Medicare Part B & Part D Premium IRMAA Appeals
Appealing Your Part B & Part D Premium
The Office of Medicare Hearings and Appeals (OMHA) handles appeals of the Medicare program’s determination of a beneficiary’s Income Related Monthly Adjustment Amount (IRMAA), which determines a Medicare beneficiary’s total monthly Part B and Part D insurance premiums.
The Social Security Administration (SSA) notifies a beneficiary of his or her Part B insurance premium and any IRMAA with the beneficiary’s annual notice of Social Security benefits (referred to as an initial determination). SSA is responsible for issuing all initial and reconsideration determinations. It is important to remember that IRMAAs apply for only one year. A beneficiary will be notified by SSA near the end of the current year if he or she has to pay an IRMAA for the upcoming year.
A beneficiary or his authorized representative can request an appeal within 60 days of receipt of an IRMAA determination notice.
As a beneficiary, you have the right to appeal if you believe that an Income Related Monthly Adjustment Amount (IRMAA) is incorrect for one of the qualifying reasons. First, you must request a reconsideration of the initial determination from the Social Security Administration. A request for reconsideration can be done orally by calling the SSA 1-800 number (800.772.1213) or completing the appeal form and sending or bringing the completed form to your local Social Security office.
Below are the situations which may qualify a beneficiary for a new Part B & Part D determination:
| Situation | Description |
|---|---|
| Tax return is accurate or out of date | A beneficiary filed an amended tax return for the year SSA is using to make an IRMAA decision There was an error in the IRS data The IRS provided SSA with older data and the beneficiary wants to use newer information You had a major life-changing event that significantly reduced your income |
| Life-changing event that affects the beneficiary’s modified adjusted gross income | There are 7 qualifying life-changing events: Death of spouse, Marriage, Divorce or annulment, Work reduction, Work stoppage, Loss of income from income producing property, Loss or reduction of certain kinds of pension income |
Events that result in the loss of dividend income or affect a beneficiary’s expenses, but do not affect the beneficiary’s modified adjusted gross income are not considered qualifying life-changing events.
Components of Your Part B & Part D Premiums
Equation to Determine Your Part B Premium
Medicare Part B Standard Monthly Premium + Your Income-Based Adjustment = Your Total Monthly Part B Premium
Equation to Determine Your Part D Premium
Part D Monthly Premium (Set by your insurance carrier) + Your Income-Based Adjustment = Your Total Monthly Part D Premium
