Note: This article is written specifically for Americans. We need all the help we can get navigating the convoluted world of health insurance….
The Affordable Care Act (aka Obamacare) requires mom’s health insurance plan to cover the cost of a breast pump.
What this actually means is open to interpretation.
It may be a rental pump or a new one you’ll keep. Your insurance plan will probably have guidelines as to whether the pump is manual or electric, the length of the rental, and when you’ll receive it.
We wanted to know what people are actually getting out there in the wild, so we asked our audience on Facebook.
No Choice but the Purely Yours
About half of the responders noted their insurance company offered only the Ameda Purely Yours.
This pump has been around for a very long time (we’ve been covering it for 7 years!) and it’s not terrible, but it’s certainly not one we recommend for long-term, heavy-duty pumping. So if you’re exclusively pumping (EP’ing), this pump’s probably not for you.
Exclusive pumpers (I’ll include back-to-work moms in this group) need the highest caliber pumps on the market. For occasional home use, however, the Purely Yours will probably work just fine. As you can see, it really depends on your pumping needs and lifestyle.
Alas, nearly all of the respondents who ended up with the Purely Yours were unhappy with it, and many ended up purchasing a different pump out-of-pocket. Many noted that it loses suction and power over time. Some even went as far as to speculate that it reduced their milk supply, which ultimately ended or shortened their breastfeeding journey. Not a great outcome.
Kaiser and Blue Cross Blue Shield (BCBS) Federal are two insurance companies who offer the Ameda Purely Yours as the only option, I’m sorry to say. But hey, it’s better than nothing!
For those with Options
If you are lucky enough to have an insurance plan that offers more than one option, it seems the default of many plans is the Medela Pump In Style Advanced (PISA). That’s good news! Because it’s one we highly recommend.
Other popular pumps that are sometimes offered include the Spectra and the Hygeia Enjoye, both of which we recommend (each with its own caveats).
Additional pumps offered, though not as commonly, were the Hygeia Q, Medela Freestyle, Lansinoh, Evenflo and Freemie Freedom. Overall, most people were happy with these pumps, but readers noted that the version of these pumps offered to them were a watered-down version of the full product (e.g., no carry bag, nipples, freezer bags, etc.). The most loved pump, by far, was the Spectra.
Side note: some mentioned that their insurance allowed them to pay fees for a “bag upgrade” or “pump upgrade” (Spectra S1 vs. S2), or offered different “packages” for an additional cost. In my opinion, these upgrades are usually worth it – especially if you’re a working mom.
The truth is, a lot has changed in the pump world in the last three years or so. New pumps like the Spectra, Freemie, and now the Medela Sonata, are taking center stage.
Logistics: what’s a DME?
If your insurance company offers you a choice, chances are they work with an in-network medical equipment supplier called a DME (Durable Medical Equipment Supplier)…but you’ll probably need a prescription from your doctor first (yeah, that’s right).
Specifically, it’s insurance companies like BCBS, Aetna, Priority Health, United PPO, Cigna and Medical Mutual that work this way, while United Healthcare usually allows you to purchase your pump through Target. It was mentioned that BCBS makes you wait until your baby is born to receive your pump.
Many readers recommended you get your pump as soon as possible (during pregnancy), as some DME’s run out of stock. As mentioned, Kaiser provides you with your Purely Yours (meh) during one of your prenatal appointments, or at the hospital.
Many of our readers used and recommend Aeroflow as a DME. They said Aeroflow helped them get a breastpump without the hassle of handling their insurance… and Aeroflow helped them receive maximum coverage before and after baby. Even if you don’t go through Aeroflow, they provide a helpful DME lookup tool – all you have to do is enter your state and insurer.
Still, other insurance companies allow you to choose a pump – up to a certain dollar amount – and some will reimburse you up to that amount, meaning you have to pay out-of-pocket initially, which could be a deterrent to some.
Alternatively, some insurance companies offer the option to rent a hospital-grade pump for a period of time (rather than owning your own pump), which isn’t a bad option. We discuss this scenario here.
Overall, it seems that each insurance company offers different options depending on your coverage… it’s best to call and confirm.
P.s. It’s sickening how much insurance bills for these pumps… about double the cost of what you would pay out-of-pocket!!
According to the current legislation that’s in place for now, ahem (August of 2018), “Health insurance plans must provide breastfeeding support, counseling, and equipment for the duration of breastfeeding. These services may be provided before and after birth.”
Again, exactly what does this mean?
Nearly all of the responders in a recent Facebook poll said that their insurance covered a lactation consultant (LC) while they were in the hospital, and that this consultant visited them daily. Some hospitals offer nurses that specialize in lactation support, where others have an IBCLC (International Board Certified Lactation Consultant) on staff.
Many respondents reported being told by their insurance that a lactation consultant would be covered if they were seen at their OB or pediatrician’s office, versus an in-home visit. Others respondents said phone calls were covered by their insurance.
Depending on the coverage, some noted that LCs were covered for the entire first year of life, while other policies only covered a certain number of visits. If your insurer covers in-home visits (much preferred!), it seems that most moms had to initially pay out-of-pocket for this service, then submit for reimbursement later.
Local Lactation Support
Outside of insurance, note that there are usually (free) lactation support groups offered by your hospital, children’s center, La Leche League (LLL), or even at a local children’s store or library in your town. Many respondents said they preferred this group support and didn’t feel that they needed individual private support. Bonus: many lifelong friendships are made this way!
If you live in a big city, be sure to leverage the local mothers’ groups that are in place. For example, Golden Gate Mothers’ Group in San Francisco will place you in a group according to your neighborhood and/or child’s age. While these groups may not be supervised by lactation consultants, women can find support in each other and nurse freely during meet-ups. See also: Meeting other Moms.
A common theme for everyone that sought to receive lactation support through insurance: they had to fight for it. The best advice is to proactively ask what you’re entitled to; don’t be afraid to be the squeaky wheel.
Did you know: Medela has been offering free online LC support (via email and phone) for many years through their “Ask the LC” program. But if you’re ever in need of LC support during the middle of the night or over the weekend (or any time for that matter), you can use their new 24/7 LC support via video chats through the MyMedela app. You can choose between a one ($29), three ($48) and 12-month ($96) membership depending on your needs.