How Does Getting a Breast Pump Through Insurance Actually Work?

As you begin to prepare for your newborn, you have plenty on your mind. You are already preoccupied with finding a pediatrician, babyproofing your home, preparing a nursery, and securing essential gear like a car seat, stroller, crib, and diapers. The last thing that you need right now is yet another task to complete. Thankfully, getting a breast pump through insurance is usually one of the easier things to check off your list!

Under the Affordable Care Act (ACA), most insurance plans cover a breast pump, accessories, and supplies.. When getting a breast pump through insurance with a Durable Medical Equipment (DME) provider, the process is easy!

The biggest decision you will need to make is choosing the pump model that is best for you. Most insurance plans only cover one breast pump per pregnancy, so it is key to consider the style of pump and features that would work best for your lifestyle. Remember, everyone’s body and goals are different, so try to avoid basing your decision on what is most popular. What works for another person may not work for you. Refer to [our blog](https://acelleron.com/blog/finding-the-right-breast-pump/) on this topic for more detailed information. 

 Most insurance and Durable Medical Equipment (DME) providers include at least one breast pump option at no cost to the patient. In some cases, most often with commercial insurance plans, DMEs may also offer upgraded models with additional features or added accessories. Because these upgrades go beyond standard coverage, they may include an out-of-pocket cost for the patient.

Many insurance plans also cover breast milk storage bags, often including an initial supply with your pump. This is one less item for you to purchase! If your insurance covers them, you may also be able to get a resupply throughout your baby's first year. 

Additionally, replacement pump parts may also be covered through your insurance plan and include bottles, tubing, and flanges. Some insurers are also adding duckbill valves to their list of eligible replacement items. The frequency of replacement part coverage varies significantly by insurance plan, so it’s best to contact your t DME provider to confirm your specific coverage details. 

Once you have selected a breast pump, the DME will need basic information to verify your insurance: 

• Insurance information
• Baby’s expected due date
• Personal info (name, phone number, email)
• Shipping address. 
• Your provider’s information

Most insurance plans require a prescription for a breast pump. You can get a prescription from your provider during a regularly scheduled visit, or the DME can contact your provider on your behalf.

After everything is verified, your breast pump will ship based on your insurance guidelines. Some insurance plans allow shipment several months before delivery, while others require you to be closer to your due date. Once your order is finalized, the DME provider will send you a confirmation, letting you know that the order is complete and providing the expected shipping date. 

In summary, this is everything you need to know. It may seem overwhelming at first, but the process is much easier than you may expect and will be handled for you, allowing you to focus on what really matters: your newborn!