As the new year begins, individuals enrolled in Medicare almost always see a change in their Medicare monthly premiums. Not only does Medicare often update the premium for Medicare Part B, but individuals might also find themselves subject to a Medicare IRMAA charge.
Medicare Income-Related Monthly Adjustment Amount (IRMAA) charges apply to Medicare beneficiaries whose income exceeds certain thresholds. These charges affect premiums for both Medicare Part B (medical insurance) and Part D (prescription drug coverage). Understanding IRMAA and the appeal process is essential for those who believe their charges have been incorrectly calculated or no longer reflect their current financial situation.
What is IRMAA?
IRMAA is an additional premium that individuals with higher incomes must pay for Medicare Part B and Part D. These charges are based on the beneficiary’s modified adjusted gross income (MAGI) as reported to the Internal Revenue Service (IRS) two years prior. For example, 2025 IRMAA determinations are based on 2023 income tax returns.
The Social Security Administration (SSA) uses income thresholds established annually by the federal government to determine IRMAA eligibility. If a beneficiary’s income exceeds these thresholds, they will pay higher premiums. The thresholds vary depending on filing status (e.g., single, married filing jointly, etc.). For 2025, the lowest income bracket for IRMAA begins at $106,000 for individuals and $212,000 for couples filing jointly.
How IRMAA is Applied
- Medicare Part B: The standard monthly premium for Part B in 2025 is $185. Beneficiaries subject to IRMAA will pay this amount plus an additional surcharge based on their income level. For example, those in the highest income bracket may pay over $600 monthly.
- Medicare Part D: IRMAA for Part D is also income-dependent. This surcharge is added to the standard premium charged by the beneficiary’s chosen Part D plan and ranges from approximately $13 to $85 per month in 2024.
Appealing IRMAA Charges
Beneficiaries can appeal IRMAA charges if they believe the determination is incorrect or if their financial circumstances have significantly changed since the tax year used to calculate IRMAA. Common qualifying life-changing events include:
- Marriage, divorce, or death of a spouse.
- Loss of income-producing property (not due to market fluctuations).
- Cessation of work or reduction in work hours.
- Loss of income from a pension.
To appeal, beneficiaries must:
- Request a Reconsideration: File Form SSA-44 (Medicare Income-Related Monthly Adjustment Amount – Life-Changing Event). This form allows individuals to explain their life-changing event and provide updated financial information.
- Provide Supporting Documentation: Include evidence of the life-changing event, such as tax returns, pay stubs, letters from employers, or divorce filings. This documentation is crucial for validating the appeal.
- Submit the Request: Appeals can be submitted to the SSA online, in person at a local Social Security office, or by mail. Ensure all supporting documents are included for a smoother process.
- Await Decision: The SSA will review the appeal and notify the beneficiary of its decision. If the appeal is approved, IRMAA charges will be adjusted retroactively, and overpayments may be refunded.
Additional Considerations
If an initial appeal is denied, beneficiaries can request a hearing with an administrative law judge. It is essential to adhere to deadlines and provide comprehensive documentation throughout the process.
In conclusion, IRMAA charges can significantly impact Medicare costs, but understanding how they are determined and knowing the appeal process can help mitigate undue financial burdens. Beneficiaries should regularly review their income and consider consulting with a financial advisor or tax professional to navigate IRMAA implications effectively.
If you need additional help understanding Medicare’s IRMAA charges and how to file an appeal or if you have any other questions about Medicare, please connect with one of our Member Agents. There are never any fees for their educational or enrollment services!
