Insurance Coverage

How Much Will My Insurance Cover for a Breast Pump?

  • Most health plans provide the full cost of a breast pump; some provide only a portion of the cost, or a set dollar amount allowable towards a breast pump, making you responsible for the rest of the cost.

What Breast Pump is Covered by My Insurance

  • Most of insurance plans do not specify the brand of breast pump you can get. This depends on your preference and the durable medical equipment supply/store you are getting your breast pump from. When a claim form is filed with your insurance company, it populates the HCPC code for electric breast pump. No brand information is included.
  • Most brands only give a bare pump, without accessories. Megna breast pump sets come with all the accessories needed for milk expression, storage and travel.

How to Claim your Breast Pump through Insurance

  • Your breast pump is covered by the Affordable Care Act (ACT) or commonly referred to as ObamaCare. Below are simple steps to proceed.
  • You need find a certified specialty durable medical equipment (DME) supplier who is specialized in handling breast pumps though insurance.
    • Most of traditional DMEs are not in the field of supplying breast pumps.
    • Regular retailers including online stores such as Amazon are not eligible and equipped to accept orders though insurance. In most of cases, you can’t receive re-imbursement from insurance companies if you buy from these type of online stores unless you have pre-approval from your insurance companies.
  • Check if the supplier you choose does accept your insurance. The process may go a little easier if they are participating in the insurance’s network. Only a limited insurance companies have specified DME suppliers you need go to purchase breast pump from.
  • Once got confirmation that the DME company you choose can bill your insurance company, they will also let you know how much your out-pocket cost is and what brand you can get. Most of insurance policies cover all of the cost for a breast pump to a certain “allowable” amount, which would limit your selection. You may need to pay an upgrade fee to get the top brand or model you like.
  • Prescription for a breast pump is usually needed for completing the ordering process through insurance.
  • Once you have the prescription ready, just call the certified DME stores you have selected and give them the Rx along with your insurance information, and pay any upgrade fee if needed. You will get your breast pump right away, and the DME store will take care the rest of paper work.

It’s just that simple!