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/Initial_Freedom7981 Jun 05 '25

Unfortunately Georgia is one of the few states that has not expanded Medicaid, so your friend likely will not qualify. Medicaid expansion allows anyone under the income limits to qualify, even if they are not a child/elderly/pregnant/disabled. They can buy insurance on the marketplace healthcare.gov, but without a qualifying life event that con only be done during open enrollment in November. Your friends best option is to get a job that offers insurance like Starbucks

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u/pinkyoshimitsu Jun 05 '25

That’s unfortunate. Perhaps symptoms of colon cancer (especially with a history of having developed large precancerous tumors five years prior) could be a qualifying life event?

7

u/rosebudny Jun 05 '25

That absolutely would not be a qualifying life event. The reason you can only enroll during certain windows is to avoid exactly this - people waiting until they are sick to sign up for insurance.

5

u/pinkyoshimitsu Jun 05 '25

That makes sense, definitely gives much more context to the open enrollment limits