Some people say that nursing your baby is “free”— and while there certainly are unique cost savings associated with feeding human milk, there can be expenses associated with it, too. How can you maximize your lactation-related benefits? And what does the law have to say? Adriana shares practical tips about the financial side of infant feeding.
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- Breastfeeding Benefits: Understanding Your Coverage Under the Affordable Care Act, National Women’s Law Center
- Breastfeeding Benefits, HealthCare.gov
- Medicaid Coverage of Lactation Services, Department of Health & Human Services Centers for Medicare & Medicaid Services
- Medicaid Coverage of Pregnancy-Related Services: Findings from a 2021 State Survey, Kaiser Family Foundation
- Medicaid Postpartum Coverage Extension Tracker, Kaiser Family Foundation
- WIC Breastfeeding Support, U.S. Department of Agriculture
- Who Gets WIC and How to Apply U.S. Department of Agriculture
- Establishing a TRICARE Childbirth and Breastfeeding Support Demonstration, Federal Register
- Lactation Expenses as Medical Care, Internal Revenue Service
- Breast-feeding supplies deductible, IRS rules, Reuters
- IRS Publication 502, Internal Revenue Service
- The Difference Between A Flexible Spending Account (FSA) And A Health Savings Account (HSA), National Institutes of Health
- I Still Have to Pay Out-of-Pocket for My Lactation Consultation, National Women’s Law Center
- Lactation Consultants and the Affordable Care Act, Annie Frisbie, IBCLC
- New Benefits for Breastfeeding Moms: Facts and Tools to Understand Your Coverage under the Health Care Law toolkit, National Women’s Law Center
- Breastfeeding State Laws, National Conference of State Legislatures
- Breastfeeding and the Affordable Care Act, Pediatric Clinics of North America
- Effect of the Affordable Care Act on Breastfeeding Outcomes, American Journal of Public Health
- Suggestions for Billing Codes for IBCLCs, United States Lactation Consultant Association
- Supporting Breastfeeding and Lactation: The Primary Care Pediatrician’s Guide to Coding, American Academy of Pediatrics
- Women’s Preventive Services Initiative (WPSI) 2022 Coding Guide (most recent year), Women’s Preventive Services Initiative
- Got Lactation Service Questions? We’ve Got Answers, Codify by AACP
- Look For This Documentation for Lactation Services, Codify by AACP
- La Leche League USA website
- Breastfeeding USA website
- Baby Café website
- Chocolate Milk Café website
- Find a Milk Bank tool, Human Milk Banking Association of North America
- Human Milk 4 Human Babies network map
- Eats on Feets website
- The risk of infectious pathogens in breast-feeding, donated human milk and breast milk substitutes, Cambridge University Press
- Donor Human Milk: More Valuable Than Gold? National Conference of State Legislatures
- The effectiveness of prenatal breastfeeding education on breastfeeding uptake postpartum: A systematic review, Midwifery
- Prenatal breastfeeding education and breastfeeding outcomes, The American Journal of Maternal/Child Nursing
- Facebook support for breastfeeding mothers: A comparison to offline support and associations with breastfeeding outcomes, Digital Health Journal
- Sources for ordering a pump:
Related Birthful episodes:
- How Nipple Shapes Can Impact Breastfeeding
- Going Back to Work
- Emotional Prep for Going Back to Work While Breastfeeding
- [Breastfeeding] Working while Breastfeeding
- [Breastfeeding] All About Pumping!
- [Breastfeeding] How Does Milksharing Work?
- How to Stand Up for Your Birth Rights
Milk Your Lactation Benefits!
Adriana Lozada: Welcome to Birthful Mighty Parent or Parent-to-Be! I’m Adriana Lozada and as part of our series to help you get a head start on your postpartum logistics, today’s episode is going to be one of those shorter episodes that I do from time to time without a guest, to focus on a topic that I want to dive deeper into.
So for this one, I’m going to be talking about the logistics and cost savings associated with breast- or chest-feeding your baby, and how you can make the best of the benefits and resources available to you so that you can set yourself up for success.
And just a quick note that I’ll be using the word “lactation” to refer to the act of feeding your baby milk from your body, and this can be used interchangeably with terms like breastfeeding, chestfeeding, and bodyfeeding, just to name a few. This also includes pumping— so for those of you who occasionally or exclusively pump milk for your baby or child, this episode is for you, too! Now, until just over a decade ago, many of the things related to lactation care were not covered by insurance. However, under the Affordable Care Act of 2010, this changed… for the better! The Affordable Care Act, or ACA for short, strongly emphasizes preventative care. And so as part of that preventative care, things like education, support, and tools are included, because lactation has noted health benefits for the baby and the lactating parent. In the language of the ACA, you are entitled to “comprehensive prenatal and postnatal lactation support [and] counseling” and the cost of your lactation-related supplies (so for example a pump) must be covered “for the duration of breastfeeding.” Okay, so, then… Research shows that if you take a prenatal lactation education course, it can increase your feelings of self-efficacy, meaning how you feel about your ability to do things, especially ones that are challenging. It also can increase your likelihood of exclusively feeding your baby human milk, and for a longer duration than if you had not received prenatal education. Many hospitals and birth centers provide lactation education among their prenatal course offerings, but you should also consider learning from an independent lactation consultant, too. Nevertheless, whether you learn individually or in a group setting, in-person or online, the evidence shows that prenatal education can help you meet your infant feeding goals.
In terms of how to cover the costs, some hospitals and clinics offer lactation care services that are billed to your insurance like any other care you receive there. However, you need to make sure your provider is suitably credentialed— for example, we love pediatricians as baby care providers, but unless they have completed robust lactation-specific education beyond their medical studies, they are not qualified to offer you advice on lactation management. You save money by getting right-size help from a qualified professional when you need it! Also, know that there isn’t such a thing as a “lactation nurse,” as far as credentials go, so if you hear that someone is a “lactation nurse,” then they are probably a registered nurse (RN) that also has earned the International Board Certified Lactation Consultant (IBCLC) credential, but you really have to ask to be sure.
And since we’re touching upon the topic of credentials, know that there is a significant difference in training between an IBCLC and a Certified Lactation Counselor (CLC). Things can get more confusing because some people use consultant and counselor interchangeably, even though they are two very different credentials. For the support to be covered under insurance, though, you most likely will be required to see an IBCLC (so a certified lactation consultant and not a lactation counselor). Which isn’t to say that all IBCLCs are better than CLCs, but IBCLCs have had to receive many more hours of education, submit clinical hours and complete a board examination while CLCs do not, although there are amazing CLC out there that has extensive experiential knowledge.
If there are concerns about your milk supply, how baby transfers milk, or their overall weight gain, or if either of you have medical conditions that require extra care (for instance, polycystic ovary syndrome for you, or a facial difference like cleft palate for baby), you need to escalate the care you receive so that it comes exclusively from an IBCLC or even a doctor specialized in lactation medicine. Understanding scope of practice and how lactation support professionals are tiered will help you save money, by getting the most targeted help. And know that IBCLCs work in the hospital setting, but there are plenty in private practice, as well.
And one last thing, those with a medical-level background, like the IBCLC or doctor in lactation medicine, are generally going to be the most familiar with medical coding and submitting to insurance, either for pre-approved services or retroactively providing you with a superbill that you can submit to insurance for reimbursement. Which is important because sometimes your claim might get denied because it was not properly coded… not because the service you received is ineligible for coverage!
Another reason that you might have trouble getting coverage at first depends on just how many lactation consultants are in your area, let alone in-network with your insurance. If you get in touch with your health insurance provider and say that there are no lactation consultants in your area who are in their network, do not fret! You might have recourse in something that is called a “gap exception,” which involves your insurance provider reimbursing a lactation consultant of your choice at in-network rates when the insurance company is unable to provide anyone in-network within a reasonable geographic distance. Some insurance companies may not display this information up readily—so you will have to prod them, but they legally have to provide you with a workable solution.
When it comes to health insurance, you also should double-check if your plan is one that is “grandfathered” in, meaning that its benefits and coverage predate the ACA and therefore are exempt from the expansion that made lactation care and tools more accessible. Hopefully this is not your case!
If you receive state assistance, like Medicaid or Women, Infants, and Children (WIC), you will often have access to lactation benefits. The government has a vested interest in promoting lactation, since its proven health benefits for parent and baby lead to a reduction in the cost burden on the healthcare system. Still, you will have to verify exactly what benefits you are eligible for with your caseworker, because there are slight variations in how this works in practice, from state-to-state. In many states, though, WIC programs will not only be able to supply you with a pump at no cost, but they also have free peer counseling services. The eligibility threshold for WIC is higher than for other forms of state assistance, so if you have not qualified for aid in the past, you might now that you are pregnant.
Even if peer counselors are not able to address every lactation challenge sufficiently, you can (and dare we say, should!) absolutely utilize peer-led support groups. Not only are these support groups often free to you, they can help you gain a sense of community, in addition to resolving basic lactation issues early on or referring you to more specialized care if you need it. Some common peer-led support group networks include La Leche League, Breastfeeding USA, and Baby Café, but you can also find culturally-congruent care in some cases. For instance Chocolate Milk Café provides peer-led lactation support for the Black community. If you are not able to find a group local to you, some research has shown that it helps to join a virtual support group on social media—but ideally treat it like adding tools to your kit, and mix that virtual support with in-person care to maximize your options, when possible.
Speaking of which, if you are in a pinch or live in a rural area: Go virtual! Services like The Lactation Network exist to help get you matched quickly with a lactation consultant who takes your insurance and can assist you via telehealth.
If you are lucky enough to benefit from an employer-sponsored account that can be used for healthcare-related expenses—such as a Flexible Spending Account (FSA), Health Savings Account (HSA), or Health Reimbursement Account (HRA)—many lactation-related items are eligible “medical expenses” for which you can use your funds. Some things that may be covered include pumping bras, milk collectors or silicone pumps, disposable and reusable nursing pads, milk storage bags (even the reusable silicone ones), cooler bags, nipple balm, pump parts, and breast pumps. And even if your primary health insurance plan covers a pump, some people prefer to put FSA, HSA, or HRA funds toward a second pump, for convenience’s sake.
Now, if you plan to express or pump your milk occasionally or exclusively, you’re going to need a pump, and if you have health insurance then your benefits may well cover a good selection of great pumps. There are many different vendor websites like Babylist Health, Aeroflow Breast Pumps, or Yummy Mummy that specialize in working with insurance companies and are ready to make it easy for you to see what pumps may be available to you, request a prescription from your doctor, verify your coverage and even get the pump delivered to your door. They can even provide you with upgrade options. And of course, you can also contact your health insurance directly, and while there, ask if they include retail outlets like Walmart and Target in their in-network providers, which can be another easy way to get your pump.
And when considering a pump, remember to also take into account the “sunk cost” related to the consumable parts—we are talking valve membranes, duckbill valves, backflow protectors, flanges, tubing (all the parts!). Each is subject to wear and tear, and when your pump parts aren’t in prime condition, you risk weak suction that can compromise efficient milk removal. So, work smarter, not harder! Especially if you are exclusively pumping, remember that estimates for how long it takes those pump parts to wear out are typically based on part-time (not full-time) use, so adjust accordingly. If for any reason you happen to need a hospital-grade pump, ask your lactation consultant where you can rent one.
Another scenario you might find yourself in, either temporarily or for an extended period of time, is relying on donor milk. If you have a premature baby who requires neonatal intensive care, you may have increased access to banked donor milk, because it can help minimize the risk of conditions like necrotizing enterocolitis (NEC), which causes bowel death, and is associated with formula use for these extra vulnerable babies. However, your NICU care team might not suggest using donor milk, so if you are unable or unwilling to pump your own milk, you may have to advocate for your baby’s access to it.
If your baby receives donor milk in the hospital, it will come from a milk bank. Another option is something called “community-acquired donor milk,” which means you get it from a community member and not the milk bank. Some people also call this “informal milksharing,” and using community-acquired donor milk shifts the safety responsibility from the milk bank to you and the relationships you have cultivated, which are probably not “informal” at all!
In order to donate to a milk bank, the donors must undergo health screenings. Their milk will be tested and pasteurized before it can be consumed by infants. This can provide extra reassurance for some families and their care providers. But while there are milk banks dotted across the U.S., they tend to be quite spread out (so you might not have one close nearby) and their supply can be limited. Additionally, donor milk costs roughly $3-5 per ounce, which can quickly add up! In contrast, research demonstrates that community-acquired donor milk can already be very low risk, but safest when exchanged for free (though some peer-to-peer milk donation networks allow in-kind compensation like trading storage bags or replacement pump parts for the milk). Also, people can ask their milk donors to pursue whatever health checks that make you feel most comfortable, and, if preferred, there are even research-validated ways of pasteurizing donor milk at home! If you want to know more about milksharing, I have a full episode that I will link in the show notes.
Feeding your baby is something you know you need to do, but it can seem really abstract prior to when your baby is born! However, there are ways that you can set yourself up for success and make sure that you have it covered financially too. Rather than saving all the work until postpartum, you can get your finances in order and make a plan during pregnancy, to save yourself stress!
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Birthful is created and produced by me, Adriana Lozada, with production assistance from Aysia Platte. A special extra shout out to her for the extensive research and work she did for this episode.
Thank you so much for listening to and sharing Birthful. Be sure to follow us on Goodpods, Spotify, Apple Podcasts, Amazon Music, and everywhere you listen.
Come back for more ways to inform your intuition.
Lozada, Adriana, host. “Milk Your Lactation Benefits!” Birthful, Birthful, July 12, 2023. Birthful.com.
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