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/Slowhand1971 Jun 05 '25

coverage issues on a diagnostic colonoscopy are patchy at best anyway.

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u/pinkyoshimitsu Jun 05 '25

Like even if she did have insurance, you mean?

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u/Actual-Government96 Jun 05 '25

I assume they mean it wouldn't be covered at 100% (on an ACA plan) as it wouldn't be a preventive screening (no symptoms or reason to suspect an issue). That said, it's still covered, just subject to the plan cost shares (deductible/copay/coinsurance).

The comment is misleading, this is totally standard.

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u/Slowhand1971 Jun 05 '25

yes.

history of polyps may force you into a copay on a colonoscopy.