How to Get a Breast Pump Through Insurance
Thankfully, through the Affordable Care Act, you are able to get a free breast pump through insurance. Breast pump insurance coverage varies by the specific plan you have, and you may be eligible for more than a pump. Here, we’ll run through everything you need to know about getting your breast pump through insurance. Don’t worry, it’s not as hard as it sounds!
💡 Pro tip: You may be eligible for a breast pump, breast pump replacement parts, and breast milk storage bags through insurance!
Common Questions When Getting a Breast Pump Through Insurance
So, now you know you can get a breast pump through insurance, but how does the process work? What do you need to do in order to get a free breast pump covered by insurance? What else can you get through insurance? Let’s dive in!
What to Expect When Getting a Breast Pump Through Insurance
If you work with a DME (durable medical equipment) provider, you can expect the process to be quick and easy. It’s as easy as entering your info, picking your pump, getting your pump. Many DMEs allow you to enter your insurance information on their website. From there, they’ll show you what breast pump options are available to you. Most people qualify to get a free breast pump through insurance, which would be fully covered. Sometimes you can “upgrade” to another model that is not fully covered for a small fee.
How to Get a Breast Pump Through Insurance (Step-by-Step)
To qualify for a breast pump through insurance, you need to be pregnant or have just given birth. A prescription from your doctor is usually needed. During one of your prenatal visits, you can obtain a prescription. Depending on the DME you work with, they may also help with getting a prescription. The DME you work with will handle all the paperwork with your insurance provider, so you don’t have to worry about it. A breast pump will be shipped directly to you. Some breast pumps are free through insurance. Some require an upgrade fee. If you choose a breast pump that was an “upgrade”, you will be responsible for paying the upgrade fee with the DME.
A Step-by-Step Guide:
- Be pregnant or recently postpartum
- Get a prescription
- Find a DME
- Enter your insurance information
- Choose your breast pump
- Receive the order (they ship to you)
- Unbox and set up your pump
When Should I Order My Breast Pump Through Insurance?
Why timing matters:
- Avoid delays after delivery
- Less stress when baby arrives
Best time to order:
- Early third trimester (around 28 weeks)
What to expect:
- Some plans ship before birth
- Others ship after delivery
It’s important to order your breast pump as soon as possible, preferably before baby is born. The last thing you want to do when you have a newborn, changing family dynamics, and are running on major sleep deprivation, is figure out what kind of breast pump you will be getting and how to get it. Trust us. Get that part done before baby arrives. Look at it as part of the nesting phase. While you are getting the nursery set up, also think about how you will feed your baby and what preparation is needed to set your breastfeeding journey up for success.
Keep in mind, even if you order your breast pump before baby is born, your insurance provider may not allow the breast pump to be shipped until after you deliver. If your insurance does allow you to get the breast pump before baby arrives, take a little bit of time to sanitize pump parts, read the instructions, and get a feel for the settings. This will make getting started with your breast pump even easier.
What Breast Pumps Are Covered By Insurance?
Coverage varies depending on your plan but typically the following are covered:
- Electric breast pump
- Multi-user breast pump (if medically necessary)
- Manual breast pump (less likely to be covered and not recommended for benefits)
Most people use their insurance for a double electric breast pump, as this provides the most efficiency during pump sessions. There are many different electric breast pumps that are covered by insurance. It’s important to consider getting a primary pump, a breast pump with a stronger motor and adjustable settings, that is designed to establish and maintain milk supply, like the S6 Adjustable Series with GentleFlow Technology™ (both corded and rechargeable options). Many are rechargeable and portable, making them reliable for in home, at work, and on the go. Some are even dual motor, like the S7 Dual Pro, which give you even more personalized pump sessions with some surprising benefits.
If you feel you’ll want something more portable, consider paying for that as a retail transaction (without using insurance) for a second option and using your main benefits for a primary pump. Side by side comparisons can help you see what differences there are between the pumps you are considering. For instance, you can compare Cimilre’s breast pumps to give you an idea of what features are available and what may be most important to you.
Multi-user pumps are covered when there is a medical necessity, such as baby being born in the NICU. These are typically rented out for the duration needed or allowed by insurance. It’s important to remember, even if a pump says it’s “hospital grade” it does not mean it is a multi-user breast pump. A breast pump must be classified as a multi-user pump to be considered safe to use for more than one person. If you are curious, we break down what the difference is between a multi-user and a hospital grade breast pump.
Manual breast pumps are a good tool to have. Since they are less expensive, people tend to pay for those out of pocket. While you may be able to get them through insurance with some plans, it’s recommended to use your benefits for a double electric breast pump.
Already got a pump but not happy with it? If you already received your breast pump through insurance, but aren't happy with it, you can have a second chance by switching to Cimilre with our Second Chance Pump Program!
Why Is There Sometimes an Upgrade Fee When Using Insurance?
When you enter your insurance information on a DME’s site, you’ll see fully covered options and options that have an upgrade fee. Insurance benefits have a certain allowance, or amount that is covered in full. Breast pumps that fall within the allotted coverage would be free of charge. Breast pumps that cost more would be mostly covered but would require you to pay a small fee. For instance, the S6 Adjustable is covered for free through most insurance plans. The S6+ Adjustable Rechargeable may have a small upgrade fee, depending on the plan. The DME you work with will be able to show you what options are fully covered, and which breast pumps have an upgrade fee.
Quick takeaway:
- Many pumps are free
- Upgrades cost extra
- DMEs handle the paperwork
Can I Return My Breast Pump?
Returns for breast pumps follow very strict rules because they are hygienic medical devices. In most cases, manufacturers and/or DMEs allow returns within a certain timeframe if the box is unopened. If the box is opened, it cannot be returned. Defective or damaged units will be reviewed on a case-by-case basis by the DME or manufacturer, who will work with you to ensure you get the service you need. Each breast pump has a different manufacturer warranty, so if you are looking for troubleshooting and warranty assistance, check with the manufacturer.
Can my Spouse Apply to Get a Breast Pump Through Their Insurance Provider?
To qualify, you typically need:
- To be pregnant or recently postpartum
- A prescription (in most cases)
- Insurance coverage
Insurance covers a breast pump for the person that is pregnant or has given birth. So, if you are pregnant and you are covered under your spouse’s insurance, you are covered and can work through the process. If you are trying to get a breast pump for your spouse who is pregnant, you may run into some issues as it’s the person who is currently pregnant who is eligible for a breast pump. When you work with a DME, they’ll walk you through your options and steps needed to utilize the coverage and get you a breast pump for your breastfeeding journey.
Can You Get More Than One Breast Pump Through Insurance?
In most cases, only one breast pump is allowed per birth. In some cases, one breast pump is allowed for the entire life of the birthing parent. When you work with a DME and enter your insurance information, what you are allowed through your coverage will be shown to you. If you want more details about further pregnancies, speak with the customer service team of the DME you are working with or your insurance provider who can provide you with more information.
Is it Possible to Get Replacement Pump Parts Through Insurance?
Depending on your insurance provider, you may be eligible for replacement parts and breast milk storage bags through insurance! This is helpful because breast pumps require regular maintenance and replacement parts to ensure optimal performance. Plus, you’ll need to store your precious breast milk drops for baby. Some DME providers offer a resupply program that makes the process seamless. Simply say “Yes, I am pumping and need these.” and they will automatically send you what your insurance coverage allows.
Does Insurance Cover Lactation Consultants and Breastfeeding Support?
Just as with breast pumps, the Affordable Care Act also enables coverage of lactation and breastfeeding support through insurance with a Certified Lactation Counselor (CLC), International Board Certified Lactation Consultant (IBCLC), or Certified Breastfeeding Specialist (CBS). As with all things related to insurance, coverage varies depending on your specific plan. Many times, more than one session is covered. Lactation consultants can help prevent and address issues that may arise. Some things they can help with are:
- Prenatal education and preparation
- Latch issues
- Milk supply questions
- Pumping guidance
We highly recommend meeting with a lactation professional who aligns with your breastfeeding goals.
Common Mistakes to Avoid When Getting a Breast Pump Through Insurance
Since you likely only get one breast pump covered through insurance per pregnancy, it’s important to get the most out of your coverage. It’s highly recommended by lactation professionals to get a primary pump that can establish and maintain breast milk supply. This is especially important if you are going to be pumping at work, relying on your breast pump daily, or will be exclusively pumping. Keep in mind, while wearable breast pumps are convenient, most are not recommended to use as a primary pump. Here are some other important mistakes to avoid:
- Waiting until after delivery to choose a breast pump
- Thinking all breast pumps are fully covered
- Not understanding return policies
- Not using a DME that accepts your insurance
- Forgetting a prescription
- Choosing the wrong type of pump for your needs
- Not taking advantage of replacement parts and milk storage coverage
- Not using lactation support
- Ignoring proper flange size
Sizing is crucial to pumping success!
Many times, the breast shield or flange sizes that come in the box are not the right size for you. It’s important to measure to ensure you are using the right size. Cimilre helps you get your pumping journey off to the right start with our Get the Right Fit program. When you get a Cimilre pump, if the sizes that come in the box don’t fit, you can get a third set free. Use our breast shield sizing guide to measure or schedule a virtual sizing consult with one of our CLCs.
You’ve Got This, and Cimilre is Here to Help
Thankfully, getting a breast pump through insurance doesn’t have to be complicated. Our DME partners across the US make it easy to get your breast pump through insurance. Find a partner in your region, enter your insurance information, and see what you qualify. If you have any questions or need help, let us know. We’re here to support you on this very special journey.
FAQs About Getting Your Breast Pump Through Insurance
Is a breast pump really free with insurance?
Yes! You can get a free breast pump through insurance! Some breast pumps cost a small upgrade fee, so review your options with your favorite DME to learn which ones would be free for you and which would require a fee.
Can I upgrade my pump?
An “upgrade” happens when you pay a small fee for a pump instead of getting a free one through insurance. When you get your pump, you can decide if you want a free one or you want to upgrade to one for a small fee.
Can I get a second pump?
Not usually. Most insurance plans only cover one breast pump per pregnancy.
Do I need a prescription?
Yes, most times you will need a prescription to get a breast pump through insurance.
What do I need to do to get a breast pump through insurance?
You need to be pregnant or recently given birth, insurance coverage, and (in most cases) a prescription from your doctor.
Are all breast pumps covered by insurance?
Different DMEs carry different pumps. If there is a certain pump you want through insurance but you can’t find a DME that carries it, you can reach out to the DME, your insurance provider, or the manufacturer.
Can I return my pump?
Usually (depending on the DME or manufacturer) but only if it is unopened.
Is lactation support covered?
Yes, it often is!
Are breast pump supplies covered?
Yes! Depending on your insurance plan you may be eligible to get breast pump replacement parts and breast milk storage on a regular basis during the first year after baby is born or while you are pumping.