The Social Security Administration (SSA) receives your income information from the IRS and determines whether you should pay higher premiums. If you are unsure why you are paying a higher premium, you can contact SSA by calling its national helpline at 800-772-1213. If you believe your IRMAA is incorrect, you can request that SSA make a new decision. This is called a new initial determination. Remember, you may also pay higher Part B and/or Part D premiums if you were late to enroll in these benefits. Make sure you understand the Part B late enrollment penalty and Part D penalty.
You can request a new initial determination if you believe that SSA received inaccurate or outdated information from the IRS to determine your IRMAA. For example, you may have filed an amended tax return with the IRS or have a more recent tax return that shows that you are receiving a lower income than previously reported. You can also request a new initial determination if you experience a major life-changing event that has caused your income to decrease. Life-changing events include:
- The death of a spouse
- Divorce or annulment
- When you or your spouse stop working or reduce the number of hours you work.
- Involuntary loss of income-producing property due to a natural disaster, disease, fraud or other types of circumstances.
- Loss of your pension
- Receipt of settlement payment from a current or former employer due to the employer’s closure or bankruptcy.
To make an appointment to discuss your situation, contact SSA by calling 800-772-1213. Tell the SSA representative that you are requesting a new initial determination because you believe your IRMAA is incorrect. You will need to show SSA proof of either your correct income or of the event that caused your income to decrease.
If you have not had a major life-changing event or if you were not granted a new initial determination and you disagree with SSA’s decision about IRMAA, you can appeal by following the steps below. Keep in mind that there are no timeframes that you must hear back by. If you have questions about your appeal status, contact the agency you filed your appeal with.
Complete a request to SSA for reconsideration. Contact SSA to learn how to file this request.
If your reconsideration is successful, your premium amounts will be corrected. If your reconsideration is denied, you can appeal to the Administrative Law Judge (ALJ) within 60 days of the date on the reconsideration denial. Follow the directions on the denial to file an appeal with the ALJ. If you decide to appeal to the ALJ, you may want to contact a legal services organization or lawyer to help you with this or any further levels of appeal—but this is not required.
You must submit any new evidence within 10 days of filing your appeal to the ALJ. Contact the ALJ to learn how to submit this. You can ask the ALJ for an extension if you are unable to submit new evidence within 10 days.
If your ALJ appeal is successful, your premium amount will be corrected. If your appeal is denied, you can choose to appeal to the Medicare Appeals Council (MAC) within 60 days of the date on the ALJ denial.
If your MAC appeal is successful, your Part B premium amount will be corrected. If the MAC denies your appeal, you can choose to appeal to the Federal District Court within 60 days of the date on the MAC denial.