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/laurazhobson Moderator Jun 05 '25

If her income is no higher than 150% of Federal Poverty Level she would be able to enroll through the ACA and get an ACA compliant policy.

However she would need an income of about $20,000 to qualify for a subsidy and without a subsidy the premium would be high. However, it might be worth it.

She should get a job at Starbucks because they offer decent health insurance to part time workers - anyone working at least 20 hours per week.

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u/pinkyoshimitsu Jun 05 '25

Will have to look into Starbucks! Also a ceiling of 150% FPL seems shockingly low for the ACA marketplace? I thought it exists for pretty typical low-income unemployed people, not those a hair’s breadth from actual poverty

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u/laurazhobson Moderator Jun 05 '25

The 150% of FPL is ONLY for those very low income people to be able to get ACA insurance through the marketplace outside of Open Enrollment. It was intended as a special way for those very low income people to get insured if they make slightly more than Medicaid caps - or if they live in one of the 10 states which didn't expand Medicaid.

Since the marketplace is based on annual income some low salaried workers can get to the income necessary by taking some side hustles like cleaning, baby sitting or Door Dash so they can get the subsidy.

But yes in a state in which Medicaid has expanded the marketplace is available to anyone but the premium is based on one's salary so if one makes $25,000 per year the subsidy will be large so the premium will be close to $0 and there are additional subsidies towards the actual cost of medical care if you select the appropriate Silver Tier Plan.

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u/karsk1000 Jun 05 '25

Subsidies exist up to 400% fpl using MAGI. Best bang for buck is at right below 150% or 200%. Both give cost sharing reduction at the higher levels which reduce copays, deductible and max out of pocket.

https://www.healthreformbeyondthebasics.org/key-facts-income-definitions-for-marketplace-and-medicaid-coverage/

https://www.healthreformbeyondthebasics.org/cost-sharing-charges-in-marketplace-health-insurance-plans-part-2/

Wording of magi is labeled as household income tho, which can be an issue.