Understanding the intricacies of Medicare plans can seem complicated, especially when it comes to the various components and costs involved, like IRMAA. IRMAA (Income-Related Monthly Adjustment Amount) is a surcharge added to Medicare Part B and Part D premiums. The purpose of IRMAA is to help fund the Medicare program by requiring wealthier beneficiaries to contribute more toward their healthcare coverage. This allows individuals within lower income brackets to receive the care they need at an affordable cost. In this article, we’ll help you understand what IRMAA is, who pays this surcharge, and how you can appeal it if necessary.
How does IRMAA work for people with Original Medicare?
The IRMAA surcharge is based on your modified adjusted gross income (MAGI) from two years prior. The Social Security Administration (SSA) uses tax return information to determine your income bracket. IRMAA has different income thresholds for individuals and couples filing jointly. The higher your income, the higher the surcharge.
The income brackets are subject to change annually. IRMAA applies to both Medicare Part B (medical insurance) and Part D (prescription drug coverage) premiums. The surcharge is separate for each part. If you’re subject to IRMAA, you can expect to receive a notice from the SSA. The surcharge is typically deducted from your Social Security benefits. If you do not receive Social Security benefits, you will receive a bill for the additional amount.
Can you appeal IRMAA?
If your income has changed or you believe there are other circumstances that affect your IRMAA payment, you can request an appeal with the SSA to have the surcharge adjusted or removed. This appeal is also referred to as requesting a reconsideration. When appealing IRMAA, you’ll need to have supporting documentation that demonstrates a change in your income or life circumstances. This may include proof of a significant life event such as:
Marriage
Divorce
Death of a spouse
Work reduction
A recent decrease in income
It’s important to note that the appeal process has specific deadlines, so you’ll want to act promptly if you believe you have valid grounds for appeal. If your reconsideration is denied, you can appeal to the Office of Medicare Hearings and Appeals (OMHA) within 60 days. If that appeal is denied, you may choose to appeal to the Council within 60 days of the OMHA dismissal. If the appeal to the Council is denied, you can escalate the appeal to the Federal District Court within 60 days.
SelectQuote Can Help Navigate the Complexities of Medicare Plan Costs
Understanding Medicare plan costs can be confusing, especially if you’re subject to IRMAA. Fortunately, our licensed insurance agents can help you review your Medicare plan, so you have a better understanding of the costs and coverage. They can also guide you through comparing other options, including Medicare Advantage plans, to determine which option may be the right fit for your unique needs and budget.
