Coverage for breast pumps

Does insurance cover breast pumps?

If you use SSM Health at Home, you can get a manual or electric breast pump covered at 100 percent as part of your Durable Medical Equipment (DME) benefit.

Eligible members can also rent a hospital-grade dual electric pump with required prior authorization. The rental may be subject to your cost-sharing responsibilities. See the Durable Medical Equipment benefit under your plan.

Your doctor’s office will need to submit the required breast pump order form or information to SSM Health at Home at 866-553-0824. Once SSM Health at Home receives your breast pump order, they will contact you to arrange for pick-up or delivery.

If you're a commercial member

We cover one breast pump per birth. You may receive a breast pump up to four weeks before your estimated delivery date. Have your doctor submit the breast pump order form or send the following information to SSM Health at Home by fax or electronic medical record:

• Your full name
• Your date of birth
• Your mailing address
• Your phone number
• Your member ID number
• An explanation of need (e.g. "patient delivered a baby on mm/dd/yy and needs a breastpump to help with breastfeeding)
• Type of breast pump you are requesting:
  • Manual
  • Electric
  • Hospital grade rental (prior authorization required)
• Provider name, address or location, and signature

Find out more in our FAQs for commercial members.

If you are a BadgerCare member

We cover one breast pump (rechargeable/wearable or electric) per delivery for all members, including those with Medicaid. This is an exception to Medicaid’s policy which covers a maximum of three breast pumps per member.

Follow Medicaid’s breast pump policy to request the electric or manual breast pump after delivery.  You can request a breast pump by having your doctor complete the ForwardHealth (Medicaid) Breast Pump order form after delivery and sending it to SSM Health at Home in Epic or by fax to 866-553-0824.

Find out more in our FAQs for Medicaid members.