If your income is above a certain level, you may have to pay an Income-Related Monthly Adjustment Amount (IRMAA) in addition to your Part B premium and/or Part D premium.
The determines if you owe an IRMAA based on the income you reported on your IRS tax return two years prior, meaning two years before the year when you pay the IRMAA. For example, Social Security would use tax returns from 2024 to determine your IRMAA in 2026. If you are unsure why you are paying an IRMAA, you can call the Social Security hotline at 800-772-1213.
Note: You may also pay a higher if you have a Part B or Part D late enrollment penalty A late enrollment penalty is an amount you must pay to Medicare in addition to the regular monthly premium for late enrollment in Part B or Part D. The Part B premium penalty is 10% of the Part B premium for each 12-month period you delayed enrollment without insurance from your or your spouse’s current work. The Part D premium penalty is 1% of the Part D premium for each month you delayed enrollment without creditable drug coverage. .
Requesting a new initial determination
If Social Security determines that you should pay an IRMAA, they will mail you a notice called an initial determination. This notice should include information on how to request a new initial determination. A new initial determination is a revised decision that Social Security makes regarding your IRMAA. You can request that Social Security revisit its decision if you have experienced a life-changing event that caused an income decrease, or if you think the income information Social Security used to determine your IRMAA was incorrect or outdated.
Social Security considers any of the following situations to be life-changing events:
- The death of a spouse
- Marriage
- Divorce or annulment
- You or your spouse stopping work or reducing the number of hours you work
- Involuntary loss of income-producing property due to a natural disaster, disease, fraud, or other circumstances
- Loss of pension
- Receipt of settlement payment from a current or former employer due to the employer’s closure or bankruptcy
You can make the case that Social Security used outdated or incorrect information when calculating your IRMAA if, for example, you: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
To request a new initial determination, submit a Medicare IRMAA Life-Changing Event form or schedule an appointment with Social Security. You will need to provide documentation of either your correct income or of the life-changing event that caused your income to decrease.
Appealing an IRMAA decision
If you do not qualify to request a new initial determination, but you still disagree with Social Security’s IRMAA decision, you have the right to appeal An appeal is a formal request for review if you disagree with an official health care coverage or payment decision made by a Medicare Advantage Plan, a Medicare private drug plan (Part D), or Original Medicare. Federal regulations and law specify appeals deadlines, processes for handling appeals, what information must be included in a decision, and the levels of review in the appeals process. . Appealing an IRMAA decision is also referred to as requesting a reconsideration Reconsideration is a level of appeal in Medicare appeals processes. In Original Medicare (Part A and B), reconsideration is the second level, where your appeal is reviewed by a Qualified Independent Contractor (QIC). In Medicare Advantage, there are two reconsideration phases: the plan first reviews its denial of coverage or payment, and if it upholds the initial decision, the second level is reconsideration by the Independent Review Entity (IRE). In Part D plans, reconsideration is also the second level of appeal, conducted by the IRE. . Keep in mind that there are no strict timeframes in which Social Security must respond to a reconsideration request. If you have questions about your appeal status, contact the agency currently reviewing your appeal.
- 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 Office of Medicare Hearings and Appeals (OMHA) level within 60 days of the date on the reconsideration denial. Follow the directions on the denial to file an appeal at the OMHA level. If you decide to appeal at the OMHA level, you may wish 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 OMHA level appeal. Contact OMHA for further instructions on submitting. You can ask OMHA for an extension if you are unable to submit new evidence within 10 days.
- If your OMHA level appeal is successful, your premium amount will be corrected. If your appeal is denied, you can choose to appeal to the Council within 60 days of the date on the OMHA level denial.
- If your Council appeal is successful, your Part B Part B, also known as medical insurance, is the part of Medicare that covers most medically necessary doctors’ services, preventive care, hospital outpatient care, durable medical equipment (DME), laboratory tests, x-rays, mental health services, and some home health care and ambulance services. premium amount will be corrected. If the Council denies your appeal, you can choose to appeal to the Federal District Court The Federal District Court is the final level of the Medicare appeals process, following an unfavorable decision at the Medicare Appeals Council level. within 60 days of the date on the Council denial.