member services number on the back of your insurance card. Ask these specific questions:
- What types of pumps are covered? Some plans only cover manual pumps at no cost, while others cover double electric models. Ask whether wearable or hands-free pumps are an option.
- Do I need a prescription? Most plans require one, but some don’t.
- When can I order? Shipping windows vary. Some insurers allow orders as soon as you have a prescription, others ship 30 days before your due date, and a few require proof of birth first.
- Do I need to use a specific supplier? Many plans contract with particular durable medical equipment (DME) providers. Ordering through the wrong supplier could mean paying out of pocket.
- Is prior authorization required? Some plans need your doctor to submit an authorization before the order can be processed.
Write down the answers, including the name of the representative you spoke with and the date of the call. This protects you if there’s a billing dispute later.
Step 2: Get a Prescription
Most insurers require a prescription (sometimes called a physician order) for your breast pump. Your OB-GYN or midwife can write this at a routine prenatal visit. The prescription typically includes your name, due date, and the type of pump recommended. This is usually a quick, informal process since breast pumps are considered preventive care, not a special medical request. No specific diagnosis or medical justification is needed for a standard pump.
Step 3: Order Through an Approved Supplier
Once you have your prescription and know your plan’s rules, you place the order. There are two main paths.
Through a DME Provider
Your insurance company will have a list of contracted DME suppliers. You can find these through your plan’s online “find a provider” tool by searching for durable medical equipment in your area. Your doctor’s office can also send the prescription directly to a contracted DME supplier on your behalf. Large national suppliers like Edgepark, Aeroflow, and others specialize in insurance-covered breast pumps and handle much of the paperwork for you.
Ordering Online or by Phone
Many DME suppliers let you start the process yourself on their website. You select a pump, enter your due date and insurance information, and provide your doctor’s contact details. The supplier then reaches out to your provider to verify the prescription and processes the claim with your insurer. The pump ships directly to your home. You can also call these suppliers to walk through the same process over the phone if you prefer.
Some plans allow you to purchase a pump at a retailer and submit for reimbursement, but this is less common. Always confirm this is an option before buying out of pocket, because many insurers will only pay when the order goes through their approved channels.
When to Place Your Order
Timing varies by insurer, but ordering during your second trimester is a smart move. Some plans ship pumps as soon as they receive the prescription. Others hold shipment until 30 days before your due date. In less common cases, your insurer requires proof of birth, meaning the pump arrives after delivery.
Requesting your pump well before your third trimester gives you a buffer. If there are delays with paperwork, supplier backorders, or an early delivery, you won’t be scrambling. A pump that arrives a few weeks before your due date gives you time to familiarize yourself with the parts and have everything sterilized and ready.
Upgrading to a Different Pump
Your insurance plan covers a specific pump model (or category of pump) at no cost. If you want a higher-end model, like a wearable pump or a premium brand, many DME suppliers offer an upgrade option. You pay the difference between what your insurance covers and the retail price of the upgraded pump. This difference can range from $50 to $200 or more depending on the model. The supplier handles the insurance portion of the claim, and you pay only the upgrade fee.
If you’re planning to pump frequently, returning to work, or need portability, the upgrade cost can be worth it. If you’ll be pumping occasionally or supplementing, the standard covered pump is often perfectly adequate.
Replacement Parts and Supplies
Coverage doesn’t stop at the pump itself. Updated federal guidelines clarify that insurance must cover pump parts and maintenance, not just the initial device. Breast pump parts wear out at different rates. Valves and membranes may need replacing every few weeks, while flanges and tubing can last several months. Worn parts reduce suction and pumping efficiency, so replacing them on schedule matters.
Some insurers, like Aetna, cover specific quantities of replacement supplies per year: storage bags (up to 400 per month), replacement bottles, tubing, shields, caps, and adapters. The exact quantities and frequency vary by plan. Contact your insurer or DME supplier to find out what replacement schedule your plan allows, and set a reminder to reorder before parts wear out. Many DME suppliers will send you reminders or let you set up recurring shipments.
Medicaid Coverage
Medicaid programs also cover breast pumps, though the specifics depend on your state. Some state Medicaid programs cover only manual pumps, while others cover double electric models. The ordering process is similar: you need a prescription, and you typically go through a contracted DME supplier. Your state Medicaid office or your managed care plan’s member services line can tell you exactly what’s covered and which suppliers to use. WIC offices can also help point you toward local resources if you hit roadblocks.
If Your Claim Gets Denied
Denials happen, but they’re usually fixable. The most common reasons are ordering through a non-contracted supplier, missing a prior authorization step, or having a grandfathered plan. If your claim is denied, call your insurer to find out the specific reason. If it’s a paperwork issue, your doctor’s office or DME supplier can often resubmit. If your plan denied a double electric pump but covers a manual one, your doctor can write a letter of medical necessity explaining why the electric pump is appropriate for your situation. You have the right to appeal any denial, and your insurer is required to tell you how.