IRMAA: What is IRMAA in Medicare?

If you are a Medicare beneficiary with a high annual income, it may be a shock to realize your Medicare Part B and Medicare Part D premiums are higher than you initially thought they would be. This difference in premium reflects your Income Related Monthly Adjustment Amount (IRMAA).  

The Social Security Administration determines if you owe an IRMAA based on the income you reported on your IRS tax return two years prior. If you feel your higher Medicare Part B premium is incorrect, there are steps you can take to appeal the IRMAA determination. 

How to Calculate IRMAA

To calculate your IRMAA, you will need to review your tax returns submitted to the IRS two years prior to the current year. Your IRMAA is based on the modified adjusted gross income stated on your tax form. 

Refer to the 2023 Medicare IRMAA Chart below for an idea of what Medicare costs you should expect in 2023.

You can also view the image below for more details on Medicare Part B income-related premiums after 2023.

If the SSA determines that you owe a higher Medicare Part B premium based on your MAGI, they will notify you of your new amount by mail. However, if you think the income information Social Security used to determine your Income Related Monthly Adjustment Amount was incorrect or outdated, you can request an appeal for Medicare to revisit the decision.

In this case, you may need to contact the IRS and correct any wrong information before you file the appeal. Fixing the issue may be as simple as filing an amended tax return.

A new initial determination is a revised decision that the SSA makes regarding your Income Related Monthly Adjustment Amount. If you have experienced a life-changing event that caused a decrease in income, you can request that the SSA revisit its decision.

Situations Social Security Considers Life-Changing Events:

• Marriage
• Divorce
• Spousal death
• You or your spouse stop working or reduce the number of working hours
• Involuntary loss of income-producing property due to a natural disaster, disease, fraud, or other circumstances
• Receipt of the settlement payment from a current or former employer due to the employer’s closure or bankruptcy

You can request a new initial determination by submitting a Medicare IRMAA Life-Changing Event form. You can also schedule an appointment with Social Security. Documentation will be required with proof of the life-changing event that caused your income to go down.

How to Appeal the IRMAA Decision

If requesting a new initial determination is not an option, you have the right to file an appeal for your Medicare Part B premium increase.

Social Security does not have a strict timeframe in which they must respond to a reconsideration request. If you have questions about your appeal status, it is best to contact the agency currently reviewing your appeal.

An appeal will not cost you anything, and if you state your case well enough, you may save yourself some money.

If you want to appeal your IRMAA, you should visit the Social Security website and complete the Request for Reconsideration form. The form will give you three options on how to appeal, with the easiest and most common way being a case review.

Documentation is essential for an appeal. You should write a cover letter explaining why you believe you are being overcharged and provide backup documentation.

You can appeal your Medicare Part B premium increase for outdated or incorrect information when you:

• Filed an amended tax return with the IRS
• Have a more recent tax return that shows you are receiving a lower income than previously reported

For example, let’s say you were single with an income of $95,000 the year you retired. Then, two years later, your income is only $45,000 from Social Security and IRA distributions. If this is the case, then you should not have to pay a higher Medicare Part B premium based on your former income.

Documentation Needed to File an IRMAA Appeal

• A letter from your former employer confirming your retirement
• A copy of your last pay stub to show your decreased income
• Any official documents that support your case

If you have a successful appeal, Social Security will automatically correct your Medicare Part B premium amount. If you’re denied, they will provide instructions on how to appeal the denial to an Administrative Law Judge. While you are in the process of the appeal, you will continue to pay the higher Medicare Part B premium.

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