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 and your baby must be registered under Medicaid.
Under the ACA (Affordable Care Act), the federal government requires insurance programs such as Medicaid to cover the cost of breast pumps. Although there are several conditions to this rule, most women will qualify for a free breast pump using their insurance plans.
Medicaid programs vary from state to state, but most of these programs cover the cost of getting a breast pump. There are a couple of 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. 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 also specify that moms must wait until the baby is born or a few weeks to their due date (usually two to four weeks) to get the pump.
This is a cause for concern for some moms, but 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 find out the kind of breast pump suited for a specific mother’s condition because there are various kinds of breast pumps in the market.
What The Terms of 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 before suppliers get approval to move forward with delivering the pump. But, no need to worry; you can contact the supplier directly to help streamline the process.
Some state Medicaid programs will not provide free breast pumps as per the ACA. 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 a Medicaid plan and a private insurance plan, you need to provide the personal insurance card. This is because insurance guidelines require that your personal insurance plan be billed prior to 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 the breast pump options they have.
The types of breast pumps available include:
- Manual breast pump – this is a single-user pump and it’s ideal for occasional use or daily milk extraction.
- Single electric breast pump – this is also a single-user pump ideal for occasional use.
- 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.
- Hospital-grade breast pumps – this is a multi-user pump meant for both short and long-term use. Its recommended for postnatal moms who want to maintain their milk supply.
Each breast pump supplier has various brands and models. Some of the most common breast pumps covered by Medicaid include 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 that you can match your supply to your baby’s feeding pattern, thereby ensuring 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. However, most breast pump manufacturers provide their own warranties to help moms get what they need.
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. There are several factors that you must consider when deciding 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 at home for a long time after the baby is born, and they 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. Having a breast pump with powerful suction should be a top priority because you’ll only spend a couple of minutes extracting the milk.
Some other moms out there have specific priorities including silent and discrete, portable and lightweight, display screen, etc.
To sum it all up, most Medicaid plans will pay for breast pumps, although coverage depends on the state you currently live in. Also, most states don’t cover hospital-grade breast pumps, but they will cover the cost of leasing or buying your own double electric breast pump.
Contact your local Medicaid office to find out which breast pumps your plan will and won’t cover.