MEDICARE STUDY GUIDE CORE HEALTH
INSURANCE AND GOVERNMENT PROGRAMS
REVIEW 2026
◉ Deductible.
Answer: The amount the patient must pay out of pocket to the
provider before the insurance company will pay any expenses. Once
the deductible is met, regular copays and/or coinsurance apply. It
also may not apply to certain services or prescriptions.
◉ Deductible Example - would not apply.
Answer: Annual Wellness Visit or A Bonus and/or Lifestyle
Medication
◉ Deductible Example - would apply.
Answer: If the Medical plan has a $200 deductible on medical
services, the retiree pays 100% of costs until they reach $200.
◉ Employer Group Waiver Plan (EGWP).
Answer: A type of health insurance prescription plan that private or
public employers can offer to their retired employees.
, ◉ Income Related Monthly Adjustment Amount (IRMAA).
Answer: The amount the retiree may pay in addition to the Part B or
Part D premium if their income is above a certain level. This is
determined by the income they reported on their IRS tax return two
years prior, meaning two years before the year that they start paying
IRMAA.
◉ Part B Late Enrollment Penalty (LEP).
Answer: A permanent surcharge added to the monthly premium of
the Part B plan if the retiree fails to sign up when they're first
eligible for Medicare. The retiree will be penalized if/when they
enroll in the future. They'll pay an extra 10% for each 12m period
without Part B. Penalty lasts for life.
◉ Part D Late Enrollment Penalty (LEP).
Answer: A permanent surcharge added to the monthly premium of
the Part D prescription drug plan if the retiree fails to sign up when
they're first eligible for Medicare or goes 63 days (or longer)
without Part D coverage/credible coverage. Penalty is based on the
amount of time without coverage multiplied by 1% by the "National
Base Premium". This penalty lasts for life.
◉ Low Income Subsidy.
Answer: Medicare beneficiaries with limited income may qualify.
This is a government program that helps pay for their Part D
INSURANCE AND GOVERNMENT PROGRAMS
REVIEW 2026
◉ Deductible.
Answer: The amount the patient must pay out of pocket to the
provider before the insurance company will pay any expenses. Once
the deductible is met, regular copays and/or coinsurance apply. It
also may not apply to certain services or prescriptions.
◉ Deductible Example - would not apply.
Answer: Annual Wellness Visit or A Bonus and/or Lifestyle
Medication
◉ Deductible Example - would apply.
Answer: If the Medical plan has a $200 deductible on medical
services, the retiree pays 100% of costs until they reach $200.
◉ Employer Group Waiver Plan (EGWP).
Answer: A type of health insurance prescription plan that private or
public employers can offer to their retired employees.
, ◉ Income Related Monthly Adjustment Amount (IRMAA).
Answer: The amount the retiree may pay in addition to the Part B or
Part D premium if their income is above a certain level. This is
determined by the income they reported on their IRS tax return two
years prior, meaning two years before the year that they start paying
IRMAA.
◉ Part B Late Enrollment Penalty (LEP).
Answer: A permanent surcharge added to the monthly premium of
the Part B plan if the retiree fails to sign up when they're first
eligible for Medicare. The retiree will be penalized if/when they
enroll in the future. They'll pay an extra 10% for each 12m period
without Part B. Penalty lasts for life.
◉ Part D Late Enrollment Penalty (LEP).
Answer: A permanent surcharge added to the monthly premium of
the Part D prescription drug plan if the retiree fails to sign up when
they're first eligible for Medicare or goes 63 days (or longer)
without Part D coverage/credible coverage. Penalty is based on the
amount of time without coverage multiplied by 1% by the "National
Base Premium". This penalty lasts for life.
◉ Low Income Subsidy.
Answer: Medicare beneficiaries with limited income may qualify.
This is a government program that helps pay for their Part D
