Can You Get a New Breast Pump With Each Pregnancy?
Yes, in most cases, you can get a new breast pump with each pregnancy due to provisions within the Affordable Care Act (ACA), which mandates that most insurance plans cover breastfeeding support, supplies, and counseling. This includes providing a breast pump, though the specifics of coverage can vary by insurance plan.
Background: The Affordable Care Act and Breastfeeding Support
The Affordable Care Act (ACA) revolutionized access to breastfeeding support and equipment for new mothers in the United States. Prior to the ACA, obtaining a breast pump could be a significant out-of-pocket expense, creating a barrier for some women who wished to breastfeed. The ACA’s preventative services mandate changed this landscape, classifying breastfeeding support and supplies as essential healthcare services.
This means that most health insurance plans, including those offered through employers, individual marketplaces, and Medicaid expansion, are required to cover the cost of a breast pump without cost-sharing (copays, deductibles, or coinsurance). This provision applies to each pregnancy, allowing mothers to obtain a new breast pump for each subsequent child.
Understanding Your Insurance Coverage
While the ACA mandates coverage, the specifics of that coverage can vary considerably from one insurance plan to another. Some plans may offer coverage for a manual pump, while others will cover electric pumps, including double electric pumps. Some may have preferred brands or suppliers you need to use. Still others may offer reimbursement for a pump purchased on your own. It’s crucial to understand your policy details before your baby arrives.
- Contact your insurance provider: This is the most important step. Call the number on your insurance card and ask about their breast pump coverage policy.
- Inquire about pump types: Find out if your plan covers manual, electric, or hospital-grade pumps.
- Understand the purchase or rental options: Some plans cover the outright purchase of a pump, while others may only cover rental of a hospital-grade pump for a limited time.
- Ask about preferred suppliers: Your insurance may have a list of DME (Durable Medical Equipment) suppliers you must use.
- Confirm the timeline: Determine when you can obtain the pump – before birth, after birth, or within a specific timeframe postpartum.
The Process: Obtaining Your Covered Breast Pump
Obtaining your breast pump typically involves a few straightforward steps. Here’s a general overview:
- Confirm your pregnancy: Many insurance providers require proof of pregnancy, such as a doctor’s note, before authorizing a breast pump.
- Contact your insurance company: As mentioned above, this is crucial for understanding your coverage details.
- Obtain a prescription (if required): Some insurance plans require a prescription from your doctor, midwife, or other healthcare provider.
- Choose a supplier: Select a DME supplier that is in-network with your insurance plan.
- Order your breast pump: Place your order through the approved supplier, providing any necessary documentation.
- Receive your pump: Your pump will be shipped to you or available for pickup, depending on the supplier’s policies.
Types of Breast Pumps Covered Under ACA
The ACA broadly mandates coverage for breast pumps, but the specific types covered can vary widely. Understanding the different types and their features is important to selecting the pump that best suits your needs.
| Type of Pump | Description | Pros | Cons |
|---|---|---|---|
| Manual Pump | Operated by hand, using a lever or handle to create suction. | Affordable, portable, quiet, good for occasional use. | Can be tiring for frequent pumping, less efficient than electric pumps. |
| Single Electric Pump | Operated by electricity, pumping one breast at a time. | More efficient than manual pumps, allows hands-free operation. | Slower than double electric pumps, may require more time per pumping session. |
| Double Electric Pump | Operated by electricity, pumping both breasts simultaneously. | Most efficient type of pump, saves time, can increase milk supply. | More expensive than other types, requires a power source. |
| Hospital-Grade Pump | High-powered electric pump designed for frequent use, often used in hospitals to help establish and maintain milk supply. | Most powerful and efficient type of pump, ideal for mothers with low milk supply or premature babies. | Usually requires rental, can be expensive, typically larger and less portable. |
Common Mistakes to Avoid
Navigating insurance coverage and obtaining a breast pump can sometimes be confusing. Here are some common mistakes to avoid:
- Assuming all plans are the same: As noted previously, coverage varies significantly.
- Waiting until the last minute: Start the process early to avoid stress.
- Not reading the fine print: Understand all the terms and conditions of your coverage.
- Choosing a supplier without checking in-network status: This can result in unexpected out-of-pocket costs.
- Discarding important documentation: Keep records of all communication with your insurance provider and supplier.
Frequently Asked Questions (FAQs)
Will my insurance cover a hospital-grade pump?
Hospital-grade pumps are often covered in situations where a mother has a medical need, such as a premature baby or low milk supply. However, coverage varies, and you should verify with your insurance company whether they will cover the rental or purchase of a hospital-grade pump.
Can I upgrade to a more expensive pump and pay the difference?
Some insurance plans allow you to upgrade to a more expensive pump and pay the difference out of pocket. However, this is not always the case, and you should check with your insurance provider and the DME supplier to see if this option is available.
What if my insurance denies my breast pump claim?
If your claim is denied, appeal the decision with your insurance company. Provide any supporting documentation, such as a doctor’s note, and clearly state the reasons why you believe the denial was incorrect. You may also be able to file a complaint with your state’s insurance regulator.
Do I need a prescription for a breast pump?
Some insurance plans require a prescription, while others do not. Check with your insurance provider to determine whether a prescription is necessary.
Can I get a breast pump before the baby is born?
Many insurance plans allow you to obtain a breast pump before your baby is born, usually within a certain timeframe, such as 30 days prior to your due date. Verify the specific timing with your insurance company.
What if I have Medicaid?
Medicaid programs typically cover breast pumps, often with even more comprehensive coverage than private insurance plans. Contact your local Medicaid office to learn about their specific breast pump coverage policies.
Can You Get a New Breast Pump With Each Pregnancy if I change insurance plans?
Yes, the mandate applies to each pregnancy, regardless of whether you change insurance plans. You are generally entitled to a new breast pump with each pregnancy, though you need to go through the verification and approval process with your current insurance provider.
What if my employer’s plan is “grandfathered” and exempt from the ACA?
While most plans are required to comply with the ACA, some older “grandfathered” plans may be exempt. Check with your employer or insurance provider to determine if your plan is exempt and whether it offers breast pump coverage.
Are wearable breast pumps covered?
Coverage for wearable breast pumps (like Elvie or Willow) is increasingly common but still not universally guaranteed. Check with your insurance company to see if they are covered and what their reimbursement policy is.
What documentation do I need to provide to get a breast pump?
The required documentation can vary, but typically includes proof of pregnancy (doctor’s note), your insurance card, and a prescription (if required). The DME supplier will usually guide you through the documentation process.
What if I am adopting a baby?
Breastfeeding support and supplies are also covered for adoptive mothers who intend to breastfeed or induce lactation. The same rules apply, and you should contact your insurance provider to determine their coverage policy.
If my pump breaks, will insurance cover a replacement?
Insurance typically covers the initial breast pump provided under the ACA. Replacement coverage for broken or malfunctioning pumps is less common but may be possible depending on your insurance plan and the circumstances. Check your insurance policy for details and inquire about their replacement policy.