Medicare High Income IRMAA Premium Appeal/Reconsideration Process

"IRMAA is based on a person's modified adjusted gross income (MAGI), which is their adjusted gross income plus tax-exempt interest."

What is IRMAA?

IRMAA stands for Income-Related Monthly Adjustment Amount. It is a surcharge that some Medicare beneficiaries have to pay in addition to their Part B and Part D premiums. IRMAA is based on a person's modified adjusted gross income (MAGI), which is their adjusted gross income plus tax-exempt interest.

Who has to pay IRMAA?

Not everyone who has Medicare has to pay IRMAA. Only beneficiaries with MAGI above certain thresholds have to pay IRMAA. The thresholds for 2024 are as follows:

• Part B IRMAA: If your MAGI is more than $186,000 for a single return or $372,000 for a joint return, you will have to pay Part B IRMAA.

• Part D IRMAA: If your MAGI is more than $97,000 for a single return or $194,000 for a joint return, you will have to pay Part D IRMAA.

How to appeal an IRMAA determination

If you believe that you were incorrectly assessed IRMAA, you can appeal your determination to the Social Security Administration (SSA). You have 60 days from the date of your Initial IRMAA Determination Letter to file an appeal.

To appeal your IRMAA determination, you must complete a Request for Reconsideration of Initial IRMAA Determination (Form SSA-44). You can download this form from the SSA website or request it by phone at 1-800-772-1213.

On the Form SSA-44, you will need to provide information about your income and any other factors that may affect your IRMAA determination. You can also attach any supporting documentation, such as tax returns, pay stubs, or bank statements.

The reconsideration process

Once you have submitted your Form SSA-44, the SSA will review your case and make a decision. If the SSA determines that you were incorrectly assessed IRMAA, they will adjust your premium amount accordingly. If the SSA upholds the original decision, you will have the opportunity to appeal to the Office of Medicare Hearings and Appeals (OMHA).

Tips for appealing an IRMAA determination

Here are some tips for appealing an IRMAA determination:

• Be clear and concise in your appeal. Explain why you believe that you were incorrectly assessed IRMAA and provide any supporting documentation.

• Be honest and accurate in your appeal. The SSA will verify the information you provide.

• Be patient. The reconsideration process can take several weeks or months.

• Gather as much evidence as possible to support your appeal. This may include tax returns, pay stubs, bank statements, and letters from employers or other sources.

• If you are not comfortable filing an appeal on your own, you can get help from a Medicare counselor or an attorney.

If your appeal is denied

If your appeal is denied, you have the right to appeal to the OMHA. The OMHA will hold a hearing to review your case. If the OMHA finds in your favor, they will adjust your premium amount accordingly. If the OMHA upholds the original decision, you have the right to appeal to the federal district court.

Conclusion

Appealing an IRMAA determination can be a complex process, but it is important to understand your rights and options. If you believe that you were incorrectly assessed IRMAA, you should contact the SSA or a Medicare counselor for assistance.

Additional information

Here are some additional things to keep in mind about the Medicare High Income IRMAA Premium Appeal/Reconsideration Process:

• You can appeal your IRMAA determination even if you have already paid your premiums.

• If you are successful in your appeal, the SSA will refund any overpaid premiums.

• You can appeal your IRMAA determination every year.

• If you have a life-changing event, such as a job loss or a divorce, you may be able to have your IRMAA determination reviewed outside of the normal appeal process.