Insurance Coverage for Lactation Visits

Did you know that many commercial insurances cover lactation visits with an IBCLC? Insurance plans vary in their coverage of lactation. It is worth looking into during pregnancy and lactation. The Affordable Care Act requires all new insurance policies to 1) provide coverage for comprehensive prenatal and postnatal lactation support, counseling, and equipment rental for the duration of breastfeeding, and 2) to provide that coverage with no cost sharing by the individual insured. Unfortunately, Medicaid* plans and grandfathered plans (those in existence before the ACA took effect in 2010) were exempt from this requirement. 

Coverage includes:

• Breastfeeding classes during pregnancy and after the baby is born.

• Lactation Consultations

• During the Covid-19 pandemic, many insurance companies are covering virtual lactation visits at no cost to you.

Number of covered visits vary among insurance companies. Aetna and Coventry, for example, cover 6 lactation visits at no cost to you. Many others offer coverage of 2-4 lactation visits. If there are no in-network lactation consultants available, out-of-network services must be provided with no cost sharing. This means that your out-of-network lactation consultant can provide you with a superbill that you can submit to your insurance company for reimbursement (as long as there are no in-network providers in your area). Be sure to check with your insurance company before you schedule a lactation visit. Verify your benefits and ask about any in network providers.