When you think of the preventive care services your health insurance offers, you probably think of things like free annual physicals and mammograms. You may not realize that a breast pump is another priceless gift.
Does health insurance cover a free breast pump?
Since the passage of the Patient Protection and Affordable Care Act (ACA) more than a decade ago, insurers are now required to cover lactation support. This legislation aims to help all mothers have the opportunity to provide their baby with the latest in prevention: breast milk.
of course, there is always a catch. Since the aca does not provide specific recommendations, coverage may vary depending on your health plan. while some cover hospital-grade pumps, others exclude them, and others only allow you to rent them.
There may be other hoops you have to jump through, like only getting your pump from certain providers and chasing your OB/GYN for a prescription. Also, if your employer offers an “exempt” plan, and about 20 percent of employers still do, they may not provide it at all.
But a good breast pump can really help you reach your breastfeeding goals, which in turn improves the health of you and your baby. that’s why the pumps are considered a preventive service!
A breast pump also allows you to continue giving your baby milk after you return to work or school, allowing you to breastfeed longer. That’s why it’s so important to take advantage of this important money-saving benefit if it’s available to you.
how can you get a breast pump through your health insurance?
To get your insurance to pay for a breast pump, follow these four steps:
1. call your insurance provider
tell them you would like to get a breast pump for personal use.
2. ask your insurance provider the following questions
- Do you cover the cost of buying or renting a breast pump?
- Are costs covered without cost sharing?
- Do I need a prescription? if so, where and how should they send it?
- What type of pump will you pay for? Ideally, you want a double electric pump, which is more efficient and faster because it allows you to express milk from both breasts at the same time. (These must be covered by Medicaid and most private insurance plans.)
- Where can I get the breast pump? Depending on your insurance, you may only be able to buy certain brands and you may or may not order them online.
if you have medicaid, contact your medicaid provider to find out what is covered. If they can’t provide you with a breast pump, you can get your pump through WIC (The Special Supplemental Nutrition Program for Women, Infants, and Children), a program administered by the United States Food and Nutrition Service. Agriculture department. trusted source department of agriculturefind a breast pumpview all sources [1]
Some private health insurance plans require that you obtain your breast pump from a specific medical supply company (sometimes called a “durable medical equipment” or DME provider) that is designated by your insurer. trusted sourcemedicare.govdurable medical equipmentview all sources [2] be sure to call that provider as soon as possible to see if they have the pump you want and how long it will take to get it, since you’ll want to have it as soon as possible when your baby is born or soon after.
3. ask your doctor for a prescription if your insurance provider needs one
If you need the pump for a medical reason, the diagnosis must be included on the prescription. for example, your baby is having trouble breastfeeding because he is premature.
The prescription should say “eo603, standard electric breast pump” for a standard personal pump or “eo604, rental hospital grade pump” if you need a hospital grade.
4. Submit the prescription as directed by your insurance plan
follow up if necessary and ask when you can expect the pump to arrive.
what if your health insurance doesn’t cover a free breast pump?
