Medicare News and Healthcare Updates

IRMAA Appeal Process

by Alli Thomas

Jan 29, 2024

IRMAA Appeal

Navigating the IRMAA (Income-Related Monthly Adjustment Amount) process is crucial for higher-income Medicare beneficiaries. This adjustment entails an additional premium for Medicare Part B and Part D. However, if you’ve encountered one of the seven life-changing events acknowledged by the Social Security Administration, you have the opportunity to submit a Medicare IRMAA appeal.

Who is considered a higher-income beneficiary? 

To determine if you fall into the category of a higher-income beneficiary, your modified adjusted gross income (MAGI) from the most recent IRS-provided tax return is considered by the Social Security Administration.

For the year 2023, meeting specific income thresholds is key. If, as a single filer, you earned more than $97,000 or, as a joint filer, more than $194,000 in 2022, you are required to pay IRMAA on Medicare Part B and Part D. Keep in mind that IRMAA is tiered, meaning the higher your income, the greater your premium payment will be. Understanding these details is essential for informed decision-making regarding your Medicare coverage.

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,  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 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 

Begin by assembling all pertinent documentation supporting the change in circumstances. Examples include a marriage certificate, divorce decree, spouse’s death certificate, or a retirement confirmation letter from a former employer. Additionally, ensure a signed copy of a tax return for the year when the income was reduced is on hand.

Next, proceed to fill out Form SSA-44.

Please note that the processing time for the appeal may take several weeks.

If the appeal is successful, Social Security will rectify the situation by incorporating the additional premiums into the benefits for one month. The credited amount will be reflected on a future invoice for those who have not yet commenced Social Security benefits. Understanding this process is vital for a seamless and effective resolution of the IRMAA appeal.

What should you do if your Medicare IRMAA appeal is denied?  

If your initial appeal gets denied, you can initiate three additional appeals to address the situation.

Direct the first appeal to the Office of Medicare Hearings and Appeals and the second appeal to the Medicare Appeals Council. The third and final recourse involves filing with the federal district court in your residence.

During this process, persistence is key. Be ready for in-person appointments or multiple phone calls to your local Social Security office, as these may be necessary to advance your appeal.

In certain instances, seeking legal guidance, possibly through an attorney, might prove beneficial throughout the appeals process. However, if one of the seven recognized life-changing events is the basis of your appeal, there is a reasonable expectation for approval. Remaining persistent and seeking the necessary assistance can significantly enhance the chances of successfully resolving your appeal.

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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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