Your insurance plan likely covers a breast pump at no cost to you
The Affordable Care Act requires most health insurance plans to cover one breast pump per pregnancy without charging you a copay, coinsurance, or deductible. This means you can get a pump for free — but you have to request it through your insurance company, not just buy one and ask for reimbursement. The process takes a few weeks, so starting early in your pregnancy gives you time to receive the pump before you need it.
Your insurance company will either send you a pump directly, give you a list of approved suppliers you can order from, or reimburse you after you buy one yourself. Which path you take depends on your specific plan. The key is contacting your insurance company first to find out what your plan covers, which suppliers are in-network, and whether you need a prescription from your doctor.
Key Takeaways
- Most insurance plans cover one breast pump per pregnancy at no cost, but you must request it through your insurance company rather than purchasing one on your own.
- Contact your insurance company during pregnancy to learn whether they send pumps directly, work with specific suppliers, or reimburse you after purchase.
- You will likely need a prescription or letter from your doctor stating that a breast pump is medically necessary.
- The process typically takes two to four weeks, so request your pump in the second or third trimester rather than waiting until after delivery.
- If your plan denies coverage, you can request a review or file a complaint with your state's insurance commissioner.
Contact your insurance company to learn your plan's coverage
Call the customer service number on the back of your insurance card and ask specifically about breast pump coverage. Have your member ID and date of birth ready. Tell the representative you are pregnant and want to know what your plan covers for breast pumps. Write down the answer to each of these questions: Does the plan cover a breast pump? If yes, how many per pregnancy? Do you need a prescription? Which suppliers does the plan work with? Is there a specific process you need to follow?
If the representative is unclear or gives you conflicting information, ask them to send you the answer in writing or direct you to the plan's website where the policy is documented. Many plans have a section on maternity coverage that lists breast pump benefits. If you cannot find clear information, ask to speak with someone in the maternity benefits department specifically.
Get a prescription or medical necessity letter from your doctor
Most insurance plans require a prescription or a letter from your obstetrician, midwife, or primary care doctor stating that a breast pump is medically necessary. This is a standard requirement and your doctor will be familiar with it. Call your doctor's office and ask them to send a prescription or letter to your insurance company. You can also ask them to send it to the breast pump supplier if you already know which one you will use.
The prescription does not need to be detailed — it straightforward needs to state that you are pregnant and that a breast pump is medically necessary. If your doctor's office asks what to write, you can tell them that your insurance company requires it for coverage. Most offices can send this within a few business days.
Order from an in-network supplier or through your insurance company
Once you have your prescription, your next step depends on what your insurance company told you. Some plans have a preferred supplier — often companies like Aeroflow Breast Pumps, Byram Healthcare, or Edgepark — and will send you a link or phone number to order directly. Other plans let you choose from a list of approved suppliers. A few plans will reimburse you after you purchase a pump yourself, though this is less common.
If your plan works with a specific supplier, contact that supplier with your prescription and insurance information. The supplier will verify your coverage with your insurance company and then send you a pump at no cost. If your plan gives you a choice of suppliers, pick one and call them with the same information. The entire process — from contacting the supplier to receiving your pump — usually takes two to four weeks.
What happens if your insurance company denies coverage
If your insurance company says breast pumps are not covered, ask them to explain why in writing. The Affordable Care Act requires coverage, so a denial is unusual but can happen if your plan is grandfathered (exempt from some ACA rules) or if there is a misunderstanding about your specific coverage. Request a copy of the relevant section of your plan documents that explains the denial.
If you believe the denial is wrong, you can file an appeal with your insurance company. Include a copy of your prescription and a letter from your doctor explaining why a breast pump is medically necessary. You can also file a complaint with your state's insurance commissioner if you believe your plan is violating the ACA requirement. The National Women's Law Center has a tool on its website that helps you file a complaint in your state.
Understand what "covered" means for breast pumps
Insurance coverage means the plan pays for the pump itself, not necessarily all the accessories or replacement parts. Most plans cover one electric or manual pump per pregnancy. If you want a specific brand or a more expensive model, your plan may cover only up to a certain dollar amount, and you would pay the difference yourself. Some plans also cover replacement parts like flanges or tubing, but not all.
Ask your insurance company or supplier what is included in the covered pump and what costs extra. If you want a pump that costs more than your plan covers, you can pay the difference out of pocket. Some people choose to do this if they prefer a particular brand or model.
Timing matters — order early in your pregnancy
Request your breast pump in your second or third trimester, not after you deliver. The process takes time, and if you wait until after birth, you may be without a pump for several weeks while your claim is processed. Ordering early also gives you time to troubleshoot if something goes wrong — for example, if your prescription did not reach your insurance company or if there is a delay with the supplier.
If you are already past your due date and have not received a pump, contact your supplier when ready and ask for expedited shipping. Some suppliers can send a pump within a few business days if you explain the urgency. In the meantime, you can rent a hospital-grade pump from a local lactation consultant or medical supply store while you wait for your covered pump to arrive.
Frequently Asked Questions
Do I need to be pregnant to request a breast pump, or can I order one after I give birth?
You can order before or after birth, but ordering during pregnancy is faster because you will have the pump when you need it. If you order after delivery, the process is the same — you still need a prescription and must go through your insurance company's process — but the two- to four-week wait means you may be without a pump for several weeks postpartum.
What if I have Medicaid instead of private insurance?
Medicaid also covers breast pumps without cost to you, though the process varies by state. Contact your state Medicaid office or the customer service number on your Medicaid card to learn how to request one. Some states work with specific suppliers, and others let you choose. The prescription requirement is the same.
Can I get a second breast pump if I need one?
Most plans cover one pump per pregnancy. If you want a second pump — for example, one to keep at work and one at home — you would typically pay for the second one yourself. Some plans may cover a replacement if your first pump breaks, but you would need to contact your insurance company to ask.
What if the pump my insurance covers is not the brand I want?
You can choose a different brand and pay the difference yourself. Ask your insurance company what dollar amount they cover, then subtract that from the price of the pump you want. You pay only the difference. Some people find that the covered pump works well for them, so it is worth trying it first before spending extra money.
How do I know if my plan is grandfathered and might not cover a breast pump?
Your insurance company can tell you whether your plan is grandfathered. Call customer service and ask directly. If your plan is grandfathered and denies coverage, you can still file a complaint with your state's insurance commissioner, because some states require coverage even for grandfathered plans.