Insurance Covered Breast Pumps: Which Breast Pumps Insurance Covers
Choosing the right breast pump is one of the first tasks many new parents face, and understanding what your insurance will cover can save you hundreds of dollars. In the United States, many insurers provide coverage for breast pumps through the Affordable Care Act (ACA) and through state Medicaid programs. But coverage varies by insurer, plan, and state, and not every pump on the market will be fully covered.
This guide explains how coverage works, which types of pumps insurers typically cover, realistic cost examples, and step-by-step instructions to get a pump through insurance. We also include comparisons of common pumps, timelines, and practical tips to help you get the best fit for your needs.
How Breast Pump Coverage Works Under U.S. Law and Insurance Policies
Under the Affordable Care Act, most private health plans are required to provide breastfeeding support, counseling, and equipment such as breast pumps. The ACA specifies that insurers must cover “support and equipment for breastfeeding” but the exact details are left to insurers and employers, so there’s variation in how coverage is delivered.
Key points to understand:
- Private insurance plans: Many plans cover at least one breast pump per pregnancy, often at no cost-sharing. However, coverage may be through a supplier network — meaning you must order from an approved vendor.
- Employer plans: Employers who are self-insured may not be required to follow state mandates; coverage can differ significantly for those employees.
- Medicaid: All state Medicaid programs are required to provide medically necessary breastfeeding support and equipment for pregnant and postpartum women. Coverage details (e.g., rental vs purchase, pump type) vary by state. Some states cover hospital-grade pumps when medically necessary.
- Timing and documentation: Most insurers require a prescription or a signed order from a healthcare provider listing the need for a breast pump (HCPCS code E0603 for standard electric breast pump is commonly used).
- Replacement and upgrades: Policies differ on replacement intervals (e.g., once every 12 months, once per pregnancy, or once every 3 years) and whether upgrades to a higher-tier pump are allowed or require additional payment.
Because of this variation, the best first step is to check with your insurer and your HR benefits desk to learn the specifics of your plan and any vendor networks they require.
Types of Breast Pumps Insurance Typically Covers
Insurers generally cover one of a few categories of breast pumps. Which category your plan covers depends on plan specifics and whether the purchase is considered medically necessary.
- Manual pumps: Simple hand-operated devices. These are rarely the primary covered item under most plans unless chosen by the mother and available through the insurer’s vendor.
- Single electric/personal-use electric pumps: Compact electric pumps intended for personal daily use. These are the most commonly covered type under private insurance, especially when ordered through the plan’s preferred supplier.
- Double electric pumps: More efficient for frequent pumping. Many insurers cover a double electric pump if requested, but coverage of specific brands or models varies.
- Hospital-grade pumps: High-powered, robust pumps generally intended for short-term rental through medical supply companies. These are typically covered when there is a medical need: preterm infants in the NICU, latch issues, or physician-documented supply problems.
- Accessories and replacement parts: Policies differ widely. Some cover replacement flange sets or membranes every so often; others do not, or only cover them when they are medically necessary.
In short, most insured people who want a basic double electric pump can get one covered. Hospital-grade pumps are usually available only with a medical justification or through Medicaid for NICU babies.
Common Breast Pumps and Typical Insurance Coverage
Below is a realistic overview of popular breast pump models, typical retail prices, and how insurers usually handle them. These are general patterns — exact coverage depends on your insurer and plan.
| Pump Model | Type | Typical Retail Price | Insurance Coverage Likelihood | Notes |
|---|---|---|---|---|
| Medela Pump In Style (or Freestyle) | Personal double electric | $200–$350 | High | Widely accepted by insurers; often available through preferred vendors. |
| Spectra S1 / S2 | Personal hospital-strength double electric | $160–$200 (S2) • $180–$220 (S1) | High | Popular choice; insurers may cover these models, especially S1/S2. |
| Lansinoh Smartpump 2.0 | Personal double electric | $120–$160 | Moderate | Often covered when ordered through insurer vendors; cheaper retail price. |
| Ameda Purely Yours | Personal double electric | $180–$250 | Moderate to High | Legacy hospital brand; coverage varies by plan. |
| Medela Symphony | Hospital-grade (rental) | Rental: $80–$200/week • Purchase: $900–$1,200 | Covered if medically necessary | Often used in NICU; usually supplied as a rental with documentation. |
| Hygeia Enjoi, Hygeia Caire | Personal/hospital hybrid | $250–$700 | Variable | Some insurers cover these higher-end models only with medical justification. |
Note: Retail price ranges are based on common U.S. market listings as of 2024–2025. Some insurers will supply a pump at no out-of-pocket cost; others may allow you to buy one and submit for reimbursement.
Cost Scenarios: Rental vs Purchase and Out-of-Pocket Examples
Understanding cost scenarios is helpful for budgeting. Below are sample real-world examples to illustrate differences between renting a hospital-grade pump and acquiring a personal pump through insurance or out-of-pocket.
| Scenario | Typical Cost (Retail) | Typical Insurance Outcome | Out-of-Pocket Example |
|---|---|---|---|
| Personal double electric (e.g., Spectra S2) | $160 | Often fully covered through insurer vendor; $0 if in-network | Buy retail: $160; if insurer requires in-network purchase, you may be reimbursed $160. |
| High-end personal pump (e.g., Hygeia) | $400–$700 | May require additional payment; insurer might cover a lower-tier model only | If insurer covers $200 model, you pay $200–$500 difference out-of-pocket. |
| Hospital-grade rental (Medela Symphony) | Rental: $80–$200/week; typical 4-week rehab: $320–$800 | Covered if medically necessary with documentation; may be limited to a few weeks | Without coverage, cost for a month of rental could be $320–$1,200 depending on supplier. |
| Accessories (extra flanges, tubing) | $10–$60 per item | Often not covered or only covered occasionally | Expect to pay $50–$150 for replacements over 6 months. |
Many families find paying a reasonable out-of-pocket amount for a higher-end personal pump is worthwhile for comfort and convenience, even when insurers cover a standard pump option.
How to Get a Breast Pump Through Insurance: Step-by-Step Guide
Getting a breast pump through insurance is usually straightforward if you follow the insurer’s process. Below is a typical step-by-step workflow with helpful tips at each stage.
| Step | What to Do | Typical Timeline | Tips |
|---|---|---|---|
| 1. Confirm coverage | Call your insurer and ask about breast pump benefits, vendor network, and whether you need a prescription. | 1–5 business days | Ask for the plan document name or reference code; take notes: representative name, date, and confirmation number. |
| 2. Get a prescription/order | Ask your OB/GYN, pediatrician, or lactation consultant for a written order or prescription for a breast pump (HCPCS E0603 for standard electric). | Same day to 1 week | If you have a telehealth visit or an in-office visit, request the order be faxed directly to the supplier. |
| 3. Use the insurer’s supplier or submit for reimbursement | Order from the insurer’s preferred vendor online, by phone, or submit retail receipts for retroactive reimbursement if allowed. | 5–14 business days for vendor fulfillment | Using the network supplier often ensures $0 out-of-pocket and faster shipping. |
| 4. Receive the pump and register | Inspect the pump, register the warranty, and keep the invoice and order confirmations. | Delivery: 3–10 business days | Keep documentation for appeals or future replacement requests. |
| 5. Request replacements or accessories | Contact your insurer to learn if replacements or parts are covered and how often. | Varies — often once per pregnancy or every 2–3 years | Some insurers require a new prescription for replacement parts or upgraded pumps. |
Common HCPCS codes you might see: E0603 is a standard code for a breast pump, E1399 for miscellaneous durable medical equipment. These codes help suppliers and insurers process claims properly.
If your plan requires specific suppliers, ordering outside that network may lead to denied claims or a request to pay upfront and then file for reimbursement. Keep receipts and explanation of benefits (EOBs) when you pay out of pocket.
Tips, Troubleshooting, and Frequently Asked Questions
This section answers practical questions and gives troubleshooting tips based on insurance realities and real parent experiences.
Do I need a prescription for a breast pump?
Most private insurers and Medicaid require a prescription or written order from a health care provider to process coverage. The order should include the HCPCS code E0603 or specific language stating “breast pump(s) medically necessary.” Many hospitals and lactation consultants will provide the necessary documentation if you ask.
Can I choose any brand or model?
It depends. Many insurers cover a basic double electric pump from a preferred list. If you want a higher-end pump, you may need to pay the difference in cost. For hospital-grade pumps, insurers usually require medical necessity. Always ask the insurer about a preferred supplier list and whether upgrades are allowed.
What if my pump claim is denied?
- Request a written explanation of the denial from your insurer.
- Check whether the denial was due to missing documentation (e.g., absent prescription). If so, provide the missing paperwork and resubmit.
- If denied for medical necessity, ask your provider to submit a letter of medical necessity explaining why a specific pump or rental is required.
- Keep records: notes from calls, dates, the names of representatives, and copies of all correspondence.
How often can I get a new pump?
Policies vary. Some insurers cover one pump per pregnancy; others allow one pump every 12 months or one pump every three years. Medicaid rules will differ state-by-state. Check your plan documents to know the exact interval and keep records of prior supplies.
Are accessories covered?
Accessories such as replacement valves, tubing, and extra flanges are often not fully covered. Some plans may cover one set of essential accessories with the initial pump, but replacements later may be out-of-pocket. Expect to spend $20–$150 on replacement parts over time if your insurer does not cover them.
Real-life cost examples
Here are some real-world costs experienced by families in 2024–2025:
- Family A: Private plan with in-network vendor — received a Spectra S1 shipped free; $0 out-of-pocket.
- Family B: Self-insured employer plan — insurer covered a Medela Pump In Style but only as a rental value; family paid a $75 top-up for a new pump and $30 for extra flanges.
- Family C: Medicaid (state-level) — eligible mother of a NICU baby received a hospital-grade pump rental for 6 weeks with zero out-of-pocket cost.
- Family D: Wanted a specialty small-suction pump not on insurer list — insurer allowed purchase but only reimbursed $150 toward the $500 retail price; family paid the $350 difference.
Checklist: What to have when requesting a pump
- Insurance card and policy number
- Physician or lactation consultant order/prescription (with HCPCS code if possible)
- Plan’s preferred supplier information (ask insurer)
- Contact information for HR benefits representative (if through employer)
- Copies of previous pump coverage (if requesting replacement)
- Notes from calls with insurer (dates, rep names, confirmation numbers)
Having these items ready speeds the process and reduces the chance of denial or delays.
Final thoughts: Choosing the pump that works for you
Insurance can and often does cover a breast pump, but the best approach is proactive: check your coverage early in pregnancy, get the necessary prescription, and order from the in-network supplier if required. If you need a hospital-grade pump for medical reasons, work closely with your provider to document the need. If you prefer a higher-end model not fully covered, compare the out-of-pocket difference to the benefits you’ll receive from the better fit, comfort, or performance.
Commonly, a decent double electric pump like the Spectra S2 or Medela Pump In Style is available through most insurers with little or no out-of-pocket cost. For those who value extra features, budget $200–$500 for upgrades — often a manageable expense for long-term comfort and efficiency.
Quick Resources and Next Steps
- Contact your insurer’s member services and ask specifically about “breast pump” and “HCPCS code E0603.”
- Reach out to your employer’s HR/benefits team if you’re unsure whether your plan is self-funded.
- Ask your provider or lactation consultant for a prescription or letter of medical necessity if you anticipate needing a hospital-grade pump or rental.
- Keep documentation for appeals, replacements, and future reference.
If you follow the steps above and keep clear records, you have a very good chance of getting a quality pump covered by your insurance — and getting back to feeding your baby with less stress and more support.
Source: