Georgia Medicare Low-Income Subsidy (Extra Help) Guide 2026

The Medicare Low-Income Subsidy (LIS), commonly known as Extra Help, is the single most important federal affordability program for low-income Medicare beneficiaries enrolled in Part D prescription drug coverage. For Georgia seniors living on fixed incomes, Social Security, SSI, or near-poverty earnings, LIS is the gateway to drug affordability: it pays the Part D plan premium up to a regional benchmark, eliminates the annual deductible, caps copayments at modest fixed dollar amounts, eliminates cost-sharing in long-term care settings, and eliminates cost-sharing entirely in the catastrophic phase. Without LIS, low-income Medicare beneficiaries face premiums, deductibles, and coinsurance that frequently exceed their financial capacity, particularly for chronic conditions requiring multiple medications.

By Brevy Care Team

The LIS was established by Section 1860D-14 of the Social Security Act, added by the Medicare Modernization Act of 2003 (the same statute that created Part D itself), and codified at 42 CFR Part 423 Subpart P. It is jointly administered by the Social Security Administration (SSA), which handles enrollment determinations through Form SSA-1020 or online application, and the Centers for Medicare & Medicaid Services (CMS), which oversees benefit delivery through participating Part D and Medicare Advantage Prescription Drug (MA-PD) plans.

For nearly two decades after enactment, the LIS operated on a two-tier structure: full LIS for beneficiaries up to 135% of the Federal Poverty Level (FPL) and a less-generous partial LIS for beneficiaries between 135% and 150% FPL. Section 11404 of the Inflation Reduction Act of 2022 (Public Law 117-169, signed by President Joe Biden on August 16, 2022) eliminated the partial LIS tier and extended full LIS benefits to all beneficiaries up to 150% FPL effective January 1, 2024. This was one of the largest single-year LIS eligibility expansions since the program's inception in 2006, extending the most generous Part D subsidy to hundreds of thousands of additional Medicare beneficiaries nationwide, including many additional beneficiaries in Georgia.

For Georgia eldercare specifically, LIS matters because:

• Georgia has not adopted Medicaid expansion, so the LIS and MSP pathway is the primary affordability bridge for near-poverty Georgia seniors who would otherwise have minimal coverage
• LIS coordinates with the Part D out-of-pocket cap ($2,100 in 2026), the insulin $35 cost-sharing cap, the Manufacturer Discount Program, and the Drug Price Negotiation Program Maximum Fair Prices (MFPs)

This guide explains the LIS in comprehensive detail: the statutory framework, the income and resource limits, the application process, the auto-enrollment mechanism, the benefit package, the IRA expansion, the coordination with other Medicare affordability programs, and the operational details Georgia seniors and their families need to navigate Extra Help successfully.

Statutory and regulatory framework

Section 1860D-14 of the Social Security Act

The LIS was established by Section 1860D-14 of the Social Security Act, added to Title XVIII of the SSA by the Medicare Modernization Act of 2003 (Public Law 108-173, signed by President George W. Bush on December 8, 2003). Section 1860D-14 went into effect simultaneously with the rest of Part D on January 1, 2006.

Section 1860D-14 contains the foundational provisions:

• Subsidy for premium and cost-sharing: describes the subsidy mechanism
• Eligibility determinations: income and resource thresholds, dual-eligible auto-enrollment
• Benefit structure: tiered cost-sharing limits for full vs partial LIS (now full-only post-IRA)
• Coordination with state Medicaid programs: handoff of Medicaid drug coverage to Part D for full dual-eligibles
• Coordination with Medicare Savings Programs: auto-LIS for MSP enrollees
• Enrollment: SSA application + state Medicaid agency determinations
• Reinsurance and risk corridors: federal reinsurance covering catastrophic-phase costs

42 CFR Part 423 Subpart P

CMS implements Section 1860D-14 through regulations at 42 CFR Part 423 Subpart P, which contains the detailed operational rules:

• 42 CFR 423.772: eligibility for the LIS
• 42 CFR 423.773: application and determination process
• 42 CFR 423.774: auto-enrollment of full dual-eligibles, SSI recipients, MSP enrollees
• 42 CFR 423.776: LIS cost-sharing schedule
• 42 CFR 423.778: best-available-evidence policy for retroactive LIS
• 42 CFR 423.780: premium subsidy mechanics
• 42 CFR 423.782: cost-sharing subsidy mechanics

Section 11404 of the Inflation Reduction Act of 2022

Section 11404 of the Inflation Reduction Act of 2022 (Public Law 117-169, signed by President Joe Biden on August 16, 2022) made one of the most significant amendments to the LIS since program inception. Effective January 1, 2024, Section 11404:

• Eliminated the partial LIS tier: beneficiaries with income between 135% and 150% FPL who previously received less-generous partial LIS are now eligible for full LIS
• Extended full LIS benefits: $0 premium, $0 deductible, low fixed copays, $0 catastrophic to all beneficiaries up to 150% FPL
• Preserved the resource limits: Section 11404 did not change the asset thresholds, only the income tier consolidation

For Georgia, additional beneficiaries became eligible for full LIS effective January 1, 2024. Many were already enrolled in partial LIS and had their benefits upgraded automatically; others became newly eligible and required new applications.

SSA POMS HI 03001-HI 03050

The SSA implements LIS enrollment through the Program Operations Manual System (POMS), specifically sections HI 03001 through HI 03050. These provisions govern:

• Application intake (online, phone, paper)
• Income counting rules
• Resource counting rules
• Household composition
• Re-determination cycles
• Notice requirements
• Appeals process

CMS Prescription Drug Benefit Manual Chapter 13

CMS issues operational guidance to Part D and MA-PD plans through the Prescription Drug Benefit Manual Chapter 13, which covers:

• LIS premium subsidy reconciliation
• LIS cost-sharing pass-through to beneficiaries
• Auto-enrollment data exchanges with SSA and state Medicaid agencies
• Best-available-evidence procedures
• LIS reconsiderations

LIS eligibility: income and resource limits

LIS eligibility is determined by two financial tests: income and resources (countable assets). Both tests must be satisfied. The thresholds are updated annually based on the Federal Poverty Level (FPL) (for income) and inflation (for resources).

2026 income limits

To qualify for LIS in 2026, income must be at or below 150% of the Federal Poverty Level (FPL). The precise dollar thresholds are published by SSA and CMS early each year. Contact SSA at 1-800-772-1213 or visit ssa.gov/medicare/prescriptionhelp for current limits.

2026 resource limits

For 2026 (updated annually by SSA per Section 1860D-14):

• Individual resource limit: $16,590
• Couple resource limit: $33,100

Resources include:

• Cash and bank account balances
• Stocks, bonds, mutual funds (non-retirement)
• Real property other than primary residence
• Other liquid assets

Resources exclude:

• Primary residence (any value)
• One vehicle
• Burial plots
• Up to $1,500 per person in burial funds
• Household goods and personal effects
• Life insurance with face value ≤ $1,500 (per person)
• Retirement accounts in payment status (IRA, 401(k) once distributions begin)

Income counting

For LIS purposes, income is calculated similarly to SSI countable income with some adjustments. Generally:

• Counted: Social Security retirement, Social Security Disability Insurance (SSDI), pensions, wages, self-employment income, investment income, regular cash gifts
• Excluded: SSI benefits, in-kind support and maintenance (with adjustments), certain veteran's pension Aid & Attendance benefits, some housing assistance, Energy Assistance, federal income tax refunds

The first ~$20/month of unearned income and ~$65/month of earned income (plus half of earnings above that threshold) is disregarded, which is a key technical detail that often makes near-150% FPL applicants eligible despite gross income calculations suggesting otherwise.

Household composition

For LIS, the "household" is defined narrowly:

• Single applicant: individual income and resource limits apply
• Married couple living together: couple income and resource limits apply (both must apply together if both eligible Medicare beneficiaries)
• Married couple living apart: individual income and resource limits apply to the applicant (subject to detailed SSA review)

Auto-enrollment: three categories

Three groups of Medicare beneficiaries are automatically enrolled in LIS without filing an application:

Category 1: Full dual-eligibles

Beneficiaries enrolled in both Medicare and full Medicaid (with comprehensive Medicaid benefits) are automatically enrolled in LIS the month they qualify for both. Georgia identifies full dual-eligibles through Georgia Medicaid (administered by Georgia Department of Community Health (DCH)) and transmits the dual-eligibility data to CMS, which then auto-enrolls the beneficiary in LIS.

Category 2: SSI recipients

Beneficiaries receiving Supplemental Security Income (SSI) federal benefits are automatically enrolled in LIS, even if they are not also enrolled in Medicaid. SSA transmits SSI enrollment data to CMS for auto-LIS.

Category 3: Medicare Savings Program (MSP) enrollees

Beneficiaries enrolled in any Medicare Savings Program category, including Qualified Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB), Qualifying Individual (QI), or Qualified Disabled and Working Individual (QDWI), are automatically enrolled in LIS. Georgia administers MSP through DCH and DFCS county offices; MSP determinations trigger automatic LIS enrollment.

Auto-LIS benefit level

Auto-enrolled beneficiaries receive the full LIS benefit package. Effective January 1, 2024, post-IRA, all LIS enrollees receive full LIS (the partial tier no longer exists).

Re-determination

Auto-LIS enrollees do not need to reapply annually. SSA and Georgia DCH continuously verify Medicaid, SSI, and MSP status. If a beneficiary loses underlying eligibility (e.g., income increases above MSP thresholds), they receive a notice and have an opportunity to apply for LIS independently through SSA.

Manual LIS application: two pathways

Beneficiaries who are not auto-enrolled can apply for LIS through two parallel pathways:

Pathway 1: SSA application (most common)

Most non-dual LIS applicants apply directly through SSA. There are three ways:

1. Online: ssa.gov/medicare/prescriptionhelp
2. By phone: 1-800-772-1213 (TTY 1-800-325-0778)
3. By paper: Form SSA-1020 (mailed to applicant or downloaded), submitted by mail or in person at SSA field office

SSA processes the application within ~60 days. SSA makes the LIS eligibility determination based on income and resources reported by the applicant; SSA does not require submission of underlying financial documentation at application but reserves the right to request verification.

Pathway 2: State Medicaid combined application (Georgia DFCS)

Georgia residents who may also be eligible for Medicare Savings Programs can file a combined Medicaid/MSP/LIS application through Georgia DFCS county offices. The combined application:

• Determines Medicaid eligibility (if applicable for full-Medicaid duals)
• Determines MSP eligibility (QMB, SLMB, QI, or QDWI)
• Triggers automatic LIS enrollment via MSP qualification

This pathway is strongly recommended for Georgia seniors with income near 150% FPL because:

• MSP enrollment provides Part B premium subsidy and (for QMB) Medicare cost-sharing
• LIS is bundled into MSP determination
• DFCS county offices have caseworkers experienced in MSP/LIS

DFCS county office locations are listed at dfcs.georgia.gov.

Application assistance in Georgia

• GeorgiaCares SHIP: 1-866-552-4464, free counseling on LIS application
• Atlanta Legal Aid: 404-377-0701, LIS appeals representation
• GA Legal Services: 1-800-498-9469, rural LIS assistance
• Area Agencies on Aging (12 in Georgia): outreach and application support
• 211 Georgia: referral to nearest LIS assistance

Full LIS benefit package

All LIS enrollees (effective January 1, 2024, post-IRA) receive the full LIS benefit package:

Premium subsidy

• $0 plan premium for any Part D or MA-PD plan with a premium at or below the LIS regional benchmark
• LIS beneficiaries can enroll in any benchmark plan in their region with no premium
• Beneficiaries can also enroll in non-benchmark plans (premium above benchmark); LIS pays the benchmark portion, beneficiary pays the difference

The Georgia LIS benchmark amount is published by CMS annually. Most major Part D plans operating in Georgia (Humana, UnitedHealthcare, Aetna, Wellcare, Anthem, Cigna) offer at least one benchmark plan available to LIS beneficiaries with $0 premium.

Deductible subsidy

• $0 deductible for LIS enrollees in all Part D and MA-PD plans

This is a significant benefit because the standard Part D deductible (which varies by plan) would otherwise apply.

Cost-sharing subsidy

LIS enrollees pay low fixed copayments rather than standard coinsurance. For 2026, the maximum copay per drug for full LIS beneficiaries is $12.65 per fill. Specific copay tiers by eligibility category are published by CMS annually in the Part D Final Rate Notice.

In long-term care settings: $0 cost-sharing. In the catastrophic phase: $0 cost-sharing.

Manufacturer Discount Program coordination

Under the IRA's Manufacturer Discount Program (Section 11202, replacing the Coverage Gap Discount Program effective January 1, 2025):

• LIS enrollees pay LIS copay amounts (not 25% coinsurance)
• Manufacturer discounts still apply (10% initial coverage / 20% catastrophic on applicable brand drugs)
• Manufacturer discounts do not count toward LIS beneficiary cost-sharing (which is already capped at LIS copay)
• Beneficiary always pays the lower of LIS copay or any other applicable cap (e.g., insulin $35 cap)

OOP cap coordination

The Part D out-of-pocket cap ($2,000 in 2025, $2,100 in 2026 with CPI-U adjustment) applies to all Part D beneficiaries including LIS enrollees. However, LIS beneficiaries typically remain well below the cap because:

• Their copays are very low (up to $12.65 per fill)
• True out-of-pocket (TrOOP) includes LIS-paid amounts (through federal reinsurance accounting)
• For most LIS beneficiaries, annual OOP is well below the cap

LIS beneficiaries also have no catastrophic-phase cost-sharing ($0), so even reaching the catastrophic threshold does not affect them.

Insulin cost-sharing cap coordination

The IRA insulin $35/month cap (Section 11406, effective January 1, 2023 for Part D and July 1, 2023 for Part B insulin pump) coordinates with LIS as follows:

• LIS beneficiaries pay the lower of LIS copay or $35
• LIS beneficiaries continue to pay LIS-tier copays (well below $35)
• The $35 cap is a ceiling, not a floor

Drug Price Negotiation Program coordination

The IRA Drug Price Negotiation Program establishes Maximum Fair Prices (MFPs) for selected drugs. For LIS beneficiaries:

• Plans pay the MFP for these drugs
• LIS beneficiaries continue to pay LIS-tier copays (up to $12.65 per fill)
• The MFP benefits the plan (and indirectly the federal government and beneficiaries through lower premiums); the LIS beneficiary's out-of-pocket cost is unchanged because LIS copays are already very low

Georgia LIS beneficiary population

Why LIS matters in Georgia

Georgia has a large Medicare beneficiary population, and LIS is an essential affordability tool for those with limited income and resources. The state's decision not to adopt Medicaid expansion means that LIS and MSP together serve as the primary coverage safety net for near-poverty Georgia seniors.

Why LIS under-enrollment is significant in Georgia

Multiple factors contribute to LIS under-enrollment:

• Awareness gap: many seniors do not know LIS exists or assume they do not qualify
• Application complexity: Form SSA-1020 and the online application can be confusing, particularly for older seniors with limited internet access
• Resource limit confusion: applicants overestimate the value of excluded resources (primary residence, vehicle, retirement accounts in payment status)
• Income volatility: seasonal workers, gig workers, and self-employed seniors may have fluctuating income
• Language barriers: Spanish, Vietnamese, Korean, and other language groups in Georgia face application barriers
• Stigma: some seniors are reluctant to apply for subsidized benefits
• Georgia non-expansion: Georgia has not adopted Medicaid expansion, so there is no built-in pathway to identify near-poverty seniors through state Medicaid systems

Georgia LIS outreach initiatives

• GeorgiaCares SHIP (1-866-552-4464): statewide LIS outreach during Annual Enrollment Period (October 15–December 7) and year-round
• Area Agencies on Aging (12 in Georgia): community-based LIS outreach
• DFCS county offices (159 Georgia counties): combined Medicaid/MSP/LIS application
• Atlanta Legal Aid + GA Legal Services: legal assistance for LIS appeals
• Georgia Council on Aging: policy advocacy and outreach coordination
• 211 Georgia: telephone referral to LIS resources

14 best practices for Georgia seniors and families navigating LIS

1. Apply even if uncertain about eligibility: SSA reviews many applications and approves some that applicants believed were ineligible. The 2026 resource limit ($16,590 individual) is higher than many seniors assume, and the IRA expansion to 150% FPL (2024+) brought many new beneficiaries into eligibility.

2. Understand that primary residence and one vehicle are excluded: many Georgia seniors believe owning a home or car disqualifies them; both are excluded from resource counting.

3. Apply through GeorgiaCares SHIP (1-866-552-4464) for free expert assistance: SHIP counselors are trained in LIS application, can pre-screen for eligibility, and assist with completing Form SSA-1020.

4. Apply through DFCS county office for combined Medicaid/MSP/LIS: if income is near 150% FPL, the combined application captures MSP benefits (Part B premium subsidy, QMB Medicare cost-sharing) plus auto-LIS.

5. Apply during the Annual Enrollment Period (October 15–December 7): LIS approval during AEP allows the beneficiary to also switch Part D plans for January 1 effective date, optimizing plan choice with LIS benefits.

6. Reapply if denied: LIS denials can be appealed within 60 days. SHIP and Atlanta Legal Aid / GA Legal Services can assist.

7. Update SSA when circumstances change: income decreases, resources decrease, or new dependents may trigger LIS eligibility. SSA does not automatically re-evaluate; the beneficiary must notify SSA.

8. Choose a benchmark plan for $0 premium: LIS pays premium only up to the regional benchmark. Beneficiaries who choose non-benchmark plans owe the premium difference.

9. Use the LIS-tier copay schedule, not the standard copay schedule: pharmacies should automatically apply LIS copays; if charged higher amounts, request adjustment.

10. Coordinate LIS with the insulin $35 cap: LIS beneficiaries pay the lower of LIS copay or $35 (LIS copays are well below $35 for insulin).

11. Coordinate LIS with Manufacturer Discount Program: LIS beneficiaries continue to pay LIS copays; manufacturer discounts do not increase the beneficiary's cost-sharing.

12. Maintain documentation for SSA re-determination cycles: SSA re-determines LIS eligibility periodically. Keep records of Social Security statements, bank statements, and any other income/resource documentation.

13. Verify auto-enrollment if you become a full dual-eligible, SSI recipient, or MSP enrollee: auto-LIS should trigger automatically, but errors occur. Verify by calling 1-800-MEDICARE or checking Medicare.gov/account.

14. Use Medicare Plan Finder to optimize plan choice: Medicare.gov/plan-compare allows LIS-aware plan comparison, showing only plans with LIS-eligible $0 or low premiums.

14 common issues and how to resolve them

1. LIS application denied due to resources: Often the result of misclassifying primary residence, vehicle, or retirement accounts. Reapply with corrected information. SHIP or Atlanta Legal Aid can review the denial.

2. LIS application denied due to income: Verify that excluded income (e.g., SSI, certain housing assistance, EAP) was properly excluded. Income disregards ($20/month unearned + $65 earned + 50% of remaining earnings) may not have been applied.

3. Auto-LIS did not trigger after MSP approval: Contact 1-800-MEDICARE and Georgia DCH to verify data exchange. Sometimes DCH-to-CMS transmission has delays; persistent issues require escalation.

4. Pharmacy charged standard copay instead of LIS copay: Show pharmacy your LIS eligibility letter or Medicare card with LIS indicator. Call plan to confirm LIS status. Request retroactive adjustment.

5. LIS benefit downgraded or lost after Medicaid termination: When full Medicaid ends (e.g., due to income increase), auto-LIS through Medicaid ends, but the beneficiary may still qualify based on income alone. Apply through SSA directly to maintain LIS.

6. Enrolled in non-benchmark plan and charged premium difference: Switch to a benchmark plan during AEP (October 15–December 7), Special Enrollment Period for LIS beneficiaries (year-round in many cases), or contact plan to discuss.

7. Best-available-evidence (BAE) needed for retroactive LIS: 42 CFR 423.778 allows beneficiaries to provide evidence of past LIS eligibility (e.g., proof of Medicaid enrollment for a prior month). Plans must apply LIS retroactively.

8. LIS reconsideration requested but not received: Contact SSA at 1-800-772-1213 or visit local SSA field office to status check. SHIP can assist with reconsideration tracking.

9. Married couple with one Medicare beneficiary: LIS application reviews household (couple) resources and income but only one spouse may be enrolled in Medicare. Apply with couple thresholds.

10. LIS application during a blackout period (mid-year): LIS applications can be filed any time of year; this is not limited to AEP. Approval is effective the month of application or earlier (if BAE supports retroactive).

11. Resources slightly over limit due to one-time event: One-time receipts (e.g., tax refund, inheritance, insurance settlement) can push resources temporarily over the limit. Apply after the funds are spent down (within SSI/SSA-permitted timelines).

12. Confusion between LIS and Medicare Savings Program: LIS is the Part D subsidy; MSP is the Part B and (for QMB) Medicare cost-sharing program. Apply for both; MSP enrollment triggers auto-LIS.

13. Pharmacy in long-term care setting did not apply $0 cost-sharing: Confirm that the pharmacy has the LTC institutional indicator. Contact the LTC facility's pharmacy consultant or plan.

14. LIS letter from SSA but plan not honoring: Carry the SSA eligibility letter to pharmacy. Plans receive LIS data weekly from CMS; new approvals may take 2–4 weeks to appear in plan systems. Request plan adjustment.

Worked examples

Example 1: Fulton 70, Atlanta full dual-eligible auto-LIS

Profile: 70-year-old Atlanta retiree, full dual-eligible (Medicare + full Georgia Medicaid through Aged, Blind, and Disabled category), takes 7 medications for diabetes, hypertension, heart failure.

LIS pathway: Auto-LIS through full Medicaid dual-eligibility. Georgia DCH transmits dual-eligibility data to CMS; CMS auto-enrolls in LIS.

Benefit package:

• $0 Part D premium (enrolled in benchmark plan, Humana Walmart Value Rx or similar)
• $0 deductible
• Low fixed copays per fill (up to $12.65 per drug)
• $0 in long-term care
• $0 catastrophic

Annual OOP: Well below the $2,100 cap.

Pre-IRA: Same benefit (already at full LIS).

Example 2: DeKalb 75, Post-IRA full LIS (would have been partial pre-IRA)

Profile: 75-year-old DeKalb County widower, income at approximately 143% FPL for one person, resources $14,000, takes 5 medications.

Pre-IRA (2023): Would have qualified for partial LIS due to income between 135–150% FPL. Partial LIS provided a sliding-scale premium, an annual deductible, and percentage coinsurance in lieu of the fixed-copay structure of full LIS.

Post-IRA (2024+): Now qualifies for full LIS due to Section 11404 IRA expansion.

• Full LIS premium: $0 (benchmark plan)
• Full LIS deductible: $0
• Full LIS copays: up to $12.65 per fill
• Full LIS catastrophic: $0

Annual OOP savings: Significant reduction in out-of-pocket costs compared to partial LIS.

Example 3: Cobb 68, Existing full LIS

Profile: 68-year-old Cobb County retiree, income at approximately 115% FPL for one person, resources $8,500, takes 4 medications.

LIS pathway: SSA application (Form SSA-1020 or online), approved as full LIS pre-IRA.

Benefit package:

• $0 Part D premium (benchmark plan)
• $0 deductible
• Low fixed copays per fill (up to $12.65 per drug)
• $0 catastrophic

Annual OOP: Well below the $2,100 cap.

Post-IRA: Same benefit (already at full LIS pre-IRA).

Example 4: Worth County 72, Post-IRA newly-eligible

Profile: 72-year-old Worth County rural resident, income at approximately 147% FPL for one person, resources $12,000, takes 6 medications including a biologic.

Pre-IRA (2023): Would have qualified for partial LIS.

Post-IRA (2024+): Qualifies for full LIS. Applied through DFCS county office for combined MSP-SLMB + LIS.

Benefit package:

• SLMB pays the Part B premium
• Full LIS: $0 Part D premium, $0 deductible, low fixed copays (up to $12.65 per fill), $0 catastrophic

Annual OOP: Substantially lower than without LIS coverage.

Phoebe Putney pharmacy coordinates fills.

Example 5: Bibb 80, LIS application via SSA

Profile: 80-year-old Bibb County widow, income $21,000/year, resources $15,000, takes 8 medications including insulin.

LIS pathway: SSA online application via grandson. Submitted October 2025; approved December 2025 effective January 2026.

Benefit package:

• $0 Part D premium (Wellcare benchmark plan)
• $0 deductible
• Insulin: low LIS copay per fill (well below $35 cap)
• Other medications: low fixed copays (up to $12.65 per fill)
• $0 catastrophic

Annual OOP: Well below the $2,100 cap. Atrium Navicent pharmacy dispenses.

Example 6: Hall 67, Combined MSP + LIS via DFCS

Profile: 67-year-old Hall County recent retiree, income $30,000/year (couple) with husband still employed (couple income $48,000), resources $25,000 (couple), takes 3 medications.

Initial assessment: Couple income $48,000 exceeds the 150% FPL couple threshold. Husband's employment income is counted.

Application: Filed combined Medicaid/MSP/LIS application through Hall County DFCS. Initial denial due to couple income above 150% FPL.

Reconsideration: Husband retired six months later. Couple income dropped to $28,000. Reapplied January 2026. Approved as full LIS effective January 2026.

Benefit package:

• $0 Part D premium
• $0 deductible
• Low fixed copays (up to $12.65 per fill)
• $0 catastrophic

NGMC pharmacy coordinates fills.

Get help

• Medicare: 1-800-MEDICARE (1-800-633-4227), Medicare.gov
• Social Security Administration (Extra Help): 1-800-772-1213, ssa.gov/medicare/prescriptionhelp
• GeorgiaCares SHIP: 1-866-552-4464 (free LIS counseling)
• Medicare Rights Center: 1-800-333-4114
• Georgia DCH Member Services: 1-866-211-0950
• Georgia DFCS County Offices (159 counties)
• Atlanta Legal Aid: 404-377-0701
• GA Legal Services Program: 1-800-498-9469
• Eldercare Locator: 1-800-677-1116
• 211 Georgia: 211.org
• NeedyMeds: 1-800-503-6897
• Patient Advocate Foundation: 1-800-532-5274
• Humana Customer Service: 1-800-457-4708
• UnitedHealthcare Medicare: 1-800-721-0627
• Aetna Medicare: 1-800-282-5366
• Anthem Medicare: 1-833-919-1577
• Wellcare Medicare: 1-833-444-9088
• Cigna Medicare: 1-800-668-3813

Find personalized help navigating Medicare Extra Help at brevy.com.

This article is part of Brevy's Georgia Medicaid and Medicare resource library. Last verified May 14, 2026. The Medicare Low-Income Subsidy program is subject to annual CMS and SSA updates; verify current income, resource limits, and copay tiers at ssa.gov/medicare/prescriptionhelp and medicare.gov.