This e-form is for Medicaid & Medicare Savings for Qualified Beneficiaries, Georgia residents only.

Georgia Application for Medicaid and Medicare Savings for Qualified Beneficiaries

The Medicare Program provides health insurance coverage for approximately 42 million people age 65 and older and younger individuals with disabilities. However, many beneficiaries incur substantial out-of-pocket costs for health care even though they have Medicare coverage. The Medicaid program provides protection from some or all of Medicare’s cost sharing for some low-income individuals. Medicaid provides partial financial assistance with Medicare premiums, deductibles, or coinsurance – through the Medicare Savings Program (i.e., Qualified Medicare Beneficiaries, Specified Low-Income Medicare Beneficiaries, and Qualifying Individuals) – to certain low income Medicare beneficiaries who are not entitled to the full Medicaid benefit package.

By clicking on "Apply Now" you can fill out an application for the Georgia Medicare Savings Program.

These forms are easy to complete on-line and can save you time. You are able to save your application and go back to it at a later time to complete it or to make changes to your information. We hope to add new forms in the future. The e-forms eliminate the need for you to complete the same information on form after form by securely saving your information and automatically filling in similar fields on additional forms.

The forms are divided into steps to make it easier for you to complete. Each page has a button that can be clicked to go to the next question, back to the previous question, or to close the form. You can quit at any time by closing the form and the system will prompt you to cancel, save or print your data.

You will need Adobe Acrobat Reader to print the form. Download Acrobat Reader.