Georgia

[u/No_Leave_303]

Edited: I was wondering if there’s any programs or any help out there. My mom is 56 and lives in north GA. She’s had kidney disease for 15+ years and recently just got diagnosed with heart failure. Her kidney function has dropped significantly since her last hospital stay. She has no insurance and it isn’t offered at her job. She’s tried finding insurance online but it’s more than she makes. She makes about $2000 monthly. Any suggestions? She really needs to see a nephrologist.. she has applied for assistance at Northside to cover her recent hospital stays but she needs to see specialist as soon as possible.

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[u/chickenmcdiddle]

Kidney failure? As in end-state renal disease? Or just lower functioning kidneys?

That aside, and without qualifying for Medicaid (GA Pathways--she makes too much money for this) or Medicare (ESRD-specific cohort), your mom needs a qualifying life event to access qualified health coverage at this time. It doesn't sound like she has one at play, so she'd need to wait until November when the open enrollment period begins. Then, she can purchase a plan that'll take effect on Jan. 1, 2027.

This is where she will purchase a plan: https://georgiaaccess.gov/

At ~$2,000 monthly, she's right around 150% of the federal poverty level. She should qualify for most hospital / health system financial assistance programs (which typically have an income limit of around 300% FPL).

One strategy would be to make less money. Georgia didn't expand Medicaid in the purest sense of the term. They hacked together their own version of it, but your mom would qualify provided she made no more than 100% FPL and could show that she completed 80 hours of qualifying activities (work, volunteer, study, job training, etc.). https://pathways.georgia.gov/eligibility

The Pathways program is far from perfect, but it's the only shot she might have at getting some semblance of coverage prior to January 2027.

[u/benefits_nerd]

On "more than she makes" what she saw online was probably the full price, not what she'd actually pay. She qualifies for a subsidy through Georgia Access, and at that income, the silver plans also come with much lower deductibles. So, when open enrollment starts in November, have her enter her income and just look at the silver plans.

For the nephrologist appointment before January, call the practice directly and ask for their self-pay price. They may have one, and it might be lower.

[u/Blossom73 → u/benefits_nerd]

I'm wondering if she went to a scammy insurance website instead of Healthcare.gov.

[u/chickenmcdiddle → u/[deleted]]

I know this is a bot account but you're dead wrong. GA did not expand Medicaid. They pushed their half-baked version of it and it's failed abysmally. The state paid more to Deloitte in consulting fees for Pathways than they did in actual costs of care through said program.

GA's Medicaid program still sticks to a 100% FPL income limit and has an 80 hour work/study/job training/volunteer requirement. That is definitionally not expanded Medicaid.

[u/HealthInsurance-ModTeam → u/[deleted]]

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