The Breast Pump Saga: What's Covered and What's Not

Being a mom is hard. Being a breastfeeding mom is also hard. Being a breastfeeding mom who has to pump at work is really really hard. As a mom who pumped at work for more than a year in a less than ideal “designated pumping room,” I know how important it is to have a good quality pump. Luckily, thanks to the Affordable Care Act, insurance companies are required to provide you with a free or discounted pump as well as lactation consultation without paying a copay. The problem is that they don’t always offer the pump you want. And the process can be confusing especially for someone with pregnancy brain or new mom brain. Sometimes, if you are one of the few that are on “grandfathered” plans, your insurance provider won’t cover pump-related needs at all.

Part of what makes this confusing is that coverage and the process to obtain a pump seems to be all over the board. If you’re anything like me, I consult with my girlfriends on almost every pregnancy-related topic under the sun—including pumping. But when we swapped stories, we all had a different experience with coverage and our provider.  One friend had their pick of pumps fully covered by insurance, one had to choose from a list and get a prescription from their doctor, one was fully covered but for an off-brand option, one wasn’t aware pumps were covered at all so bought one on her own dime and the last one was on a grandfathered plan and forced to pay out of pocket.

My insurance company covered all but about $50 of the Medela Freestyle pump I wanted, which was considered an upgrade. They required a prescription from my doctor. I purchased the pump from Buy Buy Baby and then submitted a claim, which was reimbursed with quicker than expected turnaround.

My advice is to get your ducks in a row before you are on the brink of labor, or even worse, in those first few weeks after baby comes when your brain just refuses to work from lack of sleep. And don’t pass up the lactation consultant services that are covered by your plan. Having a reliable pump and a freezer full of milk makes the transition back to work less stressful.

So here is what you need to know.

Do your research

Taking time to research plan coverage will pay off. The good news is that you have plenty of time to educate yourself since the majority of plans don’t allow pump pickup until after baby arrives. Figure out what type of pump will be best for you. If you only need to pump occasionally, your needs would be very different than someone who pumps several times a day at the office. Know the difference between manual and electric, double electric, hospital-grade, hands-free, etc.

Ask the right questions

Once you’ve done your homework, give your insurance company a call. Here’s what to ask:

  • What breastfeeding-related benefits does my plan offer?
  • What types of pumps are covered?
  • Can I get a specific brand of pump?
  • Is rental of an electric pump covered?
  • Do I need to buy or rent my breast pump from a certain supplier that’s in network (i.e., a specific pharmacy, retailer, or medical supply company)?
  • Do I need a prescription from my doctor for my pump?
  • Can I request or buy the pump before my baby is born?

If you don’t get the answers you are looking for at first, call back and talk to a difference representative.  I encountered very helpful people and very unhelpful people when asking questions about my insurance coverage. Since most carriers are still shaping their breast pump coverage policies, it is worth your time to speak your mind and stand up for what you want. It might make a difference for you or for a breastfeeding mom down the road.

Don’t compromise on pumps

If a covered pump isn’t available in network under your insurance plan, the majority of carriers will be flexible with your options. You can then choose from an alternate list or purchase on your own and submit a claim afterward. This requires a dialogue between you and your insurance provider.

The majority of plans allow you to upgrade from their basic option and cover the difference in price out of pocket.  While getting your dream pump free of charge is the ultimate here, paying a small upgrade is the next best thing. Not all plans proactively communicate this option to their members so it’s important to ask.

The loophole

Grandfathered plans are those that were initiated before the implementation of the Affordable Care Act. They are not required to cover breastfeeding equipment or consultation. If you are part this loophole, rumor has it that hospitals will lend you a rental pump free of charge as part of their efforts to promote breastfeeding. Just ask!

Why Take Command Health?

Take Command Health believes in transparency and empowerment in the often confusing realm of health insurance. We use data to provide unbiased information for on- and off-market plans as well as faith-based plans to meet the needs of you and your family. We want to help you make smart decisions and avoid wasting money on the wrong plan. It doesn’t hurt that it takes five minutes and it’s free!

Share this with your girlfriends who are moms or soon to be moms!

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