Medicaid covers most services in a different way than private insurance companies; for the most part, Medicaid has stricter guidelines and stipulations for almost every benefit. But what are the Medicaid insurance guidelines for breast pumps? How will you know the specific stipulations of your policy? Will having an MCO make a difference? We have the answers to all of your questions!

Prescription required for breast pumps

Most Medicaid policies require that you have a prescription on hand before you get your breast pump. Most policies also require that moms wait until the birth of the baby or close to it (typically 2 weeks-30 days out from delivery) to obtain the pump. This can cause some alarm for some mommies, but, do not fret — most hospitals will provide a pump if one is necessary during mom's hospital stay.

Breast pump warranty

Some Medicaid policies require that pumps have warranties (which most pumps do).  A lot of people think that since a company is in network (contracted) with a state's Medicaid, they are in network with all the different forms of Medicaid for that state, but this is not so. There are MCO’s (or Managed Care Organizations) that manage different Medicaid policies and a company must be contracted with a specific MCO to be considered “in network”.

Types of breast pumps covered by Medicaid

Most Medicaid insurance guidelines for breast pumps will only cover personal use standard electric pumps or manual pumps, not hospital-grade breast pumps.

It is also important to note that if you have Medicaid as well as WIC, you may qualify for a breast pump through your insurance. You can contact your local WIC office to find out if your policy is covered.

Medicaid breast pump coverage terms

Some state Medicaid plans will not cover breast pumps per the Affordable Care Act at all — rather, they cover them per medical necessity (baby in the NICU, inverted nipples, etc), or not at all. As of 2016, states with plans that don't cover breast pumps could face fines if they do not change their policies, although this could change with future legislation. Certain states have stipulated that if the mother and baby will be separated for extended periods of time (due to either work or school), a pump will be covered.

Aeroflow Breastpumps can help you!

While we are not able to work with all Medicaid policies, Aeroflow Breastpumps strives to provide the best possible products to every mom at a great price. We have also extended special offers to moms in some states that have Medicaid plans we are in-network with, but which do not cover pumps.

You can find out if your policy is compliant by completing our simple Qualify Through Insurance form or by contacting a Breastpump Specialist directly at 844-867-9890. A representative will verify your coverage and network status, and be in contact with you with your options within 3-5 business days.

If you have additional questions about the Medicaid insurance guidelines for breast pumps, give us a call today at 844-867-9890. We’re here to help!