FREE Breast Pump?
Thanks to the Affordable Care Act that went into effect in August of 2012, most health insurance plans are now required to provide breastfeeding equipment and counseling for pregnant and nursing women. According to a U.S. government website:
You may be able to get help with breastfeeding at no cost: Health insurance plans must provide breastfeeding support, counseling, and equipment for the duration of breastfeeding. These services may be provided before and after you have your baby. These rules apply to Health Insurance Marketplace plans and all other health insurance plans, except for grandfathered plans.
Coverage of breast pumps: Your health insurance plan must cover the cost of a breast pump – and may offer to cover either a rental or a new one for you to keep. Your plan may have guidelines on whether the covered pump is manual or electric, how long the coverage of a rented pump lasts, and when they’ll provide the pump (before or after you have the baby).
How do I find out if I am covered?
Call your health insurance provider and ask what breastfeeding equipment and support are covered with your policy. Ask specific questions about:
- What is covered: manual breast pump purchases, electric breast pump purchases, breast pump rentals, and/or lactation consultant services.
- Where breast pumps and services must be purchased: Most health insurance plans require mothers to purchase their pump through a durable medical equipment (DME) supplier. Write down all of the suppliers that your insurance works with because different suppliers stock different pumps and may follow different processing protocols, so you may need to contact several approved suppliers before finding the right fit.
- Which makes/models are covered: Write down all of the pumps covered by your health insurance plan. Get the specific brand, make and model for each.
- How much is covered: Your health insurance may have a cap on the dollar amount they will cover for breastfeeding supplies. Find out if there is a cap and, if so, the exact dollar amount they will cover.
- When is the pump covered: Your health insurance plan may have a specific time frame for when you can order a breast pump (not before 30 days prior to your due date, after the birth, etc.).
- Is a prescription or doctor’s referral required: Ask what documentation is required to access your breastfeeding benefits. Many health insurance providers require a prescription from your doctor. Most DME suppliers will contact your doctor on your behalf and complete this step for you if a prescription or doctor’s referral is required.
How do I get my breast pump?
With the information you gathered from your insurance provider in the section above:
- Decide which of the breast pumps covered by your insurance that you would like. If you are deciding between several pumps, you may want to verify that they are available through the DME suppliers your insurance works with before spending too much time researching the pumps.
- Contact the DME suppliers provided to you by your insurance by phone or go to their websites to find out which pumps they offer. Many DME suppliers have streamlined the process on their websites, providing information about the breast pumps they offer for different insurance plans.
- Be careful on this step. Unfortunately, the information provided by DME suppliers about pumps available to you may be outdated or inaccurate. This is why we recommend contacting your insurance first to get the make and model information for breast pumps covered by your insurance plan. Otherwise, you may waste time researching pumps that aren’t actually covered by your plan.
- Once you have selected a DME supplier that works with your insurance and offers the breast pump you want (from the list provided by your insurance), ask what they will charge your insurance company for the pump. If the DME supplier gives you a dollar amount, verify that it is not more than what your health insurance covers. The DME supplier may not be able to provide a price to you, as they may negotiate a price with your insurance based on your coverage.
- Complete the order request process with the DME supplier. Many DME suppliers have forms on their websites for expectant mothers to easily and quickly submit their request.
- If your health insurance plan has a specific time frame for when you can order a breast pump (not before 30 days prior to your due date, after the birth, etc.) and you contact the DME supplier before you are eligible to order, some DME suppliers will send you a courtesy reminder to order your pump once your eligibility date arrives.
- If a prescription or referral for a breast pump is required, most DME suppliers will contact your doctor on your behalf and complete this step for you.