Do Medicaid and WIC Cover Breast Pumps?

Thanks to the Affordable Care Act (ACA), many moms now have access to high-quality breast pumps covered partially or in full by their insurance. But, the rules and guidelines for breast pump coverage and what costs are covered vary greatly by provider. Because Medicaid is a joint state and federal program, the discretion of coverage benefits is left up to each state and therefore causes disparities between different regions of the United States.

Most state Medicaid plans will cover the entire cost of a breast pump, but Medicaid covers these services differently than private insurance companies. So, what are the Medicaid guidelines for breast pumps? And how will you know the specific stipulations of your policy? Will having a Managed Care Organization make a difference?

Obtaining a breast pump through Medicaid can be an extensive process. Because lactation services are not specifically mentioned or outlined in the Medicaid guidelines, some state Medicaid health plans do not cover a free breast pump with insurance per the Affordable Care Act. There is a wide variety in scope and coverage from state to state for those seeking assistance with pre and postnatal care under Medicaid. 

Instead of reimbursing all moms for pumps, Medicaid may only cover these costs in medically necessary circumstances, including long stays in the NICU, inverted nipples, and similar situations.

Certain states do stipulate that if the mother and baby will be separated for extended periods (due to either work, school, or other needs), a breast pump will be covered. If your policy only covers the pump under these circumstances, a prescription will be required as well as documentation verifying your work or school time commitments.

The best way to find out if you are covered for a breast pump through insurance is to submit our quick and easy Qualify Through Insurance Form. Please note that some Medicaid plans require prior authorization to receive a breast pump, which can take up to 10 business days. Aeroflow Breastpumps will work with you and your healthcare provider to gather the correct information from your insurance.

If you have both a commercial insurance plan and a Medicaid plan, it is important to provide us with your commercial insurance plan first. Insurance guidelines require that a patient's commercial/primary insurance be billed before their Medicaid plan.

Many Medicaid policies require that you have a prescription on hand before you can get your breast pump covered in any capacity. Most policies also require that moms wait until they give birth, or, at the very least, are close to their anticipated delivery date (typically from 2 weeks before to 30 days after their due date) to obtain the pump. This can cause alarm for some mamas, but don’t fret! If necessary, many hospitals will provide a temporary pump to new moms during their hospital stay when necessary.

Some Medicaid policies require that breast pumps meet specific performance and manufacturing standards, and have warranties (luckily, most pumps do!). If you are covered for a breast pump under your Medicaid plan, Aeroflow Breastpumps offers you the best breast pumps that comply with the standards outlined by your health insurance.

Most Medicaid insurance guidelines for breast pumps will only cover personal use of standard electric pumps or manual pumps and not hospital-grade breast pumps. If your Medicaid insurance coverage does not include a breast pump, one of our specialists can discuss your possible options.

Though coverage varies greatly from person to person, some of the insurance-covered breast pumps we offer that are included under Medicaid are:

• The Spectra S2 PLUS Double Electric Breast Pump weighs just 3 lbs and is extremely quiet, offering you the privacy that you need and want. It can be combined with the Aeroflow Breastpumps Sydney backpack for optimal organization.
• For a simple, manual, straightforward breast pump, try the Motif Manual Breast Pump. It’s flexible and made of 100% food-grade silicone. There are so many benefits to this simple pump—no extra parts, pieces, wires, or assembly—and it’s compact and easy to use.
• Lansinoh’s Wearable Double Electric Breast Pump offers a hands-free option with tons of opportunities for customization, from multiple flange size options to customizable pump settings. Plus, it comes with larger, 8 oz click-tight cups. There are no cords or tubes to deal with and the pump is lightweight while providing hospital-strength pumping power.
• The Zomee Z2 Double Electric Breast Pump makes it possible to customize how you pump with three different modes and 19 different suction levels that mimic a baby’s natural nursing rhythm. The pump is designed to be comfortable, efficient, lightweight, and pain free.
• The Philips Avent Manual Breast Pump is another great manual breast pump option that is gentle and comfortable. The pump’s Natural Motion Technology is a combination of suction and nipple stimulation to help quicken milk flow.
• The Evenflo Deluxe Advanced Double Electric Breast Pump is great if you need to pump multiple times throughout the day. With multiple options for customization, the pump is designed to make each session efficient and comfortable.
• If you’re looking for another manual breast pump option, the Medela Harmony Manual Breast Pump can be used when you’re away from your baby or as a backup for an electric pump. The pump was designed to be portable and discreet and has an ergonomic swivel handle that makes pumping more comfortable.
• For a compact, lightweight, quiet pump, try the Ameda Mya Joy Double Electric Breast Pump. Its variety of settings, flange sizes, and features make it possible to customize your pumping experience to suit your needs. 

These aren’t the only pumps that can be covered by Medicaid—see more here. To determine which pumps are covered by your unique plan, fill out our form.

Aside from covering your breast pump through insurance, Medicaid also can provide coverage for milk storage bags and postpartum compression garments. These are medical devices that have been designed by healthcare professionals to provide support, relief, and stabilization for increased comfort during pregnancy and to assist with postpartum healing.

Browse pregnancy compression and postpartum recovery items on our website.