What is Medicare IRMMA and How Can I Appeal this Medicare Surcharge?

When the subject of Medicare comes up for people who are eligible for Medicare health benefits, it’s common to assume everyone receives the same benefits for the same premiums each year.

But do they?

Not always. If you are a Medicare recipient with a higher annual income, your Part B premiums for Medicare, and Part D premiums (the drug prescription plan) may be higher. The Social Security Administration determines each year what the Income Related Monthly Adjusted Amount (IRMMA) is for individuals who exceed levels in their tax two years prior.

Example: Social Security will use your tax returns from 2021 to determine your IRMMA for 2023.

In 2003, as part of the Medicare Modernization Act Congress adopted the IRMMA provision.¹ The reason for this provision was to financially build and stabilize Medicare for future participants.

IRMMA is based each year on a pre-determined amount. You can find these on the Medicare.gov site or the Social Security site². If your reported income is above the designated amount, you may be eligible.

This does not necessarily mean you will be subject to this adjustment to your Medicare premiums. If your submitted tax return does not exceed the current IRMMA amount, you will not be charged.

There are other factors that may affect your situation and current money status. Appeals can be made to The Social Security Administration (SSA)³.

Situations Social Security Considers Life-Changing Events:

1. Marriage
2. Divorce
3. Spousal Death
4. You or your spouse stop working or reduce the number of working hours
5. Involuntary loss of income
6. Receiving a settlement payment from a current or former employer due to the employer’s closure or bankruptcy

If one or more of these factors have affected your income, then you can appeal to Social Security by filling out the Medicare Income-Related Monthly; Adjustment Amount-Life Changing Event form (SSA-44)⁴. You can submit the form and also set up a scheduled interview with the Social Security office if you choose.

1. Making the case with the Social Security Administration (SSA) may require proof that you filed an amended tax with the IRS, or
2. You have reported recent tax returns that demonstrates your income is lower than previously reported and filed.

Once you fill out the form and send it to SSA, the office will either make the amendments to your Medicare premiums or deny them.

If you are denied, you have within 60 days of the date on the reconsideration denial time to appeal to the Office of Medicare Hearings and Appeals (OHMA). Follow these direction at the OMHA level⁵. If you believe you need assistance then contact a legal services organization or lawyer to assist you with any further levels of appeal, but it may not be necessary.

If there is new evidence to support your appeal, it must be filed within 10 days of your OMHA appeal submission. Contact OMHA for instructions and submission.

Whether you can appeal a higher premium, it is advised to check each year to determine if you need still meet the additional surcharge or not.

Resources:

1. https://www.medicarefaq.com/faqs/irmaa/
2. https://www.ssa.gov/benefits/medicare/medicare-premiums.html
3. https://www.medicareinteractive.org/get-answers/medicare-denials-and-appeals/premium-appeals/appealing-a-higher-part-b-or-part-d-premium-irmaa
4. https://www.ssa.gov/forms/ssa-44-ext.pdf
5. https://www.hhs.gov/about/agencies/omha/index.html
6. https://secure.ssa.gov/poms.nsf/lnx/0601101031
7. https://www2.unitedamerican.com/articles/october-2021/medicare-premiums-for-high-income-seniors-what-to-expect-(1)
8. https://www2.unitedamerican.com/articles/october-2021/will-i-be-penalized-for-not-signing-up-for-medicare-at-65