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 65.1,2 It serves people with a disability who went back to work, lost their Social Security disability benefits, and later lost premium-free Part A as well.3

QDWI is one of the four Medicare Savings Programs (MSPs), and its Medicaid eligibility group is set out at 42 CFR 435.126.3,4 The program exists because of an unusual interaction between Social Security Disability Insurance (SSDI) return-to-work rules and Medicare: a worker can lose the SSDI cash benefit but keep free Part A for at least 93 months after the trial work period, and only once that continued coverage ends does the Part A premium become a real bill.5

QDWI has the highest income limit of any MSP (built on 200% of the Federal Poverty Level) but the lowest asset limit ($4,000 single / $6,000 couple) 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.3 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.3 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 you don't have premium-free Part A), the Part B premium, and the Part A and Part B deductibles, coinsurance, and copayments, and confers automatic Part D Extra Help. Income limit 100% FPL.4
• Specified Low-Income Medicare Beneficiary (SLMB): pays the Part B premium only, and confers automatic Part D Extra Help. Income limit 120% FPL.4
• Qualifying Individual (QI): pays the Part B premium only (first come, first served, from a capped yearly federal allocation), and confers automatic Part D Extra Help. Income limit 135% FPL.4
• Qualified Disabled and Working Individual (QDWI): pays the Part A premium only, and does not confer Extra Help. Income limit 200% FPL; asset limit $4,000 single / $6,000 couple.3,4

QDWI is the only MSP that does not extend to the aged Medicare population. It is restricted to Medicare beneficiaries under 65 who have a disability and are working, and losing premium-free Part A after returning to work is the eligibility trigger, not a disqualifier.3,2

How a Worker Keeps Medicare After Losing SSDI

A worker who becomes disabled can claim Social Security Disability Insurance (SSDI). For a first period of disability the SSDI cash benefit follows a five-month waiting period, and Medicare entitlement under Section 226(b) of the Social Security Act begins with the 25th month of SSDI entitlement, on the basis of disability rather than age.5

When a worker on SSDI returns to work, the rules unfold in sequence:

• Trial Work Period (TWP): a 9-month trial period, triggered by a monthly earnings amount lower than the SGA amounts below.2
• Substantial gainful activity (SGA): in 2026 SGA is $1,690/month for non-blind individuals and $2,830/month for blind individuals. Earnings above SGA generally show SSA that a person is no longer disabled for SSDI purposes, which is how the cash benefit ends, but earning above SGA does not by itself end Medicare.2
• Continued Medicare: if the cash benefit stops because of earnings and the person still has a disability, SSA says free Part A continues for at least 93 months after the trial work period (at least 7 years and 9 months), as long as the disabling condition still meets SSA's rules.5

The Part A premium only arrives after that continued coverage ends. A person under 65 who still has the disabling impairment, lost entitlement solely because of earnings above SGA, and is not otherwise entitled to Part A can then buy Part A under Section 1818A of the Social Security Act, and QDWI is the group through which Medicaid covers that premium.5,2 In 2026 the premium is $311/month for someone with at least 30 quarters of Medicare-covered employment, or who is married to someone with at least 30. CMS lists the full $565/month rate for certain uninsured aged people with fewer than 30 quarters and for certain individuals with disabilities who have exhausted other entitlements, so check your own record, and your spouse's, before assuming which rate applies.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 Social Security disability benefits and lost them, along with premium-free Part A, because they returned to work.3 The premium Part A that QDWI pays for is open only to someone who lost entitlement solely because of earnings above the substantial gainful activity (SGA) amount.5 If SSA ended your benefits for a different reason, such as medical improvement, this route does not fit; ask SSA how your case was closed.

Condition 2: Free Part A Has Run Out

QDWI starts where the free coverage stops. A worker whose cash benefit ended because of earnings keeps free Part A for at least 93 months after the trial work period, as long as the disabling condition still meets SSA's rules. Once that continued coverage ends, they can enroll in premium Part A under Section 1818A if they still have the disabling impairment and are not otherwise entitled to Part A, and that premium is what QDWI pays.5 To find out when your continued coverage ends, ask Social Security, whose national number is 1-800-772-1213.9

Condition 3: Under Age 65

QDWI is limited to people under 65. At 65 the disability basis for Medicare ends and entitlement arises on the basis of age instead, but for someone buying Part A under Section 1818A that switch is not automatic: they need to apply for Part A on the age basis.5 Most people then qualify for premium-free Part A through at least 40 quarters of Medicare-covered work, on their own record or a spouse's, so the Part A premium and QDWI both end.1 Someone who reaches 65 and still owes a Part A premium would generally look to QMB instead, which pays the Part A premium for people who don't have premium-free Part A.4

Condition 4: Currently Working

The applicant must be working when they apply.3 Being able to work, without actually working, does not count.

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

Countable income must be at or below 200% of the Federal Poverty Level. HHS publishes the 2026 guidelines as annual income: $15,960 for one person and $21,640 for two in the 48 contiguous states and DC. Twice those figures is $31,920 and $43,280 a year, which comes to about $2,660 and $3,607 a month once you divide by twelve, an arithmetic conversion rather than a published monthly figure.6

That base understates how much a worker can actually earn, because the QDWI income figures build in earned-income disregards on top of the $20 general income disregard. That is why the 2026 QDWI income limit SSA and CMS publish is higher than a bare 200% FPL: $5,405/month for an individual and $7,299/month for a couple in every state except Alaska and Hawaii, Georgia included.7 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.3 By comparison, the 2026 federal resource limit for QMB, SLMB, and QI, which sets the floor for Georgia, is $9,950 single / $14,910 couple, nearly two and a half times higher.4 So the QDWI asset test is the strictest of the four MSPs even though its income test is the most generous.

Not everything you own counts toward the limit, so ask DFCS which of your resources are excluded before you rule yourself out. The low limit is a persistent trap: a modest inheritance, a tax refund, or an emergency savings buffer can push an otherwise-eligible worker over $4,000.3

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

The state pays the QDWI enrollee's Part A premium, but not through the State Buy-In agreement that covers QMB, SLMB, and QI. The federal Centers for Medicare & Medicaid Services (CMS) has states pay QDWI premiums through a separate group-payer process and does not let them fold QDWI into their buy-in agreements.2 In 2026 the premium is $311/month ($3,732/year) for someone with at least 30 quarters of coverage, or married to someone with at least 30, and $565/month ($6,780/year) at the full rate.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)1
• Part A hospital coinsurance and skilled nursing facility coinsurance after the no-cost days end1
• 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.3 A QDWI enrollee who wants Extra Help has to apply for it separately, through SSA.

This is the most counterintuitive feature of QDWI. A QDWI enrollee's assets ($4,000 or less) sit far below the 2026 Extra Help resource limit of $16,590 for one person, yet nobody enrolls them automatically.1 Income is a separate test, so apply and let SSA decide.

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 2026 federal figures, which set the floor for Georgia, compare as follows.

The QMB, SLMB, and QI figures are the 2026 federal limits. They are floors, not caps: states can raise them for those three programs, so apply even if you look slightly over.4 The QDWI published ceiling reflects earned-income disregards layered on the 200% FPL base.7 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.3

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) lets a former Supplemental Security Income (SSI) recipient who goes to work, and earns too much for an SSI cash payment, keep Medicaid.10 The person keeps Medicaid as long as they still have the qualifying impairment, would meet the SSI rules but for their earnings, need Medicaid to keep working, and have gross earnings at or below their state's Charted Threshold Amount.10 In Georgia for 2026 that threshold is $41,927 of gross annual earned income. Earning more does not by itself end 1619(b): SSA's field office checks whether the worker qualifies under a higher individualized threshold built from costs such as their own higher Medicaid spending or impairment-related work expenses, and someone with none of those costs is ineligible.11

The core distinction:

• QDWI is for former SSDI (Title II) recipients whose continued free Part A has run out. It pays only the Medicare Part A premium.
• Section 1619(b) is for former SSI (Title XVI) recipients. It continues Medicaid coverage, not just premium assistance.

If you have a history with both SSI and SSDI, ask SSA which of these work protections applies to you before assuming you need one or the other.

How to Apply for the Georgia QDWI Medicare Savings Program

In Georgia, the Division of Family and Children Services (DFCS) processes Medicare Savings Program applications through Georgia Gateway, and the state pays the QDWI Part A premium through CMS's group-payer process rather than the buy-in agreement.4,2 The Georgia Department of Community Health (DCH) runs the Medicaid Member Services line for Georgia Medicaid member questions.12

Where to Apply

• Georgia Gateway: Georgia's online system for Medical Assistance and other benefits. DFCS asks you to upload applications, renewals, and verification paperwork there when you can.8
• DFCS county office: if you don't have online access, DFCS says to mail your paperwork directly to your local county office.8
• DFCS Customer Contact Center, 1-877-423-4746: the number to call to request a Medicaid application.12
• Someone helping you: a family member, social worker, or legal aid lawyer can help you gather papers; ask DFCS how to name them on your application.

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 your Medicare Part A (your Medicare card, plus any SSA notice saying when your free Part A ended)
• 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 standard can be exceeded in unusual circumstances, such as a delay by you or an examining physician.13 Ask DFCS whether your coverage can start before the month you apply. Renewals also go through Georgia Gateway, so watch for DFCS notices and send what they ask for on time.8

A Few Traps Worth Naming

QDWI's income test is not a bare 200% FPL applied to gross pay: the earned-income disregards built into the published limit can keep a worker eligible even when gross pay sits above the 200% FPL base.3 The asset limit is the other trap: a single inheritance or tax refund can push someone over $4,000.3 And because QDWI does not deem Extra Help, applying separately for the Part D Low-Income Subsidy is an easy step to miss. Free help is available from GeorgiaCares, the state's Medicare counseling program, and from Georgia Legal Services and Atlanta Legal Aid.14,12,15

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.