Breast pump coverage

If you plan to return to work after your baby arrives, ask your employer where you can pump and store milk. Most employers are required by law to give you time and a place to pump.¹

You may be eligible to get a breast pump through insurance. If you have a UnitedHealthcare health plan, sign in to your member account or the UnitedHealthcare app to view your benefits. Read on to learn tips on how to get a breast pump through insurance.

Maternity and newborn care — including breast pumps — are essential health benefits. This means qualified health plans must cover them.³

Health insurance plans must provide breast pumps and nursing support — such as counseling from a doula or lactation consultant — for the duration of breastfeeding, according to the U.S. Department of Health & Human Services. This applies to ACA Marketplace plans, most Medicaid plans and all other health insurance plans, except for grandfathered plans.⁴

Medicaid plans in most states cover manual and electric breast pumps, but some require prior authorization. Since states, not the federal government, control Medicaid plans, coverage may vary depending on where you live.⁵

TRICARE breast pump coverage includes breast pump supplies and breastfeeding counseling at no cost for new parents. This includes families that adopt an infant and plan to breastfeed.⁶

Powered or wearable pumps usually work on both breasts at once. Powered pumps may be hands-free if you purchase a hands-free pumping bra.²

Breast milk storage bags may be included in your coverage.

Your health plan may have rules, like needing prior authorization from your provider. Your insurance will typically follow your provider’s recommendations on what’s medically appropriate. Talk to your provider about what’s best for you.³

As part of preventive care benefits for women, ACA Marketplace and Medicaid breast pump coverage typically includes breastfeeding support from trained providers and access to breastfeeding supplies, such as breast pumps, for women who are pregnant or nursing.⁷

These services are typically covered without charging a copayment or coinsurance, even if you haven’t met your yearly deductible. Coverage may vary. $0 cost isn't guaranteed in all cases.⁷

To request a breast pump, UnitedHealthcare members can sign in to your member account or the UHC app. You may also contact a national breast pump supplier. These suppliers typically ask you to fill out an online form with your insurance information, health care provider name and other personal details. The supplier may check this information with your provider before the breast pump is ordered.

You may need a prescription from your health care provider to get a breast pump. You will not be reimbursed for a breast pump purchased at a retail store.

If you have Medicaid, you may be covered for a breast pump, but every state's Medicaid program is different. In some states, Medicaid may only cover a breast pump in medically necessary circumstances, such as long stays in the NICU or inverted nipples.⁸

In most states, Medicaid requires a prescription for a breast pump from your health care provider. Some states require prior authorization for breast pumps. This can take up to 10 business days.⁸

Additionally, many Medicaid plans won’t provide a breast pump until the baby is born. Hospitals will typically allow you to rent a pump while you wait for yours to arrive. Check with your Medicaid provider to find out what's covered for you before your baby is born.⁸

To request a breast pump, call the phone number on your health plan ID card, or contact a national breast pump supplier. The supplier will typically ask for your current state and insurance provider. Once you choose a pump, the supplier may check this information before you complete your order.

If you cannot access a covered breast pump through Medicaid, you may be eligible for assistance from the U.S. Department of Agriculture (USDA) Special Supplemental Nutrition Program for Women, Infants and Children (WIC). WIC offers food, nutrition counseling and access to health services — including breast pumps — for breastfeeding women with a low-income. Reach out to your local WIC clinic to find out if you're eligible.^{9, 10}

UnitedHealthcare members can shop for an eligible breast pump using these national suppliers. Compare the options available to you through your plan and then order directly.

Choosing whether to breastfeed or formula-feed your baby is a personal choice. For some, breastfeeding may not be possible. For people who can't breastfeed or don't want to, formula is a healthy choice. It gives babies the nutrients they need to grow and thrive.

If you choose to breastfeed, there are some health benefits you might want to know about — for both mom and baby. Studies show that breastfed babies have lower risks of asthma, childhood leukemia, childhood obesity, ear infections, sudden infant death syndrome (SIDS), respiratory diseases and Type 2 diabetes. For mothers, nursing can lower the risk of Type 2 diabetes, ovarian cancer and certain types of breast cancer.¹¹

The American Academy of Pediatrics (AAP) recommends breastfeeding as your baby’s one source of nutrition for their first 6 months. The AAP recommends continued breastfeeding, while introducing solid foods, starting around 6 months. Breastfeeding can continue for up to 2 years or longer, if it benefits both parent and child.¹²

Breastfeeding might be easy for you, but it's normal to need help, especially at first. If you have challenges with breastfeeding, such as latching difficulties, pain or low milk production, lactation counseling can be very helpful.

Most UnitedHealthcare plans include coverage for lactation counseling with a network provider, including lactation support classes or lactation counseling during an office or other outpatient visit.

If you deliver in a hospital, most benefit plans also include coverage for lactation support during your inpatient admission. Contact your OB/GYN, pediatrician or primary care physician to learn about lactation counseling services that they offer.

You may be eligible under your UnitedHealthcare health benefit plan for lactation counseling at no cost to you. UnitedHealthcare members can sign in to your member account or the UHC app to view your benefits.

UnitedHealthcare members may have access to resources that include breastfeeding support. Members with ACA Marketplace plan or an employee-sponsored plan may be eligible for online maternity support resources. UnitedHealthcare Community Plan members may be eligible for pregnancy support programs such as Healthy first steps and Wellhop.