If you are a Georgian on Medicare managing one serious chronic condition, Medicare Principal Care Management (PCM) pays your doctor to coordinate that single condition between visits. This guide explains what Georgia Medicare Principal Care Management covers, what it costs a beneficiary in 2026, why most people who have both Medicare and Medicaid pay nothing, and how to get it, from asking your specialist to calling GeorgiaCares for free help.

What Georgia Medicare Principal Care Management Covers

Principal Care Management is a Part B benefit under Medicare for a person who has one chronic, high-risk condition expected to last at least 3 months, such as cancer, that puts them at risk of hospitalization, physical or cognitive decline, or death. Under PCM, your doctor or other health care professional manages your care for that single condition, builds a disease-specific care plan, and continuously monitors and updates it, including any changes to the medicines you take.

The service is disease-specific, meaning it focuses on the one condition that is driving your care rather than your health overall. In Georgia, PCM is often furnished by the specialist who already manages that condition, a nephrologist for advanced chronic kidney disease, a cardiologist for heart failure, a pulmonologist for severe chronic obstructive pulmonary disease (COPD), or an oncologist during and after cancer treatment. Your primary care doctor can also furnish PCM when a single complex condition is the center of your care. Your provider makes the formal determination, but if one serious condition is driving your appointments and medication changes, it is worth asking whether PCM fits. The full federal mechanics of the benefit, including the monthly time thresholds and consent rules, are in our national Medicare Principal Care Management guide; this page focuses on what Georgians pay and where to get help.

PCM vs. Chronic Care Management

PCM has a close sibling, Chronic Care Management (CCM), and the difference is the number of conditions. PCM is for one complex chronic condition. CCM is for two or more serious chronic conditions expected to last at least 12 months. Both run through Medicare's Part B and carry the same cost-sharing. If two or more long-term conditions describe your situation, read the Georgia Medicare Chronic Care Management guide instead.,

Principal Care Management (PCM) Chronic Care Management (CCM)
Conditions covered One complex chronic condition Two or more chronic conditions
Expected duration At least 3 months At least 12 months
What it focuses on Managing that single condition Coordinating your overall care
2026 cost-sharing 20% after the $283 Part B deductible 20% after the $283 Part B deductible

What Georgia Medicare Principal Care Management Costs

PCM follows the usual Part B cost-sharing. After you meet the annual Part B deductible, which is $283 in 2026, you generally pay 20% of the Medicare-approved amount for the service, and Part B covers the rest.,

What you actually owe depends on the rest of your coverage. A Medigap policy or other supplemental insurance may cover that 20%. And in Georgia, people who are dually eligible for both Medicare and Medicaid generally owe nothing, because Medicaid picks up the Medicare cost-sharing.

If you are not already on full Medicaid, a Medicare Savings Program can still cover the cost. In Georgia, the Qualified Medicare Beneficiary (QMB) program pays the Part B deductible and coinsurance, so PCM costs a QMB enrollee nothing. The Specified Low-Income Medicare Beneficiary (SLMB) and Qualifying Individual (QI) programs pay only the Part B premium, so those beneficiaries still owe the PCM deductible and coinsurance themselves.

The Medicare Savings Program income and resource limits below are the federal 2026 figures, published by the Social Security Administration and CMS, and they are the thresholds that decide whether Georgia Medicaid covers your PCM cost-sharing.

One caution before you read the table. Georgia Medicaid's own Medicare Savings Programs FAQ still publishes an older asset ceiling, $7,390 for one person and $11,090 for a married couple, which is lower than the federal figures below. Confirm the current limit with DFCS at 1-877-423-4746 and file the application either way. Medicare's own guidance is that you may still qualify in your state even if your income or resources run above the federal limits listed, and that you should apply even if you do not think you qualify.,

Program Monthly income limit (single / couple) Asset limit, federal 2026 (single / couple) Covers PCM cost-sharing?
QMB $1,350 / $1,824 $9,950 / $14,910 Yes, pays the deductible and the 20% coinsurance
SLMB $1,616 / $2,184 $9,950 / $14,910 No, pays only the Part B premium
QI $1,816 / $2,455 $9,950 / $14,910 No, pays only the Part B premium

Georgians who have both Medicare and full Medicaid can also get their care, including PCM, through a Dual Eligible Special Needs Plan (D-SNP), a type of Medicare Advantage plan built for people with both coverages. A D-SNP covers the same Part A and Part B benefits as any other Medicare Advantage plan, adds care coordination, and must include Medicare drug coverage (Part D). Which D-SNPs are available in Georgia differs from county to county, because insurers decide where they do business, and the Georgia Department of Community Health placed a moratorium on contracting with any new D-SNPs starting August 1, 2025. Check which plans are offered at your own address using Medicare's plan finder or by calling GeorgiaCares, rather than assuming a plan you have heard of serves your county.

How to Get Principal Care Management in Georgia

1
Step 1

Confirm the condition qualifies

PCM is for one complex chronic condition expected to last at least 3 months that puts you at risk of hospitalization, decline, or death. Note which single condition, such as advanced kidney disease or heart failure, is driving your care.

2
Step 2

Ask the doctor who manages that condition

Raise PCM with the specialist or primary care physician who already treats it, a nephrologist, cardiologist, pulmonologist, or oncologist. The practice enrolls you, sets up the disease-specific care plan, and coordinates your care between visits.

3
Step 3

Check what it will cost you

With Original Medicare, expect 20% after the $283 Part B deductible in 2026, unless a Medigap policy, full Medicaid, or a Medicare Savings Program covers it.,

4
Step 4

If cost is a barrier, apply for a Medicare Savings Program

Georgia's Division of Family and Children Services (DFCS) processes QMB, SLMB, and QI applications through Georgia Gateway. QMB approval means Medicaid pays your PCM deductible and coinsurance.

5
Step 5

Get free help from GeorgiaCares

Call Georgia's SHIP at 1-866-552-4464 (option 4) for free, unbiased counseling on PCM cost-sharing, Medicare Savings Programs, and plan choices.

Where to Get Help With Medicare in Georgia

GeorgiaCares (Georgia SHIP) Free, unbiased Medicare counseling, including PCM cost-sharing and Medicare Savings Programs. Georgia SHIP is not affiliated with any insurance company and its counselors do not sell insurance. 1-866-552-4464, option 4, Monday through Friday, 8 a.m. to 5 p.m.https://acl.gov/programs/connecting-people-services/state-health-insurance-assistance-program-ship aging.georgia.gov/georgia-ship
Georgia Division of Family and Children Services (DFCS) Processes QMB, SLMB, and QI Medicare Savings Program applications through Georgia Gateway. 1-877-423-4746https://dhs.georgia.gov/contact dfcs.georgia.gov
Georgia Department of Community Health (DCH) Runs Georgia Medicaid, including full dual-eligible coverage that pays Medicare cost-sharing. dch.georgia.gov
Palmetto GBA (Georgia's Medicare Administrator) Handles Georgia Medicare claims and provider questions, including PCM billing. palmettogba.com
Medicare General Medicare benefit questions and the official PCM coverage page. 1-800-633-4227https://www.medicare.gov/talk-to-someone medicare.gov
Your next step Call GeorgiaCares at 1-866-552-4464 to find out whether Principal Care Management fits your condition and what it will cost you in Georgia.

Frequently Asked Questions

What is Medicare Principal Care Management?

Principal Care Management, or PCM, is a Part B benefit under Medicare in which your doctor or other health care professional manages your care for one complex chronic condition. It is disease-specific, meaning it focuses on that single condition. Your provider creates a disease-specific care plan and continuously monitors and updates it over time, including any changes to your medicines.

How is PCM different from Chronic Care Management?

The difference is the number of conditions. PCM is for one complex chronic condition. Chronic Care Management (CCM) is for two or more chronic conditions expected to last at least 12 months. Both run through Medicare's Part B and carry the same cost-sharing. If you have two or more ongoing conditions, ask about CCM instead.,

What does PCM cost in Georgia?

With Original Medicare, PCM uses the usual Part B cost-sharing: after the $283 Part B deductible in 2026, you generally pay 20% of the Medicare-approved amount. A Medigap policy, full Medicaid, or a Medicare Savings Program may cover that share.,

Do I pay for PCM if I have both Medicare and Medicaid?

Generally no. Georgians who are dually eligible for both Medicare and full Medicaid usually owe nothing for PCM, because Medicaid covers the Medicare cost-sharing. The Qualified Medicare Beneficiary (QMB) program specifically pays the Part B deductible and the 20% coinsurance.,

Who can I call for free Medicare help in Georgia?

Call GeorgiaCares, Georgia's State Health Insurance Assistance Program (SHIP), at 1-866-552-4464 (option 4) for free, unbiased Medicare counseling, including help understanding PCM cost-sharing and applying for a Medicare Savings Program.

Learn More

MedicaidGeorgia Medicare Chronic Care Management (CCM) BenefitsMedicare Chronic Care Management (CCM) pays Georgia providers to coordinate care for people with two or more chronic conditions. Learn what CPT 99490 covers. MedicaidGeorgia Medicare Savings ProgramsGeorgia Medicare Savings Programs in 2026: how QMB, SLMB, QI, and QDWI pay Medicare premiums and cost-sharing, the income and asset limits, and how to apply. MedicaidGeorgia Qualified Medicare Beneficiary (QMB) ProgramGeorgia QMB pays the Part B premium ($202.90/month in 2026) plus Part A and Part B deductibles and cost-sharing. See the 2026 limits and how to apply. MedicaidGeorgia Medicare Remote Patient Monitoring (RPM)Medicare covers Georgia remote patient monitoring (RPM) as a recurring monthly 20% Part B cost after the $283 deductible, and QMB or Medigap can zero it out. MedicaidGeorgia Medicare Transitional Care Management (TCM) BenefitsAfter a Georgia hospital or observation discharge, Medicare Transitional Care Management pays the doctor to manage your first 30 days. What to expect and cost. MedicaidGeorgia Medicare End-Stage Renal Disease EntitlementGeorgia Medicare ESRD guide: Section 1881 entitlement, the 30-month coordination period, dialysis and transplant coverage, and Medicare Advantage rights.

Find personalized help understanding Principal Care Management coverage for your chronic condition in Georgia at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.

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