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:
- Spousal Death
- You or your spouse stop working or reduce the number of working hours
- Involuntary loss of income
- 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.
- Making the case with the Social Security Administration (SSA) may require proof that you filed an amended tax with the IRS, or
- 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.
Medicare Supplement plans allow you to choose any doctor that accepts Medicare.
Get details about policies that may meet your insurance needs.
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.
The purpose of this communication is the solicitation of insurance. United American Insurance Company is not connected with, endorsed by, or sponsored by the U.S. government, federal Medicare program, Social Security Administration, or the Department of Health and Human Services. Policies and benefits may vary by state and have some limitations and exclusions. Individual Medicare Supplement insurance policy forms MSA10, MSB10, MSC10, MSD10, MSF10, MSHDF10, MSG10, MSHDG, MSK06R, MSL06R, MSN10 and in WI, MC4810 and MC4810HD, MC4810HDG are available from our Company where state-approved. Some states require these plans be available to persons under age 65 eligible for Medicare due to disability or End Stage Renal disease (ESRD). You may be contacted by an agent or producer representing United American Insurance Company, PO Box 8080, McKinney, TX 75070-8080. OUTLINE OF COVERAGE PROVIDED UPON REQUEST.
For Ohio, you may verify the agent/broker and United American Insurance Company by contacting: The Ohio Department of Insurance 50 W. Town Street, Third Floor - Suite 300, Columbus, OH 43215. Consumer Hotline: 1-800-686-1526 or TDD Number: (614) 644-3745. For costs and complete details of coverage call or write your insurance agent or the company (whichever is applicable).