Does Medicare Cover Breast Pumps? 

Although Medicare is usually associated with retirees who are past their reproductive years, millions of Americans under the age of 65 qualify for Medicare due to disability. If you have Medicare, are pregnant and are considering nursing, you may be wondering if Medicare will help cover the cost of a breast pump.

Breastfeeding a newborn delivers essential nutrients during the first months of life. Unfortunately, not all women are able to breastfeed, and some may experience trouble with nursing. For these women, pumping milk using a breast pump may still be an option. The breast milk is collected in bottles and fed to the infant using an artificial nipple.

Breast pumps come in different forms, including those that are designed to be used while traveling or working. A breast pump can be a convenient and effective way to pump a mother’s milk in situations where natural feeding is not possible due to medical conditions for either mommy or baby.

How much do breast pumps cost?

Breast pumps range in price based on factors like size and the technology used in the pump. Some units may be available for as low as $50 while others may cost hundreds of dollars. The expense of a breast pump can be overwhelming for new mothers, especially when you factor in all of the other costs associated with bringing a new child into the world.

Private insurance plans have traditionally been reluctant to cover the cost of breast pumps, but after the passage of the Affordable Care Act, all insurance providers must include coverage for breast pumps in their plans. This is good news for mothers with private insurance, but what about mothers who are Medicare recipients?

Does Medicare Cover Breast Pumps?

Although Original Medicare was designed to provide healthcare benefits to American men and women aged 65 and over, Medicare coverage is available to Americans under the age of 65. If you have a qualifying disability and receive Social Security Disability Insurance (SSDI), you may be able to take part in Original Medicare benefits with no restriction on your age.

For mothers who qualify for Medicare, the program provides benefits for breast pumps under Medicare Part B. This is due in part to the aforementioned requirement that all insurance plans include access to breast pumps. Medicare benefits under Part B provide outpatient coverage for office visits and diagnostic testing, but they also offer benefits for durable medical equipment (DME) like breast pumps.

Although Medicare Part D, the prescription drug benefit, does not apply directly to the cost of a breast pump, you may be prescribed medications to help with natural breastfeeding. If this is the case, you will want to look at your Part D formulary, a list of all covered prescription medications included with your plan. As long as your prescription is listed in your plan’s formulary and is available to be purchased from a retail pharmacy, it should be covered by Medicare benefits.

Inpatient breast pump Medicare coverage

If you require the use of a breast pump while hospitalized in a Medicare-approved hospital or skilled nursing facility, the cost of using the breast pump is covered by Medicare Part A. This is the inpatient benefit included in Original Medicare, and it provides 60 days of 100% coverage each benefit period for hospitalization.

If you require a longer admission to a hospital or skilled nursing facility, Medicare provides an additional 30 days of coverage at a rate that is lower than the full cost of care. Beyond 90 days, lifetime reserve days can be used to continue receiving discounted care. Once lifetime reserve days have been used up, Medicare recipients become responsible for the full cost of inpatient care.

Do Medicare Advantage plans cover breast pumps?

Coverage for breast pumps under a Medicare Advantage (MA) plan will be at least the same as Original Medicare,  but many MA plans offer additional benefits like breastfeeding classes or lactation consulting. Some Medicare Advantage plan providers may require you to purchase or rent your breast pump through a supplier within the plan’s network.