State exchange hopes to connect families to affordable health care options for baby

A baby’s health care costs can be surprisingly big, averaging $4,551 in the first year, according to one March of Dimes report.

Washington’s Health Benefit Exchange points to those high costs as it encourages new parents to use 60-day “special enrollment” periods to buy insurance through the system even after the open enrollment period, which ended in March.

The exchange’s online marketplace, called the Washington Health Plan Finder and created under the Affordable Care Act, allows private insurers to compete for business and those who qualify to sign up for Medicaid.

Special enrollment applies to people looking for private plans. People who qualify for Medicaid can enroll year-round.

The state exchange is trying to get the word out about the importance of insurance for infants for well-child checks and in case of illness.

“It’s pretty staggering to see what the out-of-pocket costs could be for even just standard medical expenses,” said Bethany Frey, a spokeswoman for the exchange. “Most people don’t have huge savings accounts for a $4,500 medical bill.”

It’s also highlighting some benefits available under Affordable Care Act requirements, including breastfeeding counseling and pumps. Also among new requirements: Insurers must cover babies with birth defects or born with other health problems.

“In the past, an insurer could deny those babies coverage, because it was technically a pre-existing condition,” Frey said. “They can no longer do that.”

The system offers financial assistance, Frey said. Eighty percent of residents who bought private plans during the open enrollment period were eligible for tax credits or subsidies that lowered their monthly premiums, she said.

Kathy Bernier, a nurse at Spokane Falls Family Clinic who helps women on Medicaid connect with health resources through pregnancy and babies’ first 12 months, said people often assume they can’t afford insurance when they’re eligible for free or reduced-price coverage.

Preventive care for babies means a series of scheduled checkups and vaccinations through their first year, starting when they’re just days old.

It lets medical providers get to know a baby and her family over time and understand their health “baseline,” which makes it easier to recognize and diagnose problems, Bernier said.

In turn, it lets families access health care when they need it – making a call to a doctor’s office where providers know the baby, for instance, in the early stages of a possible illness.

“It’s that relationship that buys them that telephone call,” Bernier said.

Families without insurance tend to wait until their children are very ill to seek care, then end up in emergency departments, “the most expensive care you can ever receive,” added Toni Cooley, the clinic’s director.

Tamra Frieske, the front desk coordinator at the YWCA of Spokane, is among “navigators” trained to help people enroll for insurance through the state exchange.

She encourages families to weigh the pros and cons of the various plans. As a former nurse aide and a parent, she’s familiar with unexpected expenses that come with babies.

“Especially when you first have a child, the first couple of years, it’s wellness visits, it’s vaccinations, it’s a cough in the middle of the night or a fever that just popped up,” Frieske said.

While monthly premiums may seem high for some, Frey said, the costs of treatment could be higher.

The 2008 March of Dimes report found that newborns with other health complications, such as congenital defects, had medical expenses of $10,273 on average, although its analysis included care for infants along with their mothers’ prenatal, delivery and postnatal services. The average cost of medical care for a premature or low birth-weight baby for its first year of life was about $49,000, the report found.

Parents get 60 days after a baby’s birth or adoption to enroll for health insurance, even after the general enrollment period is over. A new baby qualifies the whole household or tax-filing unit to enroll in a new plan.

People who chose not to get insurance face fines as high as 1 percent of their income. But those costs grow when they have children, Frey said.

Parents must pay an additional fee of $47.50 per uninsured child. And that first-time fee, leveraged via 2014 tax returns due in April 2015, will rise in subsequent years, Frey said.

The next open enrollment starts Nov. 15.

About 164,000 Washington residents enrolled for private health coverage during the last open enrollment period. About 2,000 or 3,000 have enrolled since then, Frey said. Those include special enrollments along with “special special” enrollments – people still completing applications because of technical problems, Frey said.

The state’s Health Care Authority doesn’t know how many residents remain uninsured, spokesman Jim Stevenson said. That’s partly because it’s difficult to separate the “normal churn” of people signing up and dropping off Medicaid from new enrollees who wouldn’t otherwise have applied.

“We know there’s been a net increase in insured, but we don’t know how drastic, how sizable, it is,” he said.