Georgia SLMB Program: Specified Low-Income Medicare Beneficiary (2026)

If your income is a little too high for full Medicaid, Georgia's SLMB program can still pay your entire Medicare Part B premium, $202.90 a month in 2026, or about $2,435 a year back in your pocket. The Specified Low-Income Medicare Beneficiary program is the second tier of the four Medicare Savings Programs, a federal Medicaid benefit that Georgia runs as a Georgia Medicaid program.1 It is open to those with monthly income above 100% and at or below 120% of the Federal Poverty Level (in 2026, up to $1,616 a month for a single person and $2,184 for a couple, counting the $20 general income disregard) and limited assets.1,2 SLMB also automatically qualifies you for Medicare Part D's Low-Income Subsidy (Extra Help), which sets your Part D deductible at $0, pays the full premium on a benchmark plan (on a plan priced above the regional benchmark you pay the difference), and caps copays at the federal LIS maximum.3

SLMB is narrower than its sister program QMB. While QMB pays the Part B premium AND the Part A and Part B deductibles, coinsurance and copayments for Medicare-covered services (not drug-plan copays, and a small Medicaid copayment may still apply), SLMB pays only the Part B premium, plus the automatic Extra Help both programs confer. SLMB beneficiaries remain responsible for Medicare deductibles, the 20% Part B coinsurance, and Part A inpatient hospital deductibles. And critically, the federal balance billing prohibition that protects QMB beneficiaries does NOT extend to SLMB beneficiaries: providers can lawfully bill SLMB beneficiaries for Medicare cost-sharing.2,1

Despite being the less generous of the two main MSP tiers, SLMB still provides meaningful value for a typical beneficiary: the $2,435 Part B premium for the year, plus whatever Part D premium automatic Extra Help absorbs: all of it on a benchmark plan, and only up to the regional benchmark on a costlier one.2,3 For Georgia Medicare beneficiaries with income just above the QMB threshold but still limited, SLMB can mean the difference between affording medical care and skipping needed services. This guide explains the federal framework, Georgia implementation through DCH and DFCS, the 2026 income and asset thresholds, the benefit package and its limitations, how SLMB differs from QMB and QI, the application process through Georgia Gateway, retroactive coverage, annual redetermination, and the SLMB-to-QMB upgrade path when income drops.

The Federal Framework

SLMB is established under federal Medicaid law in the Social Security Act. Every Medicaid agency in the 50 states and DC, including Georgia's Department of Community Health (DCH), must provide SLMB coverage to Medicare beneficiaries whose income falls above 100% and at or below 120% of the Federal Poverty Level and whose assets are within MSP limits.1,4

SLMB is the second of four Medicare Savings Programs:

1. Qualified Medicare Beneficiary (QMB): income ≤ 100% FPL; pays the Part A premium (if you don't have premium-free Part A), the Part B premium, and Part A and Part B deductibles, coinsurance and copayments for Medicare-covered services, plus automatic Extra Help1
2. Specified Low-Income Medicare Beneficiary (SLMB): income 100% to 120% FPL; pays the Part B premium plus automatic Extra Help, but no Medicare deductibles or cost-sharing
3. Qualifying Individual (QI): income 120% to 135% FPL; pays the Part B premium plus automatic Extra Help, but it is paid from a capped yearly federal allocation, granted first-come, first-served, and must be reapplied for every year1
4. Qualified Disabled and Working Individual (QDWI): income ≤ 200% FPL; pays the Part A premium only, for certain working people with disabilities who lost premium-free Part A, and is the one program that does not confer Extra Help1

The Key Difference from QMB: No Balance Billing Protection

The federal balance billing prohibition for Medicare Savings Programs applies ONLY to QMB beneficiaries. SLMB beneficiaries do NOT receive this protection. The practical implications are significant:

• A QMB beneficiary visiting a physician owes nothing toward the 20% Part B coinsurance (though a small Medicaid copayment may apply); federal law bars the provider from billing a QMB enrollee for Medicare cost-sharing1,2
• A SLMB beneficiary visiting the same physician pays the 20% Part B coinsurance after the Part B annual deductible is met; the provider lawfully bills the patient for this amount

For a typical Medicare beneficiary, the 20% Part B coinsurance on physician visits, outpatient services, and durable medical equipment adds up over a year, and Original Medicare puts no yearly limit on it unless you have supplemental coverage such as Medigap or Medicaid. Losing this protection means SLMB beneficiaries face meaningful annual cost-sharing depending on utilization.2

Automatic Part D Extra Help (Same as QMB)

SLMB enrollment, just like QMB enrollment, automatically qualifies you for Medicare Part D's Low-Income Subsidy. Federal rules treat QMB, SLMB, and QI enrollees as meeting the full-subsidy requirements, so you don't file a separate Extra Help application.3 In 2026 the benefit for an SLMB-only enrollee looks like this:

• $0 premium on a benchmark Part D plan; on a costlier plan, Extra Help pays up to the regional benchmark and you pay the difference3
• $0 annual deductible
• Copays of no more than $5.10 for a generic and $12.65 for a brand-name drug (the SSA Extra Help page explains the program)3
• No cost-sharing at all for covered drugs once your out-of-pocket costs reach $2,100 for the year3

The lower copay tiers ($0 for full-benefit dual eligibles in a nursing facility or on home and community-based services, and $1.60 generic or $4.90 brand-name for full-benefit dual eligibles at or below 100% FPL) are for people who also have full Medicaid, not SLMB alone.3 On drug costs, SLMB-only and QMB-only enrollees get the same Extra Help.

Federal Asset Limits and Outreach

For 2026 the federal MSP resource limits are $9,950 for a single person and $14,910 for a couple, per Social Security's program rules. Extra Help has its own, higher resource limits, so don't mix the two. Those are the federal standards, not an absolute cutoff: states can effectively raise both the income and the resource limits by disregarding certain income and resources, so an applicant somewhat over either figure should apply rather than rule themselves out.2 Verify current resource limits on the Medicare Savings Programs page.

For help applying, Georgia's State Health Insurance Assistance Program (Georgia SHIP, which the state also lists as GeorgiaCares SHIP) gives free counseling that includes applying for programs that lower Medicare out-of-pocket costs.5

A federal data-sharing pathway run by the Social Security Administration applies to SLMB as well as QMB: since January 1, 2010, an Extra Help application filed with Social Security starts the MSP application process unless you object, and SSA sends that data to the state Medicaid agency.1

Who Qualifies for SLMB in Georgia

SLMB has three eligibility criteria: Medicare entitlement, income (within the SLMB band), and assets.

Medicare Entitlement

• Must have Medicare Part A and Part B; SLMB pays the Part B premium, and federally it requires both1
• Most SLMB applicants are 65 or older with premium-free Part A, which goes to people who, on their own or a spouse's work record, paid Medicare taxes long enough (generally at least 10 years, or 40 quarters of coverage)2
• Some applicants are under 65 with disability-based Medicare (it usually starts after 24 months of Social Security Disability Insurance (SSDI) benefits, with no waiting period for ALS) or End-Stage Renal Disease (ESRD)6

2026 SLMB Income Range

Monthly countable income must be above 100% FPL (otherwise QMB applies) and at or below 120% FPL. The 2026 federal limits, which set the floor for Georgia, put the SLMB ceiling at $1,616 a month for a single person and $2,184 for a couple, and the QMB line below it at $1,350 and $1,824; both include the $20 general income disregard.1 Georgia's own DFCS Medicaid Policy Manual (Appendix A1, effective July 2026) prints the same limits net of that $20: $1,596 single and $2,164 couple for SLMB, and $1,330 and $1,804 for QMB.1 The SLMB band sits between the QMB and SLMB lines.

Income disregards apply (already included in the thresholds above for the $20 general disregard):1

• $20/month general income disregard1
• $65/month earned income disregard plus 50% of remaining earned income disregarded7

For example, a single applicant with monthly Social Security retirement that places countable income above the QMB threshold but below the SLMB threshold will qualify for SLMB.

2026 SLMB Asset Limits

QMB, SLMB, and QI share one federal resource limit: $9,950 for a single person and $14,910 for a couple in 2026. Social Security notes that those limits don't include the $1,500 per person ($3,000 per couple) burial exclusion, so a burial fund up to that amount sits on top of the limit.1 Georgia's DFCS manual (Appendix A1, effective July 2026) still lists $9,660 for an individual, which is the federal 2025 figure, alongside the current $14,910 for a couple; if your countable resources fall between $9,660 and $9,950, apply anyway. Georgia's undated MSP FAQ page prints lower figures still ($7,390 and $11,090) that match neither the manual nor the federal limit, so don't use them to rule yourself out.1 Confirm the operative state policy with DFCS and the CMS Medicare Savings Programs page.

Not everything you own counts. Georgia's MSP FAQ lists your home, a car, an irrevocable burial account up to $10,000 each for you and your spouse, and life insurance with a cash value of $1,500 or less as assets that aren't counted.1 Federal MSP rules use SSI's resource rules, which also exclude burial spaces such as plots, headstones and markers outright.7

Anything outside those exclusions, such as money in the bank, can count toward the limit. List every account on the application and let DFCS apply the exclusions.

Citizenship and Residency

• U.S. citizen or legal resident1
• Georgia resident
• Documentation of identity and residency required

What SLMB Pays For

Medicare Part B Premium

The 2026 Medicare Part B standard premium is $202.90 a month, or about $2,435 across the year, per CMS's 2026 premium announcement.2 Georgia Medicaid pays this premium under a state buy-in agreement with CMS. How the buy-in works:8

1. Georgia and CMS exchange buy-in enrollment data (federal rules require a daily exchange)
2. Once buy-in takes effect, the federal government bills the state for the premium and stops collecting it from you
3. Your Social Security check stops having the Part B premium taken out, so it goes up by that amount
4. It isn't instant: you may keep seeing the premium withheld for one or more months after approval, and no published figure fixes how long
5. Once buy-in coverage is effective, Social Security refunds any premiums deducted for months you were enrolled in the buy-in8

Medicare Part D Extra Help (Automatic)

SLMB enrollment automatically qualifies the beneficiary for Medicare Part D's Low-Income Subsidy, with no separate application:3

• $0 premium on a benchmark Part D plan (above the benchmark, you pay the difference)
• $0 deductible
• 2026 copays of at most $5.10 generic and $12.65 brand-name (see the SSA Extra Help page)3
• Nothing more for covered drugs after $2,100 in out-of-pocket costs for the year3

That is the same Extra Help a QMB-only enrollee gets; people who also have full Medicaid can qualify for lower copay tiers.

What SLMB Does NOT Pay For

The critical limitations of SLMB compared to QMB:

Medicare Cost-Sharing (Beneficiary Responsibility)

In 2026, the Medicare cost-sharing amounts the SLMB beneficiary remains responsible for include:2

• Part A inpatient hospital deductible: $1,736 per benefit period2
• Part A daily coinsurance: $434/day for hospital days 61-90; $868/day for each lifetime reserve day
• Part A SNF coinsurance days 21-100: $217/day
• Part B annual deductible: $283
• Part B 20% coinsurance: on physician visits, outpatient services, durable medical equipment, ambulance services, and most other Part B-covered services

No Balance Billing Protection

Providers can lawfully bill SLMB beneficiaries for the Medicare cost-sharing amounts listed above. This is a fundamental difference from QMB.

No Long-Term Services and Supports

SLMB does NOT cover nursing facility custodial care, HCBS waiver services, personal care attendant services, or adult day health programs; in Georgia it pays the monthly Part B premium only.1 For these benefits, Full Benefit Dual Eligible (FBDE) status through Georgia's Aged/Blind/Disabled Medicaid is required.

No Medicare Part A Premium (Rare)

SLMB does not cover the Part A premium for beneficiaries who must pay it.1 CMS scopes that premium to people 65 and older with fewer than 40 quarters of coverage, counting a spouse's work record, and certain people with disabilities; many people under 65 on disability get Part A without a premium, but not all.2 Among the MSPs, QMB is the one that pays a Part A premium for a low-income beneficiary; QDWI pays it only for certain working people with disabilities who lost premium-free Part A. SLMB beneficiaries without premium-free Part A pay the Part A premium themselves. In 2026 the reduced premium is $311 a month for people with at least 30 quarters of coverage, or who were married to someone with at least 30 quarters, so check a spouse's work record before assuming the higher rate; the full $565 a month applies to certain uninsured aged people with fewer than 30 quarters and to certain people with disabilities who have exhausted other entitlements.2

Annual Out-of-Pocket Impact: A Typical Georgia SLMB Scenario

To illustrate the practical value of SLMB, consider a typical scenario for a 70-year-old Atlanta SLMB beneficiary with several chronic conditions:

Without SLMB

• The annual Part B premium of $2,435 (12 months at the standard 2026 monthly rate of $202.90)2
• The annual Part B deductible of $283
• Part B 20% coinsurance on primary care visits, specialist visits, lab work, and an annual eye exam
• Part D premium and copays (without Extra Help)

With SLMB

• Part B premium: $0 (Medicaid pays the full $2,435 for the year through buy-in)2
• Part B annual deductible: $283, still patient responsibility
• Part B 20% coinsurance: still patient responsibility
• Part D copays with Extra Help: capped at the federal LIS maximum

For a typical beneficiary, SLMB saves the full $2,435 annual Part B premium and, through automatic Extra Help, eliminates the Part D deductible and zeroes the Part D premium on a benchmark plan; on a plan priced above the regional benchmark, Extra Help pays up to the benchmark and you pay the difference. Plan premiums vary, but for scale, CMS projects the average stand-alone Part D premium at $34.50 a month in 2026.2,3 Those two lines are what the household keeps for the year, before counting the drug-copay reduction. For comparison, the same beneficiary on QMB would also have the $283 Part B deductible and the 20% Part B coinsurance covered by Medicaid, for additional annual savings.

Georgia Implementation

SLMB is administered through the same agencies and processes as QMB:

• Georgia Department of Community Health (DCH): state Medicaid agency; sets policy; handles Medicare buy-in
• Division of Family and Children Services (DFCS): processes applications; conducts annual redeterminations; operates Georgia Gateway
• Georgia Gateway (gateway.ga.gov): integrated benefit application portal
• GeorgiaCares (SHIP): free Medicare counseling at 1-866-552-4464, option 45

Georgia's Medicaid Policy Manual

Georgia runs QMB, SLMB, and QI as Georgia Medicaid programs. The figures DFCS applies sit in its Medicaid Policy Manual (Appendix A1, ABD Financial Limits), which carries the federal SLMB rules into Georgia's own procedures.1

DFCS Application Processing

DFCS automatically evaluates Medicare beneficiaries' applications for the appropriate MSP tier based on income and assets:

• Income at or below 100% FPL → QMB1
• Income above 100% but at or below 120% FPL → SLMB
• Income above 120% but at or below 135% FPL → QI

The applicant does not need to specify which MSP to apply for. DFCS makes the determination from the documentation.

Medicare Buy-In

Georgia's buy-in agreement with CMS covers SLMB the same way it covers QMB:8

• Daily exchange of buy-in enrollment data with CMS
• A lag of one or more months before the premium stops coming out of your check, with no fixed published length
• A Social Security refund of premiums deducted for months you were enrolled in the buy-in

Application Process

Step 1: Gather Documentation

• Medicare card (showing Medicare ID and Part A/B effective dates)
• Social Security card and recent benefit award letter
• Proof of all income (Social Security, pensions, employment, investments, rental)
• Proof of all assets (recent bank statements, investment accounts, retirement accounts, life insurance with cash values, real estate deeds)
• Proof of Georgia residency (driver's license, voter registration, utility bill, lease/mortgage)
• Proof of citizenship or legal residency (passport, naturalization certificate, birth certificate)
• Spouse information if married

Step 2: Submit the Application

Pathways:

1. Online via Georgia Gateway (gateway.ga.gov): most efficient for those comfortable with online portals
2. Phone via DFCS (1-877-423-4746): for those preferring phone assistance9
3. In-person at local DFCS office: for those who need in-person help
4. Paper application (form 700): mail or hand-deliver it to your county DFCS office1
5. SSA pathway: an Extra Help application filed with Social Security also counts as an MSP application, unless you tell SSA you object1

Step 3: DFCS Review

Federal rules give DFCS no more than 45 days to decide an application like this one (the 90-day limit is only for people applying on the basis of disability), except in unusual circumstances such as a delay on the applicant's side.10 If DFCS asks for more documents, send them by the deadline on the request.

Step 4: Approval and Effective Date

• DFCS mails an approval letter
• Start dates differ by tier: Georgia starts QMB the month after the month eligibility is determined, while in certain cases it can grant SLMB up to three months before the month you applied1
• Federally, a QMB determination applies only to services furnished after the month it is made, so QMB never reaches back11

Step 5: Buy-In Activation

• Georgia sends your buy-in enrollment to CMS through the state-CMS data exchange8
• The premium may keep coming out of your check for one or more months while the buy-in processes
• Once it's active, your Social Security check goes up by the standard 2026 Part B premium of $202.90 a month2
• Social Security refunds premiums deducted for any month you were enrolled in the buy-in8

Step 6: Annual Redetermination

• DFCS sends a renewal packet ahead of your renewal date
• Complete and return it with current income and asset documentation
• An unreturned packet can close your case

SLMB Retroactive Coverage: How It Differs from QMB

Retroactive coverage is one place where SLMB can do something QMB can't.

QMB: No Retroactive Coverage

Federal law makes a QMB determination apply only to services furnished after the end of the month in which it is made, so QMB runs forward from the determination, never back.11 Georgia starts QMB benefits the month after the month eligibility is determined, so Medicare cost-sharing paid before then isn't covered by QMB.1

SLMB: Up to Three Months Back, in Certain Cases

Georgia states that in certain cases SLMB and QI benefits may be granted up to three months before the month of application.1 Because SLMB pays only the Part B premium, what reaches back is premium help, not cost-sharing:

• Medicare cost-sharing you paid in those months: not covered (SLMB doesn't cover cost-sharing going forward, either)
• Part B premiums deducted from your Social Security for months the buy-in covers: refunded by Social Security once buy-in coverage is effective8

Georgia's wording is "in certain cases," not every case, so ask DFCS in writing whether your SLMB can start before your application month, and which month. If it reaches back the full three months, that is up to three months of the standard 2026 Part B premium of $202.90 a month coming back to you.2 Federal law is also changing the general Medicaid retroactive window: for applications made on or after January 1, 2027, it shrinks to a maximum of two months before the application month for most enrollees.4 Georgia's guidance doesn't yet say how that change will apply to SLMB, so confirm the current window with DFCS before you count on it.

Transitions Between MSP Categories

QMB to SLMB Transition (COLA-Driven)

A move from QMB to SLMB can be triggered by Social Security's annual Cost of Living Adjustment (COLA). Each January, Social Security applies a COLA to benefits. The Federal Poverty Level also adjusts, but the COLA and FPL adjustments don't always align.

Result: a QMB beneficiary whose Social Security increase outpaces the FPL increase may find themselves above the 100% FPL QMB threshold but still below the 120% FPL SLMB threshold. They transition from QMB to SLMB.1 Federal law softens the timing: for each month through the month after the new poverty guidelines are published, the January COLA raise doesn't count against the QMB income test.7

The transition is typically automatic. DFCS reviews the new income at annual redetermination (or upon notification of the COLA) and adjusts the case category. The beneficiary does not need to file a new application.

Consequences of QMB to SLMB transition:

• Continue Part B premium coverage through buy-in
• Continue Part D Extra Help
• LOSE Medicare cost-sharing coverage: the $283 Part B deductible, the 20% Part B coinsurance, and the Part A deductible and coinsurance2
• Lose the federal balance-billing prohibition (it covers QMB only)
• A meaningful annual cost increase in Medicare cost-sharing now owed by the beneficiary, its size depending on how much care the beneficiary uses

Pickle Amendment Mitigation

The Pickle Amendment (section 503 of a 1976 federal law) is a partial remedy for one kind of COLA-driven loss, and it is narrower than its reputation.12 Under it:

• People receiving Social Security who lost Supplemental Security Income (SSI) or a state supplement after April 1977, and who would still qualify for it if the Social Security COLAs since then were subtracted, must keep Medicaid12
• COLAs paid to a financially responsible spouse or parent count in that test too
• It protects people who lost SSI, not people who lost QMB, so a QMB-to-SLMB move on its own doesn't trigger it

If you think you lost SSI this way, ask DFCS or a Georgia SHIP counselor to check.

SLMB to QMB Upgrade

When a SLMB beneficiary's income drops below 100% FPL (loss of pension, reduction in part-time work earnings, etc.), they should reapply for QMB to access the broader benefit package.1 The transition is not always automatic; the beneficiary may need to actively file a new application or report the income change.

Steps to upgrade:

1. Report the income change to DFCS promptly
2. DFCS reviews the new income
3. If QMB applies, DFCS transitions the case (typically without requiring a new application)
4. If DFCS does not auto-transition, beneficiary files a new application

SLMB to QI Transition

When a SLMB beneficiary's income increases above 120% FPL but stays at or below 135% FPL, they transition to QI.1 The benefit is the same as SLMB (Part B premium only, plus automatic Extra Help), but QI comes with strings: it is paid from a capped yearly federal allocation and granted first-come, first-served (with priority for people who had QI the year before), it must be reapplied for every year, and it is only for people who don't qualify for any other Medicaid.1

Loss of MSP When Income Exceeds 135% FPL

A SLMB or QI beneficiary whose income exceeds the QI ceiling ($1,816 a month single, $2,455 for a couple, in 2026) loses MSP eligibility entirely.1 The beneficiary retains Medicare but loses the Part B premium subsidy, which alone is $2,435 a year in 2026, and the automatic Extra Help that came with MSP.2 Extra Help itself reaches higher incomes, though: in 2026 its limit is below 150% FPL, about $1,995 a month for one person and $2,705 for a couple, so apply for it directly through Social Security rather than assuming it's gone.3

Beneficiaries near the 135% FPL threshold should consider planning for this possibility:1

• If income approaches the threshold, evaluate whether reducing employment income (reduced hours, less self-employment) makes financial sense
• Compare Medicare Advantage options, including whether you'd qualify for a Dual Eligible Special Needs Plan (D-SNP), with a Georgia SHIP counselor
• Plan for the higher out-of-pocket costs

Worked Examples

The people below are illustrative composites, not real beneficiaries. Their income and asset figures are hypothetical inputs chosen to show how the 2026 Georgia SLMB rules play out; your own numbers and outcome will differ.

Linda 68 Macon: SLMB Approval

Linda is 68, lives alone in Macon, single. Her Social Security retirement places her countable income (after the $20 general disregard) above the QMB ceiling but well below the SLMB ceiling. Linda qualifies for SLMB.1

Linda's assets: $6,500 in checking and savings. Her home (excluded) and one car (excluded). Countable assets of $6,500 are below the MSP resource limit.1

Linda applied through Georgia Gateway on February 10, 2026, and DFCS approved SLMB on March 15, 2026.

The Part B premium kept coming out of her Social Security for the first months after approval while the buy-in processed. Once it took effect, her check went up by the standard 2026 Part B premium, and Social Security refunded the premiums it had withheld for months she was enrolled in the buy-in.8

Linda's annual SLMB benefits:2

• Part B premium savings: $2,435 for the year (12 months at the standard 2026 rate of $202.90)
• Part D Extra Help savings: her Part D premium drops to $0 on a benchmark plan, and on a plan priced above the regional benchmark she would pay the difference; her Part D deductible is $0 either way, and her three prescriptions cost no more than the LIS copay caps3
• Total annual savings: the $2,435 Part B premium plus her Part D premium (at CMS's projected 2026 stand-alone average of $34.50 a month, about $414 a year), before the copay reduction on her three drugs2

Linda's continuing out-of-pocket Medicare costs:2

• Part B annual deductible: $283
• Part B 20% coinsurance on her 4 primary care and 2 specialist visits

Suppose, as a hypothetical figure, that the Medicare-approved amounts for those six visits come to $900 for the year. Linda pays the first $283 as her deductible, then 20% of the remaining $617, or $123.40, for $406.40 in Part B cost-sharing, against the $2,435 Part B premium and the Part D premium SLMB puts back in her pocket.2

Bob 73 Savannah: QMB to SLMB Transition

Bob is 73, Savannah, single. He has been QMB for two years. His Social Security retirement has been just below the QMB countable-income line.

In January 2026, Social Security applies its annual COLA. Bob's new monthly Social Security pushes his income just past the 2026 QMB line ($1,350 a month single).1 The raise doesn't count against his QMB income test right away: federal law ignores the COLA through the month after the new poverty guidelines are published.7

Bob is below the 2026 SLMB ceiling ($1,616 a month single), so once that grace period ends, DFCS moves him from QMB to SLMB.1

Practical impact for Bob:2

• Continues Part B premium coverage (Medicaid keeps paying the full $2,435 annual Part B premium through buy-in)
• Continues Part D Extra Help (the Part D premium stays at $0 on a benchmark plan; on a plan priced above the regional benchmark he pays the difference)3
• LOSES Medicare cost-sharing coverage:
  • Part B annual deductible of $283 now patient responsibility
  • Part B 20% coinsurance on physician, lab, and outpatient services
  • Part A deductible ($1,736 per benefit period) and coinsurance if hospitalized
• LOSES the federal Medicare provider balance-billing prohibition (it applies only to QMB)

Bob's annual out-of-pocket Medicare cost-sharing increases meaningfully, depending on utilization and any hospitalizations.

Bob explores options:

1. Pickle Amendment evaluation: Bob's GeorgiaCares counselor evaluates whether he qualifies. To qualify for Pickle Amendment protection, Bob would have to have received SSI, lost it, and still qualify for it today once the Social Security COLAs since then are subtracted. Bob never received SSI (his Social Security retirement was always too high), so Pickle does not apply to him.12

2. Medicare Advantage D-SNP: Bob considers a D-SNP for October 2026 open enrollment to get lower cost-sharing through an integrated plan. He asks his GeorgiaCares counselor which plans in his county, if any, accept SLMB-only members.

3. Plan for the cost increase: Bob adjusts his annual budget to accommodate the new cost-sharing he now owes. He continues SLMB as his primary cost-saving program.

Patricia 70 Atlanta: SLMB with Cost-Sharing Burden

Patricia is 70, lives alone in Atlanta. Her monthly income: $1,420 Social Security + $100 small annuity = $1,520. Her assets: $7,800 in checking and savings.1

Patricia qualifies for SLMB: countable income after the $20 disregard sits above the QMB line but below the SLMB ceiling; assets are below the MSP resource limit. DFCS approves SLMB.1

Patricia has multiple chronic conditions: type 2 diabetes (insulin), hypertension, hyperlipidemia, mild heart failure. Her 2026 Medicare utilization includes:

Physician visits (Medicare Part B):2

• Primary care: monthly visits
• Endocrinologist: a handful of visits per year
• Cardiologist: routine follow-ups
• Each visit carries a 20% Part B coinsurance Patricia is responsible for2

Outpatient services (Medicare Part B):

• Quarterly labs (HbA1c, lipid panel, CBC, kidney function), with 20% coinsurance on any that aren't covered as preventive services2
• Annual echocardiogram subject to 20% coinsurance
• Diabetic retinopathy screening (preventive)
• Mammogram screening (generally $0)
• DEXA bone density on the recommended cadence

Prescription drugs (Medicare Part D, with Extra Help):

• Insulin: no more than the $12.65 brand-name LIS copay per fill in 20263
• Several generic maintenance medications at no more than $5.10 per fill
• Annual Part D copays: a modest annual total under Extra Help

Hospitalization: None in 2026

Patricia's 2026 Medicare cost-sharing (NOT covered by SLMB):2

• Part B annual deductible: $283
• 20% Part B coinsurance on her physician visits and non-preventive outpatient services after the deductible
• Worked arithmetic: suppose, as a hypothetical figure, that the Medicare-approved amounts for those Part B services come to $3,000 for the year. She pays the $283 deductible, then 20% of the remaining $2,717, or $543.40, for $826.40 in Part B cost-sharing2

Patricia's 2026 Part D costs with Extra Help: a modest annual total, held down by the LIS copay caps and the $2,100 yearly out-of-pocket threshold, after which covered drugs cost nothing3

Patricia's total 2026 Medicare out-of-pocket with SLMB: that $826.40 in Part B cost-sharing, plus her drug copays of no more than $5.10 per generic and $12.65 per brand-name fill.2,3

Without SLMB, Patricia would instead owe:2

• The full $2,435 annual Part B premium
• The same $826.40 in Part B cost-sharing
• Full Part D drug costs with no Extra Help (the plan's premium, a Part D deductible, and unsubsidized copays)

SLMB covers Patricia's full $2,435 Part B premium for the year, plus her Part D premium, which Extra Help covers in full only while she stays on a benchmark plan, and it caps her drug copays. Her $826.40 in Part B cost-sharing is the same with or without SLMB.2,3

Despite SLMB, Patricia still faces meaningful Medicare cost-sharing that's significant on her fixed income. She considers D-SNP enrollment to reduce cost-sharing further.

William 75 Augusta: SLMB Retroactive Reimbursement

William is 75, Augusta, single. He started Medicare on October 1, 2025 (delayed enrollment after retiring from a part-time job with employer coverage). He did not know about SLMB until his GeorgiaCares counselor told him in October 2026.

William's monthly income: $1,420 ($1,200 Social Security + $220 small pension). His assets: $5,200. He qualifies for SLMB (income above QMB limit but below SLMB; assets below limit).1

William applies through Georgia Gateway on October 15, 2026. DFCS approves SLMB on November 20, 2026.

Retroactive coverage analysis:

• Application month: October 2026
• Possible retroactive window: July, August, and September 2026, the three months before his application month, which Georgia can grant for SLMB in certain cases1
• During those months, Medicare deducted the standard 2026 Part B premium from William's Social Security check

William's counselor tells him to ask DFCS, in writing, to make his SLMB effective as early as the rules allow. If DFCS sets the start in July, the buy-in covers those months and Social Security refunds the premiums it withheld for them.8

The buy-in also takes time to process, so the premium may keep coming out of his check for one or more months after approval. Social Security refunds those deductions too, for any month he was enrolled in the buy-in, and after that his check goes up by the full Part B premium.

Susan 67 Columbus: SLMB-to-QMB Upgrade

Susan, 67, Columbus, has been SLMB for two years. Her monthly income in 2025 and early 2026: $1,420 ($1,200 Social Security + $220 supplemental retirement pension).1

In April 2026, the supplemental retirement pension provider notifies Susan that the pension is being terminated due to plan changes (sponsor company bankruptcy and PBGC takeover). Susan's pension benefits will end May 1, 2026.

Susan's new monthly income starting May 2026: just her Social Security. After the $20 disregard, her countable income falls below the 2026 QMB ceiling ($1,350 a month single).1

Susan reports the income change to DFCS right away (April 18, 2026). DFCS reviews the documentation:

• PBGC notice of pension termination
• Last pension payment statement
• Social Security award letter

DFCS determines in May 2026 that she qualifies for QMB, and her QMB starts June 1, 2026, the month after that determination; QMB never reaches back.1

Practical impact for Susan:

• Continues Part B premium coverage (now under QMB instead of SLMB)
• Continues Part D Extra Help
• GAINS Medicare cost-sharing coverage (the $283 Part B annual deductible, the 20% Part B coinsurance, the Part A deductible and coinsurance)2
• GAINS the federal Medicare provider balance-billing prohibition for QMB1

Her annual Medicare out-of-pocket costs decrease meaningfully with the QMB upgrade, partially offsetting the income loss from the terminated pension.

Joseph 78 Athens: SLMB Renewal with Asset Increase

Joseph, 78, Athens, has been SLMB for three years. His monthly income: $1,500 ($1,200 Social Security + $300 modest pension). His assets at the time of original approval: $6,000.1

In November 2025, Joseph's aunt (who lived in Florida) passes away. Her will leaves Joseph an inheritance from the estate. Joseph deposits the check in early December 2025. His total assets now exceed the 2026 MSP resource limit.

Joseph's annual SLMB redetermination is scheduled for January 2026. He must report the inheritance and the resulting asset increase.

Joseph's options:

1. Report and accept termination: SLMB ends; Joseph pays the Part B premium and full Part D costs going forward.

2. Spend down before redetermination: Convert countable assets to non-countable assets or pay legitimate debts. Joseph identifies:

   • Outstanding home equity line of credit balance (pay off)
   • Funeral arrangements (prepaid through an irrevocable burial account, which Georgia's MSP FAQ excludes up to $10,000)1
   • Home repairs for a new HVAC system (money spent on the home, which isn't counted)
   • Replace a failing refrigerator

3. Transfer to family (gifts): if Joseph might need Medicaid to pay for nursing facility care later, gifts made within the 60 months before that application can trigger a transfer penalty under Medicaid's look-back rule.13

Joseph chose Option 2 (spend down). He paid off the HELOC, prepaid funeral arrangements, replaced the HVAC, and bought the refrigerator. At redetermination in January 2026, he reported the inheritance and the spend-down activities with documentation. DFCS verified the spend-down was legitimate (no gifts) and renewed SLMB without interruption.

Joseph's strategic benefit:

• Preserved SLMB eligibility
• Avoided transfer-penalty exposure for any future FBDE application
• Made legitimate improvements to his home and life using money that would otherwise have disqualified him from SLMB

Special Considerations

SLMB and Medigap (More Complex Than QMB)

For QMB beneficiaries, Medigap is largely redundant because QMB already pays the Part A and Part B deductibles, coinsurance and copayments for Medicare-covered services.1 For SLMB beneficiaries, Medigap can complement SLMB by covering the cost-sharing that SLMB does not cover.

The cost-benefit analysis for SLMB + Medigap:

• Medigap premiums vary with the policy you buy, where you live, and other factors, and can change each year; get quotes from several insurers rather than relying on a single figure2
• Medigap coverage: what a policy pays depends on its plan letter; in Georgia, no policy covering the Part B deductible (Plans C and F) can be sold to someone newly eligible for Medicare on or after January 1, 202014
• Medigap value: depends on utilization
• In Georgia, Medigap is regulated by the Georgia Office of Commissioner of Insurance and Safety Fire, and after your six-month Medigap open enrollment window closes an insurer can medically underwrite a switch unless you have a guaranteed-issue right, such as losing employer coverage that supplemented Medicare14

For high-utilization SLMB beneficiaries (chronic conditions, multiple specialists, frequent labs), Medigap may save more than it costs. For low-utilization beneficiaries, paying the cost-sharing out of pocket may come out cheaper.

GeorgiaCares SHIP counselors can run individual cost-benefit analyses with each beneficiary's utilization pattern.

SLMB and Medicare Advantage / D-SNPs

Medicare Advantage plans (Part C) are an alternative to Original Medicare. For SLMB beneficiaries:

• SLMB pays only your Part B premium; it does not pay a Medicare Advantage plan's own premium1
• Every Georgia beneficiary has access to a $0-premium Medicare Advantage plan in 202615
• D-SNPs are Special Needs Plans for people who have both Medicare and Medicaid; they cover the same Part A and Part B benefits as other Medicare Advantage plans, add care coordination, and must include Part D drug coverage16
• Which D-SNPs you can join depends on your county and on each plan's eligibility rules, so check whether a plan accepts SLMB-only members before you count on one16

Georgia DCH placed a moratorium on contracting with new D-SNPs starting August 1, 2025, so the menu may not grow soon.16 Review your coverage every year during the annual Medicare Open Enrollment Period (October 15 to December 7).17 Because you get Extra Help, you can also switch stand-alone Part D plans once a month (unless your drug plan has notified you that you're identified as at-risk under its drug management program); the monthly special enrollment period into an integrated D-SNP is for full-benefit dual eligibles.18

SLMB and Disability

SLMB is available to Medicare beneficiaries under 65 with disability (Medicare usually after 24 months of SSDI benefits, with no wait for ALS) or End-Stage Renal Disease.6 The application process is the same.

SLMB and Working Beneficiaries

Working Medicare beneficiaries can qualify for SLMB. The income disregards ($20 general + $65 earned + 50% of remainder) are favorable for earners. A senior with $3,000 a month in gross earnings and no other income would have countable income of 50% x ($3,000 - $20 - $65) = 50% x $2,915 = about $1,458. That's above Georgia's $1,330 net QMB limit and under its $1,596 net SLMB limit, so it lands in the SLMB band.7,1

SLMB and Spousal Considerations

When evaluating SLMB for a married couple:

• If both spouses are Medicare-eligible: apply for SLMB as a couple (couple income/asset limits apply)
• If only one spouse is Medicare-eligible: typically apply for SLMB for that spouse; household income/assets count

SLMB and Estate Recovery

Georgia's estate recovery is limited by age and by service. For members 55 or older it reaches only nursing facility services, personal care, home and community-based services, and hospital and drug services provided to people in a nursing facility or receiving home and community-based services; the Part B premium SLMB pays is not on that list. Georgia's rule also reaches members of any age who were inpatients in a nursing facility or other medical institution where they had to spend all but a minimal amount of their income on their care.19

If a SLMB beneficiary also receives full Medicaid long-term care, estate recovery can apply to those services, and Georgia uses an expanded estate definition that reaches property passing outside probate, such as joint tenancy, life estates and trusts. Recovery waits until a surviving spouse has died and there is no surviving child under 21 or child who is blind or permanently disabled.19

Common Mistakes Georgia Families Make

1. Confusing SLMB with QMB. It's easy to assume SLMB covers everything QMB covers, but in Georgia SLMB pays the monthly Part B premium only, while QMB also pays deductibles and coinsurance.1

2. Paying providers for Medicare cost-sharing under the false belief that SLMB provides balance-billing protection. The federal Medicare provider balance-billing prohibition covers QMB only. SLMB beneficiaries are responsible for Medicare cost-sharing.

3. Not knowing SLMB exists. Income just above the QMB threshold doesn't end MSP help: SLMB is a separate program with a higher limit.

4. Not upgrading to QMB when income drops. When income drops below 100% FPL, beneficiaries should reapply for QMB to gain cost-sharing coverage and balance billing protection.1

5. Missing annual redetermination. Renewal paperwork must be returned, and an unreturned packet can close your case.

6. Not reporting income or asset changes promptly. Late reporting can leave you in the wrong tier.

7. Overestimating income. Disregards apply ($20 general + $65 earned + 50% of remainder).1,7

8. Not asking about retroactive coverage. In certain cases Georgia can grant SLMB up to three months before your application month, which can bring back Part B premiums already deducted.1

9. Filing a separate Extra Help application. SLMB enrollees are automatically treated as eligible for Extra Help and don't need to apply.3

10. Not appealing denials. Request a fair hearing within 30 days of the notice of the decision.9

11. Counting excluded assets. Georgia doesn't count your home, a car, an irrevocable burial account up to $10,000 each, or life insurance with a cash value of $1,500 or less.1

12. Dropping Medigap unnecessarily. Unlike QMB (where Medigap is largely redundant), for SLMB the Medigap analysis depends on utilization.

13. Not coordinating SLMB with Medicare Advantage. Ask whether a D-SNP in your county accepts SLMB-only members; one may lower your cost-sharing.

14. Forgetting SLMB does not provide LTSS. Nursing facility care requires FBDE.

15. Not preparing for COLA-driven QMB-to-SLMB transitions. Beneficiaries close to the QMB threshold should plan for potential transitions.

Need help with SLMB in Georgia? These are the offices that apply your case, pay the premium, and answer questions.

Learn More

Find personalized help checking your eligibility for Georgia's Medicare Savings Programs 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.