Does Insurance Cover Breastfeeding Costs?

Breastfeeding has a lower cost compared to formula when looking at the direct costs. Breastfeeding costs about $950 while formula can cost $1,110 in the first year. Maternal care is an essential health benefit meaning that all insurance plans must cover some form of breastfeeding support, counseling, and equipment for the duration of breastfeeding.           

If you’re looking for additional care options during pregnancy, Mira can help. With a variety of options including same-day lab testing, specialist and imaging referrals, and up to 80 percent discounts on prescriptions, Mira can help you cut costs while planning your family or preparing for a baby.

Cost of Breastfeeding

In general, breastfeeding is the cheapest option when choosing how to feed your baby when comparing direct costs. All health insurance plans and Medicaid cover maternity and newborn care as it is considered an essential health benefit—meaning that all qualified health plans must cover them. However, maternity care is a broad term, resulting in varying scopes of coverages and types of services provided for maternity care from state to state. 

Insurance Coverage for Breastfeeding Mothers

Health insurance plans must provide breastfeeding support, counseling, and equipment for the duration of breastfeeding, except for grandfathered plans (an individual insurance policy purchased on or before March 23, 2010, that may not include some protections under the Affordable Care Act). 

Your health insurance plan must cover the cost of a breast pump that may either be a rental unit or a new one that you’ll keep. Typically, your insurance plan will follow your doctor’s recommendations on what’s medically appropriate for you. There is a range of support that helps mothers initiate and maintain breastfeeding, including breast pumps, lactation counseling by certified consultants, and educational programs.

Medicaid Coverage for Breastfeeding Mothers

States must cover breast pumps and consultation services for Medicaid expansion beneficiaries under the Affordable Care Act. Many ACA plans offer both electric and manual breast pumps. While Medicaid offers services that help initiate breastfeeding, most services stop when the mother goes home from the hospital. 

Below is a table displaying states reporting breastfeeding-related coverage under traditional Medicaid. The table represents survey findings on behalf of KFF and the Family Planning Report from 40 states and Washington DC that responded. DC is counted as a state in this table.

Breastfeeding Services by State under Medicaid

Source: Medicaid Coverage of Pregnancy and Perinatal Benefits: Results from a State Survey, 2017

Coverage for Breastfeeding Mothers by the Children’s Health Insurance Program (CHIP)

If you are eligible for Medicaid, you may also be eligible for the Children’s Health Insurance Program (CHIP). Eligibility depends on your household size, income, citizenship status and varies by state. 

If you are eligible during your pregnancy, you’ll be covered for 60 days after birth and will be notified if your coverage is ending. After that, you may no longer qualify. If you already have Medicaid when you give birth, your newborn is automatically enrolled in Medicaid coverage for at least a year. 

Cost of Breastmilk vs. Formula 

The cost of formula feeding is reportedly $1,100 more than breastfeeding the first year, which is approximately $950 for the first year. Hillary Swetz, a certified doula who manages a frugal living website for moms, has spent time crunching these numbers. She says, “a year of formula feeding will cost you at least $1,500 for basic Enfamil (a brand of infant formula), and that’s not including baby bottles or cleaning supplies.” 

Breastfeeding can be free if you pick up the skill right away and can stay home with your baby. Even if you need help and purchase lactation support or other comfort products like breastfeeding pillows, lanolin cream, or need a bottle or pump because of work or persistent latch problems, breastfeeding is still the more affordable option. 

Swetz says, “If you need a few hours of paid lactation consultant help–say, 5 hours at $30 per hour– that will set you back a mere $150 in comparison. If you need to pump breastmilk and bottle feed your baby, you only need to add the cost of a free breast pump through your health insurance and baby milk bags that cost about $0.06 each at Walmart using HSA/FSA funds.”  

Estimated Costs of Breastfeeding Compared to Formula

Source: Cost of Breastfeeding Vs. Formula by Plutus Foundation

Breastfeeding Benefits for Mom

The health benefits of breastfeeding for mothers range from physical to mental and financial. Breastfeeding can protect mothers from various cancers and stimulates a faster recovery after birth. Breastfeeding can also help save money and help mothers bond with their babies.  

Physical Health Benefits for Moms

Breastfeeding has many physical health benefits for moms as it:

• Reduces the risk of UTIs
• Reduces the risk of anemia
• Reduces postpartum bleeding
• Reduces the risk of ovarian and breast cancer
• Reduces the risk of Type 2 diabetes and high blood pressure
• Stimulates the uterus to contract and return to normal size
• Promotes faster weight loss after birth

Mental Health Benefits for Moms

The mental health benefits of breastfeeding are also abundant as it:

• Reduces the risk of postpartum depression
• Can increase confidence and self-esteem
• Promotes calmness by releasing naturally soothing hormones like oxytocin and prolactin
• Can increase the emotional and physical bond between mother and child
• Can make travel easier as it is always clean and the right temperature
• Results in 6x less absenteeism from work

Breastfeeding Benefits for Infants:

Breastmilk is the most nutritious option for infants as it contains the appropriate amount of fats, proteins, vitamins, and many antibodies. Emotionally, it helps the infant build trust in their caregiver, and in general, babies who are breastfed cry less. Breastfeeding increases immunity from a vast range of illnesses, including: 

• Diabetes
• Asthma
• Eczema
• Heart disease
• Obesity
• Allergies
• Gastrointestinal diseases
• Cot death (Sudden Infant Death Syndrome)

Breastfeeding also offers several other health benefits for infants, as it:

• Reduces risk of cavities, orthodontic, and speech problems
• Improves brain maturation
• Builds stronger immune systems
• Naturally soothes infants
• May help reduce social and behavioral problems
• Lower rates of illness overall and less hospitalization

Obstacles to Breastfeeding

A lack of access to help, education, and support can cause breastfeeding to become difficult and inaccessible, especially if your work environment does not accommodate breastfeeding mothers. 60 percent of mothers do not breastfeed for as long as they intend to. The main factors according to the CDC contributing to this are:

• Issues with lactation and latching
• Concerns about infant nutrition and weight
• Mother’s concern about taking medication while breastfeeding
• Unsupportive work policies
• Lack of parental leave
• Stigma and lack of support
• Unsupportive hospital practices and policies

Reasons a Mother May Not Breastfeed

There are many reasons why some mothers do not breastfeed their babies and the decision to do so is a personal one and should be respected. Below are some reasons why a mother may not breastfeed:

Medical Conditions in the Mother

There may be instances in which the mother medically cannot breastfeed. The following medical conditions may inhibit a mother from being able to breastfeed: 

• Hypoplasia (cannot produce sufficient milk)
• Polycystic ovary syndrome (cannot produce sufficient milk)
• Serious illness (can be unhealthy for the mother)
• Breast Reduction Surgery (women who undergo this surgery are more likely to have low milk production)
• Postpartum Depression or Anxiety (it may be a stressor)

In some cases, nursing may also not be recommended by the mother when she: 

• Has an HIV infection (can be transmitted to the baby)
• Is undergoing radiation therapy (avoid breastfeeding temporarily)
• Is taking certain medications (some medications can pass to the baby and harm them)
• Is experiencing an active infection
• Is engaging in alcohol, smoking, or drug addiction (they can get passed through the milk to the baby)
• Actively recovering from a traumatic experience
• Has a fear of breastfeeding
• Experiencing obstacles in returning to work (work environment and schedule may not support breastfeeding)

Medical Conditions in the Baby

Certain medical conditions experienced by the baby may also cause breastfeeding to not be a suitable feeding option. The following conditions are not recommended for nursing: 

• Classic Galactosemia (infant is unable to break down milk)
• Phenylketonuria (PKU) (breastfeeding should be monitored)
• Maple Syrup Urine Disease (cannot break down certain amino acids in breastmilk)

Breastfeeding Frequently Asked Questions (FAQs) 

Consider the following commonly asked questions regarding breastfeeding. 

How long should I breastfeed?

The World Health Organization (WHO) and the American Academy of Pediatrics (AAP)  recommend that mothers exclusively breastfeed their infants for the first six months after giving birth. The WHO suggests that this should be followed by breastfeeding with complementary foods two years or older, while the AAP recommends breastfeeding with complementary foods for one year or more. Ultimately, it is up to you and your baby to start weaning (stopping breastfeeding). 

What is in formula milk?

Infant formula milk is regulated by the Food and Drug Administration (FDA), and there are three main types:

1. Cow milk protein-based formulas
2. Soy-based formulas
3. Protein hydrolysate formulas (contains protein that’s been broken down into smaller sizes than in cow’s milk and soy-based formulas)

Formula comes in three forms as well:

1. Powdered formula (least expensive, needs to be mixed with water)
2. Concentrated liquid formula (needs to be mixed with water)
3. Ready-to-use formula (most expensive, does not need to be mixed with water)

How can we de-stigmatize breastfeeding?

While breastfeeding in public is legal in all 50 states, it is still taboo. Only 69 percent of adults believe mothers should have the right to breastfeed in public and many mothers feel uncomfortable or embarrassed doing so. Reminding yourself why mothers breastfeed, supporting public breastfeeding, and joining and promoting local support groups are some ways to normalize breastfeeding. 

What is a birthing-friendly designation?

The United States has the highest maternal mortality rate compared to other high-income countries and is increasing. As part of Vice President Kamala Harris’s call to action to reduce maternal mortality and morbidity, the Department of Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS) are proposing a “birthing-friendly” designation to drive improvements in perinatal and postnatal maternity care.

The designation would identify hospitals that provide perinatal care, are working to improve their maternity care quality, and have implemented recommended patient safety practices. 

Bottom Line

Breastfeeding is the healthiest option when it comes to feeding your baby for both mother and infant, although there are exceptions as to why some women choose not to. Having a good support system, work environment, and some form of health insurance can make breastfeeding more accessible and pleasurable.  

If you’re looking for additional care options during pregnancy, Mira can help. Mira offers family plans that provide gym memberships, up to 80 percent discounts on prescriptions, and discounted lab-testing that can help you cut costs while family planning or preparing for a baby.