Nobody’s perfect, and that includes the Social Security Administration (SSA). If you’re on Medicare and your income is above a certain level, you may have to pay extra on your Part B and/or Part D premiums. But if you get the notification of your Social Security Income-Related Monthly Adjustment Amount (IRMAA) decision and you think it’s wrong, you have the right to appeal.
What is an IRMAA?
The IRMAA is an amount of money you may be required to pay in addition to your regular Part B premium and/or Part D premium if your income is above a certain level. Every year, the SSA determines your IRMAA, if any, based on information from your income tax return from two years prior, which the SSA obtains from the Internal Revenue Service. The SSA then uses a mathematical formula established by law to calculate whether you will have an adjustment payment for the next year and how much it will be. For 2021 payments, the SSA used tax numbers from 2019. Individual filers with a yearly income of $88,000 or more and couples filing jointly with a yearly income of $178,000 or more were charged an adjustment.
The SSA sends an annual notice of your Social Security benefits. (In government speak that’s called an initial determination.) You get notified by the SSA near the end of the current year if you’ll be required to pay an IRMAA once the calendar flips to January. The IRMAA lasts for one year, and the SSA reevaluates your benefits again for the next year.
What are the grounds for appealing your IRMAA?
The truth is, if your IRMAA draws on information from two years ago, much could have changed since then. That’s frequently the starting point for pleading your case, and the SSA agrees in principle that life-changing events warrant consideration. So if you’ve had a life-changing event, you can request a new initial determination about your IRMAA.
Keep in mind, however, that the SSA has its own definition of life-changing events, and it includes:
- The death of a spouse
- Marriage
- Divorce or annulment of your marriage
- You or your spouse stops working or reduces the number of hours you work
- Involuntary loss of income-producing property due to a disaster, disease, fraud, or other circumstances
- Loss of pension
- Receipt of a settlement payment from a current or former employer due to the employer’s closure or bankruptcy
There are other factors that might work in your favor if you want to appeal. For example, if you have proof that Social Security used outdated or incorrect information when it calculated your IRMAA, that might help your case. Perhaps you filed an amended tax return with the IRS that shows you’re receiving a lower income than shown on the records it has on file.
How to appeal your IRMAA
If any of the listed circumstances applies to you, you can request a new initial determination, submit a Medicare IRMAA Life-Changing Event form, or schedule an appointment with Social Security. To get an appeal form, you can go into a nearby Social Security office, call 800-772-1213, or check the Social Security website.
Even if you haven’t experienced a life-changing event, you can still appeal an IRMAA. Request an appeal in writing by completing a request for reconsideration form. To get an appeal form, you can go into a nearby Social Security office, call 800-772-1213, or check the Social Security website.
You’ll also need to provide documentation of the life-changing event that caused your income to decrease or of your correct income, whichever applies.
What if you disagree with the decision of your IRMAA reconsideration?
If you’re dissatisfied with the SSA’s reconsideration determination, you still have more options. You may request a further review, including a hearing before an Office of Medicare Hearings and Appeals (OMHA) Administrative Law Judge.
If you’re dissatisfied with the ALJ’s decision, you can proceed to Level 4 of the Medicare appeals process and then on to Level 5 of the appeals process if you remain unhappy with the IRMAA determination. To help you understand the process, check out the Appeals Process Chart.
Keep in mind that you must appeal to OMHA within 60 days of the date on the reconsideration denial. Follow the directions on the denial to file an appeal at the OMHA level. If you decide to appeal at the OMHA level, you may want to contact a legal services organization or lawyer to help you with this or any further levels of appeal, but that’s not required.
After filing your OMHA level appeal, you must submit any new evidence within 10 days. Contact OMHA for further instructions on submitting. If you’re not able to submit new evidence within 10 days, you can ask OMHA for an extension.
A successful OMHA level appeal will result in your premium amount being corrected. If your appeal is denied, you can choose to appeal to the Medicare Appeals Council within 60 days of the date on the OMHA level denial.
If your Council appeal is successful, your premium amount will be corrected. If the Council denies your appeal, you can choose to appeal to the Federal District Court within 60 days of the date on the Council denial.
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