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.
Technically, insurance companies could offer you a rental pump, for example. Or only a specific type of pump (manual/electric). Several years into this long-overdue legislation, however, most companies are now offering expecting women a handful of new pump options to choose from.
We wanted to know which pumps moms were actually getting from their insurance companies out there in the wild, so we asked our audience on Facebook. This will give you a good feel for what’s what.
Sadly, many women are offered only a single choice for a breast pump through their insurers. (Frankly, this is *BS.)
Well, maybe it wouldn’t be that bad if the single option were top notch — but it doesn’t tend to be. If you’re offered only one pump, it’s entirely possible that it will be a middling product — not entirely lackluster, but not state-of-the-art. Many moms in this situation end up buying their own pump out of pocket for this exact reason. (Like I said: BS.)
For a long time, one of the most common “this-was-all-they-would-give-me” pumps was the Ameda Purely Yours^^, which wasn’t terrible, but was also not exactly… recommended. But Ameda upgraded that pump (and has come out with some improved devices, too), plus insurers are trending toward more options — so we’re crossing our fingers that you have some items to choose from.
Keep in mind: if you anticipate being an exclusive pumper (I’ll include back-to-work moms in this group), you’ll need (want) one of the highest caliber pumps on the market. Yes: for occasional home use, any-old-breast-pump-your-insurance-sends-you will probably work just fine. But it really depends on your pumping needs and lifestyle.
For Those with Options
If you are lucky enough to have an insurance plan that offers more than one option, many plans offer the Medela Pump In Style Advanced (PISA). That’s good news! Because it’s one we highly recommend.
Additional pumps offered, though not as commonly, are the Hygeia Q, Medela Freestyle, Lansinoh, and Evenflo. Overall, most people were happy with these pumps, but oftentimes insurers offer moms a watered-down version of the full product (e.g., no carry bag, nipples, freezer bags, etc.).
Side note: Many insurers will allow you to pay fees for a “bag upgrade” or “pump upgrade” (Spectra S1 vs. S2), or offer 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 few years. Even new-ish pumps — like the Spectra, Freemie, or Medela Sonata — are now looking increasingly dated alongside wireless offerings like the Willow, Elvie, or Baby Buddha.
If you have options, you can refer to our guide on picking a breast pump for more help choosing the best one for you.
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. (Some insurers may make you wait until your baby is born to receive your pump.)
Some OB offices will guide you through the process, too — it’s worth asking, because if they do, this often makes the whole shebang much easier.
*We recommend that you get your pump as soon as possible (during pregnancy), as some DME’s run out of stock, and others make you go through a process. Either way, it’s nice to get this out of the way.
Many of our readers have used and recommend Aeroflow as a DME, saying that Aeroflow helped them get a breastpump without the hassle of handling the insurance side of things… 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 any pump you wish up to a certain dollar amount — and then will reimburse you up to the max costs. This can be nice, as it affords you more control over the decision (and the ability to lean into all the new breast pump technology that’s available), but it also means 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, 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): “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?
Many plans cover a partpartum lactation consultant (LC) in hospital. Some hospitals offer nurses that specialize in lactation support, where others have an IBCLC (International Board Certified Lactation Consultant) on staff.
Afterwards, coverage often gets tricky. Some insurers only cover lactations consultants during in-person clinic visits (like the OB or the pediatrician’s office). Others cover phone calls or video appointments (yes, telelactation is a thing). Depending on your coverage, an LC might be covered for the first full year of your baby’s life, or only a certain number of visits. (Sometimes, moms have to initially pay out-of-pocket for lactation services, then submit for reimbursement later.)
Local Lactation Support
Outside of insurance, note that many local organizations (ie hospitals, children’s centers, La Leche League, etc.) usually offer (free) lactation support groups. In the past, many of our readers have told us that they actually prefer these kinds of group support groups — to the extent that they never felt the need to pursue individual private support. These days, of course, many of these wonderful initiatives have been forced to hit the pause button, or else shift to an online platform, which is nice, but less… personal. (See also: digital resources for new parents.)
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 also use their 24/7 LC support via video chats through the MyMedela app.
At the end of the day, the common theme for women seeking to receive lactation support through insurance: you have to fight for it. The best advice is to proactively ask what you’re entitled to — and then push for it. Don’t be afraid to be the squeaky wheel.