A DME provider’s Guide to Breast Pump Insurance Coverage
Frequently Asked Questions
Your customers will have a lot of questions about insurance coverage of their breast pumps. Unfortunately, many of the answers depend on their specific insurance plans. We recommend starting with these answers and then working with the customer, and the insurance company, to provide more specifics.
What does the Affordable Care Act (ACA or Obamacare) require?
The ACA requires coverage for “breastfeeding support, supplies, and counseling” including the full coverage (no copayment or deductible) of a breast pump for women who are lactating. What kind of pump is covered varies depending on state, insurer, plan and network. Keep in mind that “grandfathered plans” do not have to comply with this mandate.
Are accessories included?
Accessories are not typically covered by insurance. In some cases, breast pumps that come with accessories are covered, but it is uncommon.
When can I get my breast pump?
Some insurance plans will allow you to file a claim 30 to 60 days before your due date. Others do not allow for a claim until the birth of the baby.
Do I need a prescription?
Yes. A physician will need to write a prescription. Sometimes a physician can prescribe a pump that exceeds the typical coverage—such as a double electric breast pump if it’s not usually covered—if a patient is experiencing a problem like low milk supply.
Breast Pump Comparison Chart
