Are Breast Pumps Covered By Medicaid


Ask Your Insurance Provider The Following Questions

WIC Public Service Announcement – Breastfeeding Support and More!
  • Do you cover the cost of buying or renting a breast pump?
  • Are the costs covered with no cost-sharing?
  • Do I need a doctor’s prescription? If so, where and how should they send it?
  • What kind of pump will you pay for? Ideally, you want a double-electric pump, which is more efficient and faster because it allows you to pump both breasts at the same time.
  • Where can I get the breast pump? Depending on your insurance, you may only be able to buy certain brands, and may or may not be able to order them online.

If you’re on Medicaid, reach out to your Medicaid provider to find out what’s covered. If they can’t provide a breast pump, you can get your pump through WIC , a program run by the Food and Nutrition Service of the U.S. Department of Agriculture.Trusted SourceU.S. Department of AgricultureFinding a Breast PumpSee All Sources

Some private medical insurance plans require you to get your breast pump from a specific medical supply company that’s designated by your insurer.Trusted SourceMedicare.govDurable Medical EquipmentSee All Sources Make sure to call that supplier as soon as possible to see if they have the pump you want and how long it will take to get it, since you’ll want to have it as soon as your baby arrives or shortly after.

What Brands Of Breast Pumps Are Covered By Insurance

Unfortunately, some brands of breast pumps may not be covered fully by insurance, or covered at all. So if you have your eye on a specific type of pump, be sure to double check with your insurance provider if its covered. Alternatively, its worth looking into if they offer a reimbursement option you could take advantage of, like I did.

Right now, wearable breast pumps made by Elvie and Willow are generating the most buzz despite rarely being covered by insurance due to their high price point, Canzano says.

However, the good news is, many more affordable models of wearable breast pumps are being offered, so you may find a different option that works just as well for you. Medela and Spectra breast pumps are probably the two most popular and known brands outside of the wearable category which make up the majority of the breast pump market, he adds.

What Does Nc Pregnancy Medicaid Cover

Medicaid for Pregnant Women covers only services related to pregnancy: Prenatal care, delivery, and 60 days postpartum care

Does NC state health plan cover breast pump?

Benefits for breast pumps and related supplies included with breast pumps are now available to members during their last trimester of pregnancy or after they have delivered. Supplies, such as milk storage bags, nursing bras, or creams are not covered.

Are breast pumps covered by insurance?

Coverage of breast pumps Your health insurance plan must cover the cost of a breast pump. It may be either a rental unit or a new one youll keep. Your plan may have guidelines on whether the covered pump is manual or electric, the length of the rental, and when youll receive it .

Also Check: Magellan Medicaid Prior Authorization Form

Can I Get A Free Breast Pump Through Wic

WIC is a public nutrition program that provides support to low-income women, infant, and children who may be at risk for nutritional deficiencies. WIC programs help provide families with important nutrients and help support healthy behaviors through childhood.WIC can help provide a breast pump and breastfeeding support to families in need. When insurance doesnt cover a breast pump or in cases where you may not have insurance, many WIC offices have resources to provide a single-user manual or electric pump to mothers. If youve already delivered and are waiting for your free breast pump through insurance, WIC may be able to loan you a pump while you wait to receive your free pump through the mail.If youre attempting to receive a free WIC breast pump, they may ask to verify your insurance plan to ensure youre not eligible for a breast pump through your provider. If you are eligible through insurance, theyll help you submit a claim. If not, WIC can provide a loaner breast pump or a free breast pump to keep.Most WIC locations offer breastfeeding support to mothers throughout all stages of the nursing journey, from birth through the process of weaning your baby. Visit your local WIC office to find out what resources are available in your area.

Do I Need A Breast Pump Warranty

Breast Pumps

Depending on your Medicaid coverage and state of residency, you may be required to obtain a breast pump that is covered under a warranty. This is often to make sure that the breast pump you receive meets certain standards as defined by Medicaids eligibility coverage. Luckily, all of the breast pumps ordered from Byram Healthcare come with a warranty of at least one year.

Also Check: Can You Have Both Medicare And Medicaid

Here Are Options For Finding A Breast Pump At A Low Cost

Looking to get a breast pump? There are a variety of ways to find a pump at low cost, like through your private insurance or Medicaid, your local hospital, and some WIC clinics. Some moms get to keep their pumps forever, and some moms rent their pumps while they are breastfeeding. Talk to your WIC clinic about which option is best for you.

Information Regarding Medicaid Breast Pump Coverage Terms

As with all federal programs, state coverage varies. In some instances, the process for obtaining your Medicaid covered breast pump can take a considerable amount of time and effort. In some states, breast pumps arent covered under the Affordable Care Act. While this doesnt mean that you wont be able to receive one at all, you may need to enter information about why a breast pump is medically necessary. For some women, this can be difficult to explain. Some of the reasons for medical necessity, as defined by Medicaid plans, include inverted nipples, premature birth, oral defects, breast infections, or an inadequate milk supply. If your baby needs to stay in the NICU for prolonged periods of time or cannot latch properly, you may also be eligible for coverage. Work with your doctor to better understand your nursing needs and determine what, if any, your medical eligibility is.

You may also be able to obtain eligibility if you and your baby will be separated for extended periods, such as in the case of attending school or going back to work. Under these conditions, Medicaid will provide breast pump coverage. However, you will need to present documentation to show that you are legitimately in need. This is where Medicaid differs from private health insurance. While it can be frustrating, working with Byram Healthcare can make the process easier. If youre worried about your coverage, talk to your doctor to learn more about how you can obtain a prescription.

Also Check: Florida Department Of Children And Families Medicaid

Does Medicaid Cover Breast Pump Replacement Parts

Some Medicaid plans may cover additional breast pumping equipment or replacement parts, but many breast pump brands offer their own warranties to help moms get what they need. If your Medicaid plan does not cover additional parts, you can order replacement parts covered by your warranty with your breast pump provider or check with your local WIC to see if they have any available services.

Breast pumps help moms enjoy more flexibility as they breastfeed and are essential for moms returning to work. Although Medicaid coverage differs from state to state, Pumps for Mom is here to help moms find the best insurance breast pump for them.

Motherhood may not be easy, but getting your breast pump through insurance can be with help from Pumps for Mom. With a range of breast pump brands and insurance-covered maternity compression garments, Pumps for Mom can help make new and expectant moms lives easier. Our team of experts is ready to walk you through the process step by step until your insurance breast pump arrives at your door. Fill out our qualification form today and find the best insurance breast pump for you.

I Am Covered By Medicaid And Another Insurance Plan Why Cant I Get My Insurance

Women, Infants and Children Program (WIC) Public Service Announcement

States require that Medicaid be used as your secondary insurance if you are covered by Medicaid and another insurance provider . If your primary insurance does not provide any coverage of a breast pump , you may be eligible to receive one through Medicaid.

The only exception is when a mom has Medicaid and TRICARE coverage. In such cases, Medicaid becomes the primary insurance.

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How To Get A Breast Pump Through Insurance

While that all probably sounds great, youre probably wondering: How do you actually get a breast pump through insurance? There are a few steps you can take:

Step 1: Find out what your insurance covers.

Every insurance plan will be different for what exactly it will cover, so youll want to check the specifics for your plan. If you have an online account or app, check the benefits guide under pregnancy or breastfeeding. I was able to find my information very easily in the online benefits guide. If you cant find it online, you can also just call your insurances benefits number.

Some insurance plans may also reach out to you if you inform them of your pregnancy. For instance, after enrolling in her health insurance plans pregnancy wellness program, mother of five Gretchen Bossio, received a phone call from a benefits coordinator when she was 32 weeks pregnant to arrange for her breast pump. After confirming the pump she wanted was on the approved list, she was all set. The pump arrived in the mail a week later, says Bossio. Super easy! I was so grateful!

Step 2: Follow your plans steps to apply for the pump.

Again, every plan will be different, which is why its important to check with your specific plan about coverage rules. For instance, some plans may require a doctors order or preauthorization, some may cover only certain brands or types of pumps, and others will have you apply for a pump through a third-party site.

What Pumps Are Covered By Louisiana Medicaid

In order to be covered by Louisiana Medicaid, a breast pump must meet these criteria:

  • Have an adjustable suction pressure rate with either written instructions or an automatic mechanism to prevent a suction greater than 250 mm Hg
  • Be adaptable for simultaneous pumping of both breasts
  • Automatically cycle with an adjustable variable cycling rate, typically 30 to 60 or more cycles per minute
  • Include a battery option and adapter to be used as an alternate power source when electricity is not immediately available
  • Breast shields that are adjustable and flexible, or flanges that are available in several different sizes if rigid, including larger sizes
  • All accessories necessary for pumping two breasts simultaneously for electric pumps
  • At least two collection bottles with spill-proof standard size caps, that are bisphenol-A and diethylhexyl phthalate free and
  • Accessories and supplies must be compatible with the pump provided. Materials must be of durable quality for withstanding repeated boiling, washing and pumping use

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Are Breast Pumps Covered By Medicaid

Yes, most Medicaid plans cover breast pumps, although exact coverage details differ depending on state policies. While Medicaid may not cover hospital-grade breast pumps, many plans will cover the cost of owning or renting a personal double electric breast pump. In most cases, Medicaid requires a prescription from a medical professional to cover the price of a breast pump. Pumps for Mom experts can get in touch with your doctor and help you get a prescription if needed. Additionally, because Medicaid benefits vary by state, some states or plans may not cover the breast pump that moms need. In these cases, moms can get in touch with their local WIC clinic to see if they have a breast pump program or work with Pumps for Mom to get a breast pump without insurance coverage.

Do I Need A Prescription To Get A Free Breast Pump

Can You Get A Breast Pump Through Medicaid? How To And Some ...

Yes, in most cases you are required to submit a prescription in order to receive your free breast pump through Medicaid. However, this process may look a little different than what youre expecting.Most times, youll never have to deal with handling the prescription or paperwork to get your free Medicaid breast pump. The Lansinoh Insurance Locator tool makes getting your breast pump through Medicaid one of the simpler items to check off of your baby prep to-do list.After using the tool to choose a supplier and breast pump, the website will prompt you to submit more detailed information including:

  • Insurance plan details
  • Expected due date
  • OBGYNs office details

The supplier will verify the information with your doctor before shipping your breast pump directly to your home.Many insurance plans will require you to be at a certain stage of your pregnancy before finalizing and shipping your chosen breast pump. This is usually done between 30 weeks of pregnancy and the time of delivery. If you deliver your baby before you receive your pump, simply call your supplier to streamline the process. The hospital where you deliver should have access to a breast pump you can use during your stay, if needed.

Read Also: Medicaid Assisted Living Austin Texas

Can You Get Breast Pumps Through Insurance

Not only can you get a breast pump through your insurance, but legally, your health insurance plan has to cover it for free, without co-pays. All health insurance plans including Medicaid must cover breast pumps . The only exceptions are a few grandfathered plans, which do not have to offer the coverage, although many still do.

Thanks to the Affordable Care Act , health insurance companies now provide coverage for a broad range of womens health care services, including breast pumps and supplies, typically at no cost to you, explains Natasha Cantrell, director of individual and family sales for eHealth.

Pumps Should Be Prescribed In Coordination With Lactation Services To Determine Which Type Of Pump Is Best For The Mother

  • Manual pumps are appropriate for daily milk expression or occasional use, depending on the mother’s life schedule.
  • Personal use double electric pumps are intended for mothers who are returning to work or school, have an established milk supply, and are anticipating long-term use.
  • Personal use single electric pumps are not recommended since they are not effective in maintaining a long-term milk supply or when pumping during short time periods such as work breaks.
  • Hospital grade, multi-user pumps are designed for short and long-term use based on the mother’s and infant’s health situation, and appropriate for women who need to establish their milk supply.

Also Check: Ohio Medicaid Assisted Living Facilities

How To Request A Breast Pump

To request a breast pump, call the phone number on your health plan ID card, or you may contact one of the national network providers below. You will need a physician prescription to get a breast pump. Make sure to note that you will not be reimbursed for a breast pump purchased at a retail store.

If you contact a breast pump supplier directly, they may ask for your doctors name and phone number and the babys due date or the date the baby was delivered. The supplier may check this and other information with your doctor before the breast pump is ordered.

Medicaid Covered Breast Pumps

Lawmakers looking at breastfeeding challenges at work

Most state Medicaid plans will cover a breast pump, but Medicaid covers most services in a different way than private insurance companies. But what are the Medicaid guidelines for breast pumps? How will you know the specific stipulations of your policy? Will having a Managed Care Organization make a difference? We have the answers to all of your questions!

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Medicaid Breast Pump Coverage Terms

Obtaining a breast pump through Medicaid can be an extensive process. Please note that it can take up to 10 business days before we receive authorization to move forward with providing the pump. No need to worry, our Specialists are here to help facilitate the process!

Some state Medicaid health plans will not cover a free breast pump per the Affordable Care Act at all. Rather, they cover them under medically necessary circumstances such as long stays in the NICU, inverted nipples, etc.

Certain states have stipulated that if the mother and baby will be separated for extended periods of time , a pump will be covered. When your policy only covers the pump under these circumstances, a prescription will be required as well as documentation surrounding your work or school hours.

Aeroflow Breastpumps will work with you and your health care provider to gather the correct information for your insurance! If you have both a commercial insurance plan and a Medicaid plan, it is important to provide us your commercial insurance. Insurance guidelines require that a patient’s commercial/primary insurance be billed prior to their Medicaid plan.

How Can I Get A Breast Pump Through Medicaid

New and expectant moms can use Pumps for Mom to get their breast pump through insurance, although its important to remember that many Medicaid plans will only process payment and ship your pump when the baby is born. Our qualification form makes it easy for moms to browse breast pumps that are covered by their Medicaid plan and order their pump when they are ready. The Pumps for Mom team can help you verify your insurance coverage, assist you in getting a prescription, and keep track of your breast pump when its on the way to you. When it comes to getting a Medicaid breast pump, were with you every step of the way.

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