Breastfeeding Cafe
05/05/2014, 10:00am
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Maryland Breastfeeding Resource Guide
Insurance Coverage for Breast Pumps

Affordable Care Act Coverage of Breast Pumps

Effective 8/1/12 the Affordable Care Act (ACA) expands health plan coverage to include breastfeeding support and supplies. Breast pump coverage will vary among insurance plans, so check with your insurance policy handbook or call the customer service number on the back of your insurance card to find out the details of your benefits. Before calling, talk with a Lactation Consultant about which pump is best for your situation, especially if your baby is in the NICU or you plan on returning to work and will need to pump on a regular basis to build up or maintain your milk supply.

Questions to Ask Your Insurance Company

  • What type of pump can I get? (hospital-grade rental pump, double electric personal-use, single electric personal-use, battery or manual pump)
  • Do I have to get the "recommended" pump or can I choose to purchase one and submit the receipt for reimbursement?
  • If yes, what amount will I be reimbursed?
  • Is there a dollar limit on coverage for breast pumps?
  • If I have already obtained a breast pump, can I submit a claim for reimbursement?
  • Do I have to get the breast pump approved first?
  • When can I get my breast pump? before giving birth? after the birth of my child?
  • Where can I get my breast pump? Does it have to be from a designated place or can I choose where to get it?
  • Do I have a rental pump option?
  • Do I need a prescription for proof of medical necessity?

You may also contact one of the following DME (Durable Medical Equipment) suppliers to obtain your breastpump under the Affordable Care Act. Most insurance companies require that expectant and postpartum mothers work with an in-network or participating DME supplier.

SunMed 800-714-7434
Byram Health Care 877-773-1972
Neb Doctors of Maryland 410-335-6175
Adam Medical (Cigna) 240-566-5638

A sample Breast Pump Prescription is available here. This can be printed out and brought to your physician to be used as a Letter of Medical Necessity for a pump.

Breastfeeding supplies and services that assist lactation and are not covered by your insurance are now considered medical care by the IRS and are may be tax deductible. Some may qualify for reimbursement through a health flexible spending account (FSA) or health savings account (HSA). Contact your employer's benefit provider to find out what is covered under your specific FSA or HSA and the steps needed for reimbursement. If you do not have an FSA or HSA, you can deduct breastfeeding costs if you itemize your tax returns and if your total unreimbursed medical expenses exceed 7.5 percent of your adjusted gross income.

Further information can be found at the following links:
HRSA - Women's Preventive Services: Required Health Plan Coverage Guidelines - Affordable Care Act Rules on Expanding Access to Preventive Services for Women
Medela - Breastfeeding Insurance and Reimbursement
Ameda The Daily Feed - New Guidelines
CMS - Medicaid Coverage of Lactation Services

Straight Medical Assistance (MA) / Medical Assistance Managed Care Organizations (MCOs)

These programs will usually provide a hospital grade breast pump while the baby is in the Neonatal Intensive Care Unit (NICU) at the hospital if: 1) the length of stay is longer than a week, 2) the mother has a Durable Medical Equipment (DME) benefit, and 3) a prescription is obtained from the baby or mother's health care provider. The prescription should be faxed to the MCO by the hospital representative. The Durable Medical Equipment company provides the pump. Once the pump is ordered, the DME company representative will call the mother to arrange for delivery. Coverage of double electric or hospital-grade breast pumps may also occur with a letter of medical necessity. You will need to contact your individuals health plan.

Detailed information for obtaining a breast pump for a sick baby who has Medicaid MCO is available and can be obtained by contacting or your health plan.

Other Options Available:

Pregnant Women and Children's Program is part of the Maryland Department of Health and Mental Hygiene. For more information, call 1-800-456-8900.

Stork's Nest is located at University of Maryland Medical Center and provides breast pumps to mothers of NICU babies, who are enrolled in this program and meet criteria to qualify. For more information, call 410-328-2944.

Women, Infants and Children (WIC) has a limited number of pumps available for WIC participants, whose babies are in the NICU. Mothers should contact the breastfeeding coordinator for her local WIC program. For more information, call the WIC hotline at 1-800-242-4WIC or visit