The short answer
Under US law, health plans must cover breastfeeding support, counseling and equipment, and that includes the cost of a breast pump. It applies to Marketplace plans and other health plans, except older “grandfathered” plans. The pump may be a rental or a new one you keep, and your plan can set rules on whether it is manual or electric and when you get it. Source: HealthCare.gov on breastfeeding benefits.
When to start: we suggest calling around week 24 of pregnancy, so there is time for a prescription and shipping. It's on your Due-Date Plan. USDA's WIC program also advises calling your insurer before your baby is born.
Five steps
Call your insurer
Use the member services number on your insurance card. Say you are pregnant and want to order a breast pump through your plan, then ask the questions below. Write down the answers, the date, and the name of the person you spoke to.
Get a prescription if your plan needs one
Some plans require a prescription or pre-authorization from your doctor. If yours does, ask your OB, midwife or doctor at your next visit. HealthCare.gov notes that plans often follow your doctor’s recommendation on what is medically appropriate.
Choose an in-network supplier
Many plans work with medical equipment suppliers that ship the pump to you. Ask your insurer for its list, or ask a supplier to check your coverage for you. HealthCare.gov says preventive services are generally covered at no cost when you use an in-network provider, so staying in network matters.
Pick your pump and order
Ask which models your plan covers. If you would like a different model, ask what, if anything, you would pay before you order. Then place the order and note when your plan allows it to ship.
Keep the paperwork
Save the order confirmation and any letter from your insurer. If your claim is denied, ask why in writing. You have the right to an internal appeal, and then to an independent external review.
Sources: HealthCare.gov on breastfeeding benefits, HealthCare.gov on preventive care, HealthCare.gov on appealing a decision.
What to ask your insurer
Read these out on the call, and write down each answer:
- Do you cover a pump I keep, or a rental? If a rental, for how long?
- Is it a manual or an electric pump?
- When can I get it: before or after the birth?
- Do you ship it to me, or do I buy it and claim the money back?
- Do I need a prescription or pre-authorization from my doctor?
- Which suppliers are in network for me?
- Do you also cover replacement parts, or lactation counseling?
Adapted from USDA WIC on finding a breast pump.
If you have Medicaid
You may be able to get or rent a breast pump, but every state's Medicaid program is different. Call your Medicaid plan before your baby arrives and ask the same questions. Source: USDA WIC on finding a breast pump.
If you don't have insurance
If you can't get a pump through insurance or Medicaid, you may be able to get or rent one through WIC. Contact your local WIC clinic to check whether you qualify. Some hospitals also rent pumps. Source: USDA WIC on finding a breast pump.
Safety: new, rented and secondhand pumps
The FDA's advice, in short:
- Except for pumps made for multiple users, the FDA considers breast pumps single-user devices. Only pumps designed for multiple users should be used by more than one person.
- Pumps reused by different mothers can carry infectious particles. Buying a used pump or sharing one may also void the maker's warranty.
- If you rent a multiple-user pump, each renter needs their own new accessory kit, including breast shields and tubing.
- "Hospital-grade" is not a term the FDA recognizes, so don't rely on it.
- Most stores won't take a breast pump back once opened, for health reasons, so check the return policy first.
Source: FDA on buying and renting a breast pump.
About feeding. This guide covers getting a pump, not how to breastfeed or pump. For that, talk to your doctor, midwife or a lactation consultant. Your plan must cover breastfeeding counseling too, so ask about it on the same call.
Next on your list
The pump is one item you won't need on your registry. See what else to ask for in the minimal baby registry checklist.