Medicare News and Healthcare Updates

Medicare IRMAA Appeals

by Alli Thomas

Nov 17, 2022

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 2023, if you earned more than $97,000 in 2022 (as a single filer) or more than $194,000 (as a joint filer), you have to pay IRMAA on Medicare 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.  These could be your marriage certificate, divorce decree, your spouse’s death 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 for 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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Alli Thomas

Alli Thomas has worked in the financial services industry for nearly 20 years, with a focus on retirement-related investing. She began her career as a FINRA-licensed participant-services call-center associate at Vanguard, and then moved to Principal Financial Group, where she worked closely with employers, assisting with retirement plan set-up and design, selecting appropriate plan investment offerings, and maximizing employee participation through targeted education campaigns and enrollment meetings. Alli has also worked as a qualified 401(k) administrator and registered investment advisor for several small investment firms. She now writes about all things investment- and finance-related, leveraging her extensive experience and passion for retirement planning to help investors make well-informed financial decisions.

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