Does Insurance Cover Lactation Consultants?

Dec 14, 2023 | Breastfeeding

Breastfeeding mother receiving help from lactation consultants

Breastfeeding is widely recognized as a cornerstone of infant health, providing numerous benefits to both the baby and the breast/chest feeding parent. However, many parents face challenges during the breastfeeding journey, and seeking professional guidance from lactation consultants can significantly improve the experience. While lactation consultations are essential, the financial aspect can be a concern for many families. There is a way to help meet your needs and use your insurance to help create the lactation network you need to get there. 

The Critical Support of Lactation Consultants in Breastfeeding

Breastfeeding, though a natural physiologic process, is a learned skill for both mothers and babies. Lactation consultants, IBCLCs, are specially trained professionals who provide invaluable support to mothers in overcoming breast/chest, bottle, and infant feeding challenges. They address issues such as latch problems, low milk supply, and breastfeeding positions, ensuring a successful and comfortable breastfeeding experience to bottle use, and tongue-and-lip tie support and help you establish the lactation network you need to meet your goals. Despite the recognized benefits, financial constraints can hinder access to lactation consultations. Many mothers may be deterred by out-of-pocket expenses, leading to delayed or inadequate support during a critical period for both maternal and infant health.

In recent years, there has been a growing recognition within the healthcare industry regarding the importance of lactation support. Many insurance plans now include coverage for lactation consultations as part of maternal and infant care services, but this is not extended to all insurance plans. Plans that are “grandfathered” in are exempt from certain parts of coverage. The Affordable Care Act (ACA) has played a pivotal role in expanding these coverage options, making it more accessible for parents but understanding what your plan offers is critical. Under the ACA, insurance plans are required to cover certain preventive services without cost-sharing for the feeding parent. Lactation consultations and parent support are included in this list. This means that eligible mothers can access lactation consultations early and gain much needed effective breastfeeding support.

Medicaid and Insurance Challenges

Medicaid, the state and federally funded health insurance program for low-income individuals and families, also covers lactation support. This coverage extends the reach of lactation consultations to a broader demographic, ensuring that financial constraints do not disproportionately affect those in need. However, these provisions do not allow private practice IBCLCs to become in-network with them and they are then unable to provide services through this branch of insurance.  Coverage typically only applies to established medical providers who have the expanded lactation credential. When you are choosing your pediatrician ask if they provided comprehensive lactation support outside of a standard office visit.  

Understanding Insurance Coverage for Lactation Consultants

It’s essential for mothers to understand their insurance coverage and benefits related to lactation support. They should check with their insurance provider to confirm the details of coverage, including the number of consultations allowed, any referral requirements, and in-network providers. Despite the progress, challenges remain in ensuring universal access to lactation consultations. Advocacy efforts are crucial to encourage continued improvements in insurance coverage for establishing the lactation network you will need. This includes pushing for extended coverage periods, increased reimbursement rates for lactation consultants, and further education for healthcare providers regarding the importance of breastfeeding support.

Insurance coverage for lactation consultations is a significant step toward making breastfeeding support more accessible to all mothers but not all plans are the same. As healthcare systems continue to evolve, it’s crucial to advocate for comprehensive coverage that addresses the diverse needs of mothers and promotes optimal infant health. By leveraging insurance benefits, parents can receive the essential support they need on their breastfeeding journey, contributing to the overall well-being of both mother and child.

References:
U.S. Department of Health & Human Services. (n.d.). Women’s Preventive Services Guidelines. Retrieved from https://www.hrsa.gov/womens-guidelines/index.html
Centers for Medicaid & Medicare Services. (n.d.). Maternal & Infant Health. Retrieved from https://www.medicaid.gov/medicaid/benefits/maternal-and-infant-health/index.html

Sarah Early - MSN, APRN-FNP-C, IBCLC

Sarah Early, MSN, APRN, FNP-C, IBCLC, is a clinically trained Integrative and Functional Health Family Nurse Practitioner who specializes in women's health and is the owner of Peony Women's Integrative Health and Lactation Room. She graduated with a Master's in Nursing and Family Nurse Practitioner with high distinction and is a member of the Sigma Theta Tau International Honor Society of Nursing. Sarah has been a practicing International Board Certified Lactation Consultant (IBCLC) since 2011 and opened Lactation Room in 2014. Lactation Room specializes in supporting parent/baby dyads who are struggling with infant oral dysfunction, feeding difficulties, and tongue-and-lip ties. They earned the prestigious IBCLE Care Award from the International Board of Lactation Consultant Examiners® (IBLCE®) and International Lactation Consultant Association® (ILCA®) have recognized Lactation Room for excellence in lactation care. She is a member of ILCA, USLCA, MBC, AANP, IATP, and MBC.