Do I Need to Pay for an Upgrade on My Breast Pump?

When the Affordable Care Act went into effect in 2010, many moms-to-be were thrilled that insurance companies were now required by law to cover the cost of getting a breast pump.

And while the law has certainly helped make breast pumps more affordable, the law didn’t say that insurance companies had to cover all types of pumps. Instead, insurance companies were allowed to decide what the maximum amount was that they would cover for a breast pump under each individual plan.

Almost all insurance plans, including Medicaid, will cover the cost of at least some type of electric breast pump. However, depending on the type of health insurance plan that you have, your plan may only cover a few pumps completely.

If you’re interested in getting a pump that is more expensive than the one your insurance plan will cover, you usually can do that by paying an additional fee yourself. This is called an upgrade.

The number of pumps that you can choose from that are fully covered and the number you can get for an upgraded fee depends on what type of plan you have and what state you live in. For example, if you have Blue Cross and Blue Shield in Illinois, the maximum amount they will pay for a pump is $150, so any pumps that are more expensive than that are available for an extra charge. In Wisconsin, Blue Cross and Blue Shield will pay for pumps that cost up to $95, so anything over that would be available for an upgrade.

Typically, the upgrade cost is the suggested retail price minus the reimbursement of the patient’s insurance company. So, depending on your plan, you may be able to get an upgraded pump for as little as $30 or as much as $375 extra.

Can I Get an Upgraded Pump With Medicaid?

Unfortunately, due to government restrictions, Medicaid recipients cannot qualify for upgrades on breast pumps. However, that doesn’t mean that you can’t get a good pump if you have Medicaid. In fact, Medicaid recipients in Illinois can choose from seven different pumps — including ones with features such as rechargeable batteries and carrying cases, as well as the popular Medela Pump In Style Advanced — so you still have many good pumps to choose from that are covered at no cost to you.

Is It Worth It to Pay for an Upgraded Breast Pump?

Whether or not it is worth it to pay a little extra for an upgraded breast pump is up to you. For some moms, getting a pump that works well and is completely free is the best option, while others may feel that the bonus features you can find on more expensive pumps may be worth the investment.

For example, hands-free, wearable breast pumps — such as the Elvie, which retails for $549 —are more expensive than most traditional breast pumps, so they are usually not covered completely by insurance plans. But some moms think that the benefits of being able to wear your pump under your clothes without any wires make these pumps worth the extra money.

Similarly, other pumps that are available for an upgrade have other desirable features. The Medela Freestyle Flex (which retails for $379.99) is a compact, lightweight pump that comes with a rechargeable battery and smart technology that allows you to track your pumping sessions via an app. And the Unimom Opera Hospital Grade Pump (which retails for $599.99), comes with a rechargeable battery and a twin motor system that allows you to have different types of suction on each side.

How Can I Find Out Which Pumps Are Covered Under My Insurance?

The best way to decide if you want to spend the extra money on an upgraded pump is to fill out our qualify form on our website. We’ll be able to give you a list of pumps that you qualify for and let you know how much more you’d have to pay out of pocket for the upgraded pumps. Then you can do your research on each one to find out which pump is best for your budget and lifestyle. (We even have a feature on our website where you can compare up to three different pumps at a time).

Use Your FSA To Save Money on Upgraded Breast Pumps

One pro tip: If you have a Flexible Spending Account, which is a special, tax-free account that you can put money into to pay for medical expenses, you can pay for your upgrade costs with your Flexible Spending Account money so you don’t have to pay taxes on it.