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/IcyChampionship3067 Jun 05 '25

It's exactly what the government in GA has promised for years. They got elected promising this. I'm sorry this is happening, but it's certainly shouldn't be a surprise.

Apply for Medicaid. Get denied. Then, begin the process for the ACA. She may have to wait until open enrollment a few months from now.

It's unlikely she'll find insurance otherwise.

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u/pinkyoshimitsu Jun 05 '25

From what I’m hearing non-ACA insurance wouldn’t be worth it because it most likely wouldn’t cover the colon cancer issues, and would also just be generally shit. So yeah I guess waiting for the ACA open enrollment at the end of the year or doing employer-based would be the best. There could be some medical finance organizations that might be able to help subsidize the colonoscopy.