r/HealthInsurance • u/pinkyoshimitsu • Jun 04 '25

Medicare/Medicaid Colonoscopy needed but no insurance

My close 26yo friend lives near Atlanta, GA. She works part-time at a church doing childcare and part-time at HomeGoods. Along with her younger brother, she helps support her household, particularly her older sister (who has MS but seems to not qualify for disability?), and her mother (disabled + ex-alcoholic with dementia).

About five years ago, she had serious GI issues and got a colonoscopy (discounted by a friendly doctor), which found large tumors in a part of the colon known for aggressive precancerous growth. The doctor advised repeat colonoscopies every 1–3 years, but she hasn’t had one since due to a lack of insurance.

Given her part-time jobs and financial situation, would she likely qualify for Georgia Medicaid? And if not, would she be eligible for subsidized ACA marketplace insurance? Or are there any other resources or clinics in Georgia that might help her get a follow-up colonoscopy without insurance?

Thanks in advance for any advice or info, I really appreciate it.

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u/pinkyoshimitsu Jun 05 '25

To pay directly for a colonoscopy, you mean? And does the open enrollment period limit also apply to directly applying for a health insurance without the ACA marketplace?

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u/katsrad Jun 05 '25

Yes pay directly for a colonoscopy. There are plans available outside the marketplace but they are not aca compliant and don't have to cover preexisting conditions so may not cover a colonoscopy since it is a prior condition.

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u/pinkyoshimitsu Jun 05 '25

That’s kinda crazy that they can just say “no” to low-income people with significant medical issues. Hopefully we might find a non-ACA insurance that is affordable and would cover it.

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u/NewIndependence Jun 05 '25

You will be wasting your money. Non ACA plans are horrible, purely because they dont have to comply with ACA.