Does Medicaid Cover Breast Pumps

Does Medicaid Cover Breast Pumps – Overview

If you’re pregnant and you have Medicaid insurance, you might be wondering if your plan covers breast pumps.

In most instances, the answer is yes. However, for Medicaid to pay for your breast pump, you must be eligible and enrolled in Medicaid.

Under the ACA (Affordable Care Act), the federal government mandates that most health plans, including Medicaid, cover the cost of breast pumps.

While specific conditions may apply, most eligible women under Medicaid will qualify for a covered breast pump.

Medicaid programs vary from state to state, but most cover the cost of getting a breast pump. There are several ways to check if your plan covers breast pumps.

You can call your local Medicaid office to find out how to qualify for a free breast pump or find a supplier to determine your eligibility.

There’s no need to worry, though. If you have a Medicaid plan, this review will make it easy for you to find and order a free breast pump.

Do You Need a Prescription for Medicaid to Cover Your Breast Pump

Most Medicaid programs state that you should have a prescription from a physician before you get a breast pump.

These programs often specify that moms should obtain a prescription for a breast pump close to the due date or after the baby is born.

Some moms may be concerned about this, but there is no need to panic. If necessary, most hospitals have temporary pumps on standby for you to use during your stay.

When prescribing a breast pump, the hospital must liaise with lactation services to determine the kind of pump suited for a specific mother’s condition. There are various kinds of breast pumps on the market.

What are the terms for getting breast pumps under Medicaid

Procuring a breast pump using your Medicaid plan can be a long process.

Note that it can take up to 10 working days for suppliers to get approval to proceed with delivering the pump. You can also contact the supplier directly to help streamline the process.

While the ACA mandates breast pump coverage, some state Medicaid programs may have specific conditions under which they provide them.

Instead, they only provide breast pumps under medically necessary circumstances, such as inverted nipples or extended stays in the ICU.

Some states have specified that a pump will be provided if the mother and child are alienated for long periods due to school or work.

If your Medicaid plan only covers breast pumps under these circumstances, a prescription will be needed as well as documentation showing your school or work hours.

If you have both Medicaid and a private insurance plan, your private insurance may be billed first as per the coordination of benefits rules.

This is because insurance guidelines require that your insurance plan be billed before your Medicaid plan.

Which Breast Pumps Does Medicaid Cover

Your pump options will depend on the supplier you choose, the state you currently live in, and your Medicaid plan. Don’t shy away from comparing various suppliers and their breast pump options.

The types of breast pumps available include:

  1. Manual breast pump – this is a single-user pump and it’s ideal for occasional use or daily milk extraction.
  2. Single electric breast pump – this is also a single-user pump ideal for occasional use.
  3. Double electric breast pump – this is also a single-user, and it’s ideal for moms planning to return to school or work who intend to use it long-term. However, unlike single-electric pumps, double-electric pumps are suitable for use during short breaks.
  4. Hospital-grade breast pumps are typically designed for multiple users and are intended for situations where a more durable and powerful pump is necessary. Its recommended for postnatal moms who want to maintain their milk supply.

Each breast pump supplier has various brands and models. The most common breast pumps covered by Medicaid include the Signature Pro Double Electric Pump and the Smartpump 2.0 Starter Set.

These breast pumps are moveable and lightweight, giving you a calm pumping experience at home and on the go.

These pumps also have extensions and customizable suction settings, so you can match your supply to your baby’s feeding pattern and ensure that the baby is well-fed.

Does Medicaid Pay for Breast Pump Replacement Parts

Some Medicaid programs cover replacement parts or additional breast-pumping gear. Many breast pump manufacturers offer warranties that can help cover replacement parts.

If your plan doesn’t cover replacement parts, you can order them from the breast pump manufacturer so long as they are included in the warranty.

How Can You Know Which Breast Pump Is Ideal for You

Choosing a breast pump can be pretty intimidating, particularly if you’ve never had one before. Several factors must be considered when deciding on the type of breast pump that’s perfect for you.

For starters, consider how often you’ll need to use the pump. Some moms plan to stay home for a long time after the baby is born and only need to use the pump occasionally.

Others need to go back to school or work, so they need to use a breast pump frequently because they will be gone for a long time.

Also, consider the suction power that you want from the pump. A breast pump with powerful suction should be a top priority because you’ll only spend a few minutes extracting the milk.

Some other moms have specific priorities, including silent and discrete, portable and lightweight, and display screens.

Final Thought

To sum up, most Medicaid plans will pay for breast pumps, although coverage depends on the state you live in.

Although hospital-grade breast pumps are generally not covered for personal use, Medicaid often covers the cost of double electric breast pumps for personal use.

Contact your local Medicaid office to determine which breast pumps your plan will and won’t cover.

See Also

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Hardship Grants for Single Mothers

Medical Loans for Cosmetic Surgery

What Insurance Companies Cover Weight Loss Surgery

Does Medicare Cover Weight Loss Surgery

Does Medicaid Cover Braces

Current Version
April 12, 2024
Updated By
Andrea Morales G.
August 4, 2023
Updated By
Andrea Morales G.

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