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Medicare IRMAA Appeals

David Hicks

Recently, I’ve had a number of questions and inquiries about the Medicare IRMMA “tax” and how this can be avoided. And, trust me, no one wants this to be surprised to have their planned Medicare benefits cost more than expected. 

So, here we go.., If you’re considered a higher-income Medicare beneficiary, you must pay an additional premium for Part B and Part D called income-related monthly adjustment amount (IRMAA). But if you experience one of the seven life-changing events that the Social Security Administration recognizes, you can file a Medicare IRMAA appeal. 

Who is considered a higher-income beneficiary? 

Whether or not you’re considered a higher-income beneficiary is based on your modified adjusted gross income (MAGI) from the most recent tax return provided to the Social Security Administration by the IRS. 

For 2021, if you earned more than $88,000 in 2020 (as a single filer) or more than $176,000 (as a joint filer), you have to pay IRMAA on Part B and Part D.  

And there are several tiers of IRMAA—the higher your income, the higher your premium payment. 

Read more: Three Ways to Reduce Your Income-Related Monthly Adjustment Amount (IRMAA) for Medicare Part B 

What are the recognized life-changing events? 

If you experience one of the following life-changing events, you can file an IRMAA appeal and will have a good chance of having it approved: 

  • Getting married 
  • Becoming a widow/widower 
  • Getting divorced 
  • Losing income-producing property (such as livestock, crops or property due to natural disasters, disease or arson, or loss due to theft or fraud) 
  • Having your work hours reduced (or retiring)
  • Losing certain types of pension income 
  • Receiving an employer settlement due to the company’s bankruptcy or reorganization 

How to file a Medicare IRMAA appeal 

First, gather all supporting documentation that proves there’s been a change in your circumstances.  

This can include your spouse’s death certificate, a divorce decree or marriage certificate, or a letter from your former employer that says you’ve retired.  

You’ll also need a signed copy of your tax return for the year in which your income was reduced. 

Next, complete Form SSA-44, which can be found here. 

You’ll have to wait several weeks to receive a decision on your appeal.  

If you win, Social Security will make you whole by adding the additional premiums to your benefit one month. If you haven’t started collecting Social Security yet, you’ll be credited the amount on a future invoice. 

What to do if your Medicare IRMAA appeal is denied? 

You can attempt to file three additional appeals if your first appeal is denied.  

The first is to the Office of Medicare Hearings and Appeals. The second is to the Medicare Appeals Council. The third is to the federal district court where you reside.  

One thing to keep in mind is to be persistent. It may take in-person appointments or multiple phone calls to your local Social Security office before you make any progress in your appeal.  

You may need an attorney to guide you through some of these appeals. However, provided that your appeal is due to one of the seven life-changing events above, it’s reasonable to expect your appeal to be approved.

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