Medicare and Breast Pumps: Coverage Rules and Cost (2024)

Medicare primarily provides coverage for people above 65 years old. Younger people who have received Social Security disability benefits for at least 24 months can also qualify for the government insurance program.

If you fall into this category and are pregnant or have had a baby recently, you may want to purchase a breast pump. Medicare can provide some coverage because the Affordable Care Act requires all insurance companies to cover breast pumps.

Read on to learn more about Medicare coverage for breast pumps.

Original Medicare’s Part B includes suction pumps in its covered durable medical equipment (DME) list.

Original Medicare may not consider an electric pump as DME, so you may need to select a manual pump to get full coverage.

Your coverage may depend on the specific brand, even with a manual pump. You can get breast pump coverage because the law requires it, but you may not get coverage for the breast pump brand you want.

Also, you might need a breast pump while still hospitalized after giving birth or during any stay at a Medicare-approved hospital or skilled nursing facility. Medicare Part A can cover this for up to 100 days.

Does Medicare Advantage cover breast pumps?

Medicare Advantage usually provides the same coverage as Original Medicare. But it may cover a wider selection of pumps because private insurance companies manage Medicare Advantage plans.

Even so, your specific coverage might depend on what plan you select from those available in your area.

If Original Medicare approves a breast pump for home use, your coverage doesn’t kick in until you reach the $257 deductible. In 2025, you’ll also have to pay the monthly premium of $185.

The average cost of manual, handheld pumps usually ranges between $50 and $150, whereas electric pumps may be more costly at around $300. You may only pay 20% of the out-of-pocket cost if you can get Medicare coverage.

When using a breast pump in the hospital, you don’t need to pay anything for the first 60 days of your stay. From day 61 to 90, your cost is $419 per day, and from day 91 to 150, it’s $838 per day. If you stay beyond that, you need to pay 100% of the cost of your stay, including the use of any DMEs.

Your out-of-pocket costs for a breast pump with Medicare Advantage may depend on the plan.

To get a breast pump through Original Medicare or a Medicare Advantage plan, start by calling your insurance provider to confirm the benefits. Doing this a few weeks before giving birth is a good idea because getting approval and receiving the pump might take time.

You may need to provide a doctor’s prescription for a breast pump, and the clinician needs to have an affiliation with Medicare or your Medicare Advantage plan network. Similarly, your doctor must make a medical order for a breast pump during hospitalization under Medicare Part A.

From here, your insurance provider may ask that you choose from certain suppliers or brands. Once you select what you want, the supplier must order and ship it directly to you.

Original Medicare and Medicare Advantage cover many types of medical devices. These include but aren’t limited to:

Some people younger than 65 years old may qualify for Medicare under certain conditions. Medicare usually provides coverage under Part B for pregnant people who want to purchase a breast pump.

Coverage may depend on whether you want a manual or electric pump and whether you have Medicare Advantage or Original Medicare coverage.