Breast Pumps and Insurance Coverage: What You Need To Know
During National Breastfeeding Month in August, we heard lots of questions about breast pumps and insurance coverage. The decision to breastfeed is a personal one, but with everyone from Grandma to girlfriends giving you advice, it can be overwhelming to sort out all of the facts. We're here with the information you're looking for on breast pumps and health insurance. Check out these commonly asked questions (and answers).
Q: My friend told me that health insurance covers breast pumps now. Is that true?
A: The Affordable Care Act (2010) requires most health insurance plans to cover the cost of a breast pump as part of women's preventive health services. These rules apply to Health Insurance Marketplace plans and all other private health insurance plans, except for grandfathered plans.
Q: I have private insurance and they told me that they do not cover breast pumps. What should I do?
A: If you believe your plan covers the cost of a breast pump, but your claim is denied, you have the right under the Affordable Care Act to an internal appeal or external appeal. If you need help, contact your state's Department of Insurance or Consumer Assistance Program.
Go to https://www.healthcare.gov/what-are-my-breastfeeding-benefits/ for more information.
Q: I have Medicaid. Can I get a breast pump?
A: In some states, yes. Because states run their own Medicaid programs within federal guidelines, different states have different rules. Check with your Medicaid provider first.
If your state's Medicaid program does not cover breast pumps, you may be eligible for a free one through the Special Supplemental Nutrition Program for Women, Infants, and Children — better known as WIC. You may be able to get a breast pump if you already receive WIC benefits. Contact your state's WIC Breastfeeding Coordinator for more information.
Prescriptions and Pre-authorizations
Q: Can I just buy a pump and be reimbursed?
A: Some insurance plans require a prescription or pre-authorization from your doctor. Talk to your health insurance company about what is covered before you rent or purchase a breast pump.
Rental or Purchase
Q: Will my insurance plan cover a rental breast pump? What if I want to buy a new one instead?
A: Your health insurance company can tell you what specific types of breastfeeding equipment are covered under your plan. Some plans cover only rental pumps, and some plans cover new pumps but only specific types. Contact your health insurance company to find out what type of breast pump is covered.
Manual or Electric
Q: Does the law require my insurance to cover an electric pump?
A: No, the law does not require health insurance plans to cover a certain type of pump. Check with your health insurance company to see what type(s) of pump(s) your plan covers.
Going Back to Work
Q: I want to keep breastfeeding when my maternity leave is over, but I'm not sure when or where I would pump at work. What do I do?
A: It might seem difficult to keep breastfeeding after you go back to work, especially if you're not in an office — but there are a lot of ways to make it work. And the law is on your side. The Affordable Care Act amended the Fair Labor Standards Act (FLSA), which covers most hourly wage—earning and some salaried employees. Many employers are required to help their employees who are nursing moms in two ways:
- Workers must be given "reasonable" break time to pump for a breastfeeding child for one year after the child's birth. The law recognizes that each woman has different needs for pumping breaks. Employers are not required to pay employees for the time they spend pumping, and many women use existing paid breaks to pump.
- Women who need to pump or nurse must be given a private space. This space cannot be a bathroom.
To see whether you are covered under this law or if you have more protections under your state law, check out our website Supporting Nursing Moms at Work. There we have creative solutions for all types of workspaces and suggestions for talking to your employer about what you need.
Q: I need a hospital-grade pump in order to finish pumping during my break at work. Can I get one?
A: Only your health insurance company can tell you what type of pump it will cover or provide. If you choose to get a used pump from a friend or from another parent in your neighborhood, be sure that it is a multi-user pump. Only pumps that are meant to be used by more than one mother ("multi-user pumps") should be shared. The U.S. Food and Drug Administration considers all other breast pumps to be single-user devices.
Trouble Using the Breast Pump
Q: I'm having trouble using my breast pump and I have to go back to work in a few days. Can you help me?
A: Yes. First, congratulations on practicing with your breast pump before you go back to work. It's important to be comfortable pumping before you have to do it in an unfamiliar environment like work or school.
If you're having trouble, you can call us toll-free at 800-994-9662, Monday through Friday, from 9 a.m. to 6 p.m. ET, to talk to a trained breastfeeding peer counselor in English or Spanish. A counselor can answer your questions about how to store pumped milk, teach you how to clean your breast pump, and give you tips to get the milk flowing when your baby isn't there.
If you need more help with breastfeeding, ask your health insurance company for a list of providers who can provide lactation support. Most health insurance plans, including those in the Health Insurance Marketplace, must cover breastfeeding support and counseling for the duration of breastfeeding.