Georgia QDWI Medicare Savings Program (2026)

The Georgia Qualified Disabled and Working Individual (QDWI) program pays the Medicare Part A premium, $311 or $565 per month in 2026, for a narrow group of working Georgians under 65.1 It serves people who once received Social Security Disability Insurance (SSDI), then returned to work, then lost their SSDI cash benefit because their earnings rose above the substantial gainful activity level, yet still keep Medicare under a special 93-month extended-entitlement window.

QDWI is the fourth and least-used of the four Medicare Savings Programs (MSPs). It is authorized under Section 1902(a)(10)(E)(ii) of the Social Security Act and the Medicaid eligibility group is set out at 42 CFR 435.126.2 The program exists because of an unusual interaction between SSDI return-to-work rules and Medicare: a worker can lose the SSDI cash benefit but keep disability-based Medicare for nearly eight more years, and during that window the Part A premium becomes a real bill.

QDWI has the highest income limit of any MSP (200% of the Federal Poverty Level) but the lowest asset limit ($4,000 single / $6,000 couple, unindexed since 1988) and the narrowest benefit. It pays the Part A premium only, not the Part B premium, not Medicare cost-sharing, and it does not trigger automatic enrollment in the Medicare Part D Low-Income Subsidy.2 This guide explains the federal framework, the six-condition eligibility window, the 2026 Georgia figures, how QDWI compares to QMB, SLMB, and QI, how it differs from Section 1619(b) Continued Medicaid, and how to apply through the Georgia Department of Community Health (DCH) and the Division of Family and Children Services (DFCS).

In This Guide

• What the Georgia QDWI Medicare Savings Program Is
• Who Qualifies for QDWI in Georgia
• What QDWI Pays and Does Not Pay
• QDWI vs QMB, SLMB, and QI
• QDWI vs Section 1619(b) Continued Medicaid
• How to Apply for the Georgia QDWI Medicare Savings Program
• Frequently Asked Questions
• Learn More

What the Georgia QDWI Medicare Savings Program Is

QDWI is one of four Medicare Savings Programs authorized under Section 1902(a)(10)(E) of the Social Security Act.2 Each MSP helps a low-income Medicare beneficiary with a different piece of Medicare's costs:

• Qualified Medicare Beneficiary (QMB): pays the Part A premium (if any), the Part B premium, and all Medicare cost-sharing. Income limit 100% FPL.4
• Specified Low-Income Medicare Beneficiary (SLMB): pays the Part B premium only. Income limit 120% FPL.4
• Qualifying Individual (QI): pays the Part B premium only (federally block-grant funded). Income limit 135% FPL.4
• Qualified Disabled and Working Individual (QDWI): pays the Part A premium only. Income limit 200% FPL; asset limit $4,000 single / $6,000 couple.2

QDWI is the only MSP that does not extend to the aged Medicare population. It is restricted to disabled Medicare beneficiaries under 65 who are working, and the SGA-based loss of free Part A is the eligibility trigger, not a disqualifier.6 The four MSPs trace to the Medicare Catastrophic Coverage Act of 1988; although most of that law was repealed in 1989, the savings programs survived and remain in effect.

How a Worker Keeps Medicare After Losing SSDI

A worker who has paid Social Security taxes long enough to be insured can claim Social Security Disability Insurance (SSDI) if they become disabled. After a five-month waiting period the SSDI cash benefit begins, and after 24 months of that benefit the worker becomes entitled to Medicare under Section 226(b) of the Social Security Act, by disability rather than by age.

When a worker on SSDI returns to work, three federal work-incentive provisions apply in sequence:

• Trial Work Period (TWP): 9 months of unlimited earnings without affecting the SSDI cash benefit (the 9 months can fall within a rolling 60-month window).
• Extended Period of Eligibility (EPE): 36 months after the TWP. The cash benefit continues in any month earnings stay below substantial gainful activity (SGA), which in 2026 is $1,690/month for non-blind individuals and $2,830/month for blind individuals, and stops in any month earnings exceed it.6
• Extended Period of Medicare Coverage under Section 226(b): for at least 93 months (7 years and 9 months) after the TWP, Medicare entitlement continues even after the cash benefit stops.

During that 93-month window the worker must pay the Part A premium, because they no longer get premium-free Part A through the cash benefit, unless QDWI covers it. The 2026 premium is $311/month for a worker with 30 to 39 quarters of Medicare-covered employment and $565/month for one with fewer than 30 quarters.1 Most former SSDI beneficiaries had to be insured to qualify in the first place, so the $311 figure is the more common one. Over a full 93-month window, the unsubsidized cost runs from roughly $28,923 at $311/month to $52,545 at $565/month.1

Who Qualifies for QDWI in Georgia

To qualify for QDWI in Georgia, an applicant must satisfy six federal conditions at the same time. Failing any one ends eligibility. This is one of the narrowest eligibility windows in Medicaid.

Condition 1: SSDI Cash Benefit Ended Because of Earnings

The applicant must have received SSDI cash benefits in the past and lost them specifically because earnings exceeded substantial gainful activity (SGA).6 Termination for any other reason (medical improvement, the age-65 transition to retirement benefits) does not open QDWI. SSA must have coded the termination as work activity; if it was coded as medical recovery, Medicare entitlement runs only a short window and QDWI does not apply.

Condition 2: Still Entitled to Medicare Under Section 226(b)

The applicant must still be inside the Section 226(b) extended Medicare window (at least 93 months from Trial Work Period completion). Once that window closes, Medicare entitlement ends, the Part A premium disappears because there is nothing left to subsidize, and QDWI ends. Beneficiaries can confirm their end date by calling SSA at 1-800-772-1213 or checking their my Social Security account.7

Condition 3: Under Age 65

QDWI is limited to disabled Medicare beneficiaries under 65. At 65 the beneficiary becomes entitled to Medicare by age and usually qualifies for premium-free Part A through 40 quarters of work history, so the Part A premium and QDWI both end. A worker who reaches 65 without 40 quarters and still owes a Part A premium would generally look to QMB instead, because they are now aged rather than disabled-working.

Condition 4: Currently Working

The applicant must be working at the time of application, in either W-2 wage employment or self-employment that produces reportable earned income. There is no minimum hours or earnings floor other than the 200% FPL income ceiling; a person working 10 hours a week at minimum wage can qualify.3 Capacity to work without actual work does not.

Condition 5: Income Within 200% of the Federal Poverty Level

Countable income must be at or below 200% of the Federal Poverty Level. For 2026 the base FPL is about $1,330/month for one person and $1,803/month for two, so the 200% base works out to roughly $2,660/month single and $3,606/month for a couple.3

That base understates how much a worker can actually earn, because the SSI earned-income disregards apply first: a $20 general disregard, a $65 earned-income disregard, and then half of the remaining earnings. Because those disregards are built into the figure Medicare and SSA publish, the official 2026 QDWI income ceiling is higher than the bare 200% FPL: $5,405/month for an individual and $7,299/month for a couple in Georgia and the other 48 contiguous states.4 This is what makes QDWI's income test the most generous of any MSP in practice.

Condition 6: Assets Within $4,000 / $6,000

Countable resources must be at or below $4,000 for a single applicant and $6,000 for a married couple, equal to twice the SSI resource standard.2 These limits have not been adjusted for inflation since QDWI was created in 1988. By comparison, the QMB, SLMB, and QI resource limit is $9,950 single / $14,910 couple in 2026, about 2.4 times higher.4 So the QDWI asset test is the strictest of the four MSPs even though its income test is the most generous.

Standard SSI resource exclusions apply: a principal residence, one vehicle, household goods and personal effects, burial space and a modest burial fund, and certain retirement accounts. Bank accounts, brokerage accounts, cash, and a second vehicle count. The static limit is a persistent trap: a modest inheritance, a tax refund, or an emergency savings buffer can push an otherwise-eligible worker over $4,000.2

What QDWI Pays and Does Not Pay

QDWI is the most narrowly benefitted of the Medicare Savings Programs. It pays one thing: the Medicare Part A premium.

What QDWI Pays

QDWI pays the Part A premium through the State Buy-In agreement between Georgia DCH and the federal Centers for Medicare & Medicaid Services (CMS). Medicaid pays the premium directly to Medicare on the enrollee's behalf, so the enrollee never sees it billed. In 2026 that is $311/month ($3,732/year) for a worker with 30 to 39 quarters of coverage, or $565/month ($6,780/year) for one with fewer than 30 quarters.1

What QDWI Does Not Pay

QDWI does not pay any of the following. The enrollee remains responsible for each:

• Part B premium ($202.90/month standard in 2026), paid through Social Security or direct billing1
• Part A deductible ($1,736 per benefit period in 2026)1
• Part B deductible ($283 in 2026)1
• Part B coinsurance (typically 20% of the Medicare-approved amount)
• Part A hospital coinsurance and skilled nursing facility coinsurance after the no-cost days end
• Part D premium or any Part D cost-sharing

QDWI Does Not Trigger Part D Extra Help

Unlike QMB, SLMB, and QI, QDWI does not deem the enrollee automatically eligible for the Medicare Part D Low-Income Subsidy, also called Extra Help. The federal subsidy-deeming rule at 42 CFR 423.773(c)(1) lists QMB, SLMB, and QI but omits QDWI.2 A QDWI enrollee who wants Extra Help must apply separately through SSA or the Georgia Department of Community Health.

This is the single most counterintuitive feature of QDWI. A QDWI enrollee may sit well within the Extra Help income and resource limits yet not be enrolled, because the program never enrolled them automatically. Most never apply, because they do not know they qualify, and a substantial Part D benefit goes unclaimed.

QDWI vs QMB, SLMB, and QI

The four Medicare Savings Programs differ in who they serve, what they pay, and whether they unlock Part D Extra Help. The Georgia 2026 figures compare as follows.

QMB, SLMB, and QI income and asset limits are confirmed against SSA and CMS for 2026.4 The QDWI published ceiling reflects the SSI earned-income disregards layered on the 200% FPL base.4 QDWI has the highest income limit, the lowest asset limit, the smallest benefit, and is the only MSP that does not unlock Part D Extra Help.2

QDWI vs Section 1619(b) Continued Medicaid

Section 1619(b) of the Social Security Act is often confused with QDWI, because both protect benefits for disabled people who return to work. They serve different populations and protect different things.

Section 1619(b) continues full Medicaid for a former Supplemental Security Income (SSI) recipient who goes to work and earns too much for an SSI cash payment.8 The person keeps Medicaid as long as they still have the qualifying impairment, meet all other SSI rules, need Medicaid to keep working, and earn below their state's Charted Threshold Amount. In Georgia for 2026 that threshold is $41,927 of gross annual earned income, and a worker with above-average Medicaid costs can request an even higher individualized threshold.9

The core distinction:

• QDWI is for former SSDI (Title II) recipients entitled to Medicare under Section 226(b). It pays only the Medicare Part A premium.
• Section 1619(b) is for former SSI (Title XVI) recipients. It continues comprehensive Medicaid, not just premium assistance.

Some people use both pathways in sequence. A worker who started on SSI, earned enough credits to move to SSDI, then returned to work after a Trial Work Period could move from 1619(b) into the SSDI extended-entitlement window and then need QDWI to keep Medicare.

How to Apply for the Georgia QDWI Medicare Savings Program

QDWI is administered jointly by Georgia and the federal government. The Georgia Department of Community Health (DCH) sets policy, the Division of Family and Children Services (DFCS) processes applications, and the State Buy-In agreement between DCH and CMS pays the premium to Medicare.

Where to Apply

• Georgia Gateway: the online portal for Georgia means-tested benefits, including the Medicare Savings Programs. Create an account, complete the integrated application, upload documents, and track status.
• DFCS county office: each of Georgia's 159 counties has a DFCS office that accepts in-person applications, useful for hands-on help or hard-copy documents.
• DFCS Customer Service, 1-877-423-4746: a worker can start an application by phone and mail forms for signature.5
• Authorized representative: a family member, attorney, social worker, or legal aid organization can apply on the applicant's behalf.

What to Bring

• Proof of identity and Georgia residency
• Proof the SSDI cash benefit ended because of earnings (the SSA notice or a Benefits Planning Query, BPQY, report)
• Proof of continued Medicare entitlement (the red, white, and blue Medicare enrollment letter or an SSA Section 226(b) confirmation)
• Proof of current employment and income (recent pay stubs or a self-employment ledger)
• Proof of resources (bank and brokerage statements, vehicle titles)

Timeline, Retroactive Coverage, and Renewal

Because QDWI is a disability-basis pathway, the federal clock that governs is the 90-day one, not the 45 days that covers most other Medicaid applicants (42 CFR 435.912). Those 90 days are a ceiling on DFCS, not a decision you are promised on day 90, and the clock can pause in unusual circumstances, such as a delay by you or an examining physician.10 Coverage can be backdated up to three months before the application month if the applicant was eligible then, so someone who lost the cash benefit in January but did not apply until April can recover up to three months of Part A premiums, with the refund processed through SSA. QDWI then renews each year through Gateway: confirm continued SSDI-termination status, continued Section 226(b) entitlement, continued work, current income, and current assets. Missing the renewal deadline closes the case.

A Few Traps Worth Naming

QDWI counts countable income, not gross earnings, so the SSI disregards (and the impairment-related work expenses SSA allows under its income-counting rules) can keep a worker eligible even when gross pay sits above the 200% FPL base.3 For self-employment, the test uses net income after allowable business expenses, not gross. The asset limit is the more common stumbling block: a single inheritance or tax refund can push someone over $4,000, and a spend-down on excluded resources (a burial reserve, a prepaid obligation) may be needed before reapplying.2 And because QDWI does not deem Extra Help, applying separately for the Part D Low-Income Subsidy is a step most enrollees miss. Free help is available from GeorgiaCares, the state's Medicare counseling program, and from Georgia Legal Services and Atlanta Legal Aid.

Learn More

Find personalized help comparing Medicare Savings Programs and applying for QDWI 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.