How to check with your health plan to discuss coverage
For many, breast pumps have become an essential and oftentimes indispensable tool of motherhood. Whether as a cherished convenience that allows you to go on a date and leave the sitter with a bottle or the lifeline that keeps your child happy and healthy while you’re at work, breast pumps play an important role in both women’s and children’s health.
Recognizing the health benefits of breast milk, the Affordable Care Act (ACA) has made breast-pump coverage part of its preventive health-care strategy. Medela, an industry leader in and primary supplier of breast pumps to U.S. health-care facilities, reports 89% of plans provide such coverage. So whether you get your health insurance from an employer plan, your state’s Health Insurance Marketplace, or Medicaid, chances are you have coverage for part or all of the cost of a breast pump. There are a few exceptions, and insurance plans have different levels of coverage, so before you purchase a pump, here are some considerations to ask your plan representative about.
- For private, employer, and Marketplace plans: The ACA requires all private and Marketplace Health Insurance plans to cover breast pumps except those that have been grandfathered in from 2010. If you are in a grandfathered plan, you probably already know about it, since such plans are required to notify their enrollees—but double-check just to make sure.
- For Medicaid plans: Medicaid plans are run by states within certain federal guidelines, and some states decided not to participate in the ACA. Even so, if your state’s Medicaid program does not cover breast pumps, check with the Supplement Nutrition Program for Women, Infants, and Children (WIC), which likely will.
- Types of coverage: Plans that cover breast pumps will vary in terms of what you can buy and how much is covered. Before purchasing, find out the details of your policy:
- Does it cover a rental pump and/or a new pump?
- Do you need a prescription or a referral?
- What percentage of the costs is covered, what is the maximum reimbursement, and what documentation is required?
- Are there preferred providers?
- Will your hospital provide a pump on discharge?
For more information, visit Breast Pumps and Insurance Coverage: What You Need To Know on the U.S. Department of Health and Human Services website.
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