Understanding Medicaid Covered Breast Pumps 

If you aren’t currently insured and you’re looking for coverage options, Medicaid can be a good place to begin. Medicaid provides health coverage to over 70 million Americans, including low-income adults, children, pregnant women, elderly adults, and people with disabilities. To help those who need it, Medicaid works to cover a broad range of different health services in an effort to limit out-of-pocket costs. It was signed into law in 1965 in conjunction with Medicare and is overseen by the federal government. With that being said, each state administers their Medicaid program differently, which means that Americans experience varied coverage based on where they live. This makes understanding Medicaid covered breast pumps a little confusing.

In 2014, the Affordable Care Act gave the authority to expand the eligibility for Medicaid coverage and created a more standardized process for determining eligibility and providing benefits. Within this expansion of coverage, all Health Insurance Marketplace® and Medicaid plans are required to cover pregnancy and childbirth, even if your pregnancy begins prior to the start of coverage. This coverage varies depending on specific rules in each state but works to help with pre-natal care and delivery costs.

There are stipulations to coverage. For example, if you’re eligible for Medicaid due to pregnancy, you may only be covered until 60 days postpartum. At this time, a Medicaid agent may be in contact with you to notify you of changes. If you have Medicaid when you give birth, your newborn is automatically enrolled in Medicaid for at least one year.

Information Regarding Medicaid Breast Pump Coverage Terms

As with all federal programs, state coverage varies. In some instances, the process for obtaining your Medicaid covered breast pump can take a considerable amount of time and effort. In some states, breast pumps aren’t covered under the Affordable Care Act. While this doesn’t mean that you won’t be able to receive one at all, you may need to enter information about why a breast pump is medically necessary. For some women, this can be difficult to explain. Some of the reasons for medical necessity, as defined by Medicaid plans, include inverted nipples, premature birth, oral defects, breast infections, or an inadequate milk supply. If your baby needs to stay in the NICU for prolonged periods of time or cannot latch properly, you may also be eligible for coverage. Work with your doctor to better understand your nursing needs and determine what, if any, your medical eligibility is.

You may also be able to obtain eligibility if you and your baby will be separated for extended periods, such as in the case of attending school or going back to work. Under these conditions, Medicaid will provide breast pump coverage. However, you will need to present documentation to show that you are legitimately in need. This is where Medicaid differs from private health insurance. While it can be frustrating, working with Byram Healthcare can make the process easier. If you’re worried about your coverage, talk to your doctor to learn more about how you can obtain a prescription.

Prescription Requirements for Breast Pumps

Under almost all Medicaid policies, you will be required to have a prescription in order to qualify for an insurance covered breast pump. Ask your doctor to write you a prescription or partner with a medical supply company for assistance in acquiring one.

Types of Breast Pumps Covered by Medicaid

Medicaid coverage for breast pumps is similar to coverage from many insurance providers. The guidelines for breast pump coverage state that they can only be obtained for personal use and that Medicaid will cover one standard electric pump or manual pump per woman, per pregnancy. This does not include hospital grade pumps, so if you need the extra strength, you may need to purchase something out-of-pocket or talk to your hospital about how to obtain one.

When Can I Get my Breast Pump?

Medicaid has a timeline that they usually uphold for all state coverage. Many policies require that expecting mothers wait to receive their breast pumps until their baby is born. Some states allow mothers to receive their breast pump early, but most Medicaid coverage options take two weeks to four weeks after delivery in order to submit the paperwork and obtain it. If you’re worried about getting your breast pump in a timely manner, talk to your hospital about options for temporary pumps.

Do I Need a Breast Pump Warranty?

Depending on your Medicaid coverage and state of residency, you may be required to obtain a breast pump that is covered under a warranty. This is often to make sure that the breast pump you receive meets certain standards as defined by Medicaid’s eligibility coverage. Luckily, all of the breast pumps ordered from Byram Healthcare come with a warranty of at least one year.

Does Medicaid Cover Breast Pump Replacement Parts?

While certain Medicaid plans may cover replacement parts, it’s best to check your warranty first. Since most pumps come with a limited warranty, it will be easier and more streamlined to go through the manufacturer than Medicaid.

When ordering from a medical supply company like Byram Healthcare, please be informed that it may take some time to receive the proper authorization from Medicaid. This is due to insurance processing and is an external factor that’s out of our control. If you have any questions about your insurance covered breast pump, please reach out to one of our representatives.

Does Medicaid Cover Any Other Pregnancy-Related Items?

While it may seem like Medicaid’s options are limited, they do provide certain coverage for maternity compression garments alongside breast pumps. Maternity compression garments are considered medical devices, as they have been scientifically shown to help provide expecting mothers with additional support that relieves aches and pains and helps to improved overall stabilization. Maternity compression garments have also been shown to have a number of benefits on the body and can help with comfort and postpartum healing. The coverage for these items varies, but many policies will cover maternity compression bands, compression socks, and even postpartum recovery bands.

States are required to add counseling and pharmacotherapy benefits for pregnant women under Medicaid coverage.

Medicaid’s Breast Pump State-to-State Differences

Medicaid is considered to be a federal-state partnership. While the federal government upholds certain standards, it’s up to the state’s discretion on how they would like to follow these standards. Due to this, the eligibility and parameters that surround Medicaid covered breast pumps can vary. Unfortunately, North Carolina Medicaid does not currently cover breast pumps. This is one of the only states with such extreme limitations and therefore, we recommend looking into The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) for alternative support. There are a few local breast pump programs that can help. For information on other state coverage, contact your State Medicaid Agency.

It should also be mentioned that if you have a commercial insurance plan and a Medicaid plan, you will need to provide both. According to the federal and state insurance guidelines revolving around pregnancy-related care, your primary insurance needs to be billed before Medicaid.

How to Order Your Medicaid Covered Breast Pump

If you’re unsure about whether or not you qualify for a Medicaid covered breast pump, get started with the process at Byram Healthcare. Our easy, three-step ordering allows you to streamline the process and better understand your requirements and coverage eligibility. Once you understand your coverage options, it’s time to start looking for the right breast pump. Certain states or local coverage have limited options, which is why determining eligibility is a good first step. This helps you narrow things down and makes the research process easier.

While choosing a breast pump can seem overwhelming, the important thing is finding something that works for you. Some women prefer electric pumps, while others don’t mind using a manual one. Take your time comparing different models and when you’re ready, begin the ordering process at Byram Healthcare. We aim to make the process of ordering a Medicaid covered breast pump as easy and efficient as possible, even if it sounds overwhelming at first. If you have any insurance-related questions or concerns, feel free to use our live chat to speak with one of our breast pump experts.

For other tips on breastfeeding, breast pump selection, and how to navigate the complexities of pregnancy, Byram Healthcare is here to help.