Need advice finding affordable health insurance/care in Georgia for an adult with congenital heart disease
Posting for a friend because we're trying to figure out what options he has.
He is 28 and lives in Fulton County, GA. He was born with hypoplastic right heart syndrome and also has some liver issues related to his condition. He receives his cardiac care through Emory.
His doctors want him to continue regular monitoring, usually 1-2 times a year, including:
- Echocardiograms
- EKGs
- Cardiac MRIs
- CT scans
- Cardiology appointments
- Liver monitoring/imaging when needed
He currently has an Oscar Marketplace plan, I believe Silver Simple Saver, that costs around $600/month. He makes roughly $11,000/year, mostly through gig work, so the premium alone is extremely difficult for him to afford. On top of the $600 monthly premium, he told me that for some of the testing/equipment used during his appointments, his insurance requires him to pay 20% coinsurance. He was told the cost without insurance would be around $9,000, so even with insurance, his portion can still be extremely expensive.
ALSO:
- He has already applied for Medicaid and was denied.
- He does not smoke.
- He does not currently have employer-sponsored insurance that meets his needs.
- His current employer offered insurance, but it only covers more basic care like checkups and urgent care and does not adequately cover the testing/equipment he needs.
- He is actively trying to find a better-paying, more stable job but has had trouble finding work.
Even if he does find a better-paying job, we're worried these medical costs will still be overwhelming unless the employer offers really good health insurance. Does anyone know of employers in Georgia, especially around Atlanta/Fulton County, that offer health insurance that would actually cover this type of congenital heart care and the testing he needs?
Are there certain employers, government jobs, universities, hospital systems, or other places he should prioritize applying to because they have good health benefits? If you have a similar condition and get insurance through your job, I'd also really appreciate hearing what your costs are like. Obviously, with a lifelong congenital heart condition, going uninsured or skipping these tests isn't really an option because doctors specifically want him to get this monitoring regularly.
We're trying to figure out if there are any programs, insurance options, financial assistance programs, disability-related programs, grants, employers with good health insurance, or other resources we're overlooking.
We're especially looking for information about:
- Cheaper ACA/Marketplace coverage
- What to do after being denied Georgia Medicaid
- Emory financial assistance or charity care
- Help with deductibles and coinsurance
- Programs for adults with congenital heart disease
- SSI/SSDI or disability-related Medicaid
- Organizations that help with medical costs
- Employer-sponsored insurance that works well with Emory
- Employers in Georgia known for strong health benefits
He is NOT trying to get out of paying for healthcare. The numbers just don't make sense because making around $11k a year while being asked to pay roughly $7,200 a year just in premiums, before even getting into coinsurance, deductibles, specialist appointments, and testing. He's trying to make more money, but he also needs healthcare now, and these are tests he's going to need for the rest of his life.
If anyone has dealt with something similar in Georgia, especially through Emory or with adult congenital heart disease, I would really appreciate any advice or resources. THANKS!