IRMAA - What is it and Can I Appeal it?

What is IRMAA

If you are a Medicare Beneficiary, you may be familiar with IRMAA (Income Related Monthly Adjustment Amount). This additional premium applies to those with higher income levels and can significantly increase your Medicare costs. However if you believe that your IRMAA determination is incorrect or if you've experienced a life-changing event that affects your income, you have the right to appeal. This article will guide you through the process of appealing IRMAA, ensuring you understand your rights and the steps involved.
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IRMAA is an additional amount that some people with higher incomes must pay in addition to their standard Medicare Part B and Part D premiums. The Social Security Administration (SSA) determines who pays IRMAA based on the modified adjusted gross income (MAGI) reported on your IRS tax return from two years prior. For example, your 2024 IRMAA is based on your 2022 tax return.

When to Consider an Appeal

You should consider appealing your IRMAA determination if:

1. You believe there is an error. Mistakes can happen. If you believe the SSA has incorrect information about your income, you can appeal.
2. You've experienced a life-changing event. Certain life-changing events that reduce your income may qualify you for a reduction in your IRMAA. These events include:

• Death of a spouse
• Marriage
• Divorce or annulment
• Loss of pension
• Work stoppage or reduction
• Loss of income-producing property
• Employer settlement payment

Steps to Appeal IRMAA

1. Carefully review the Initial Determination Letter you receive from the SSA. This letter will explain how your IRMAA was calculated and provide instructions on how to appeal.
2.  Collect all necessary documents that support  your case. This includes tax returns, proof of the life-changing event, or any other relevant financial documents.
3. Complete Form SSA-44 "Medicare Income-Related Monthly Adjustment Amount - Life-Changing Event. This form is used to request a reduction in your IRMAA due to a life-changing event. Complete this form accurately, providing all required information and documentation.
4. Mail or take your completed SSA-44 and supporting documents to your local Social Security office. You can find the nearest office using the SSA's office locator on their website.
5. Await the decision. The SSA will review your appeal and make a determination. This process can take some time, so be patient. If your appeal is successful, your IRMAA will be adjusted accordingly.

What to do if Your Appeal is Denied

If your initial appeal is denied, you have the right to request a reconsideration. This involves a more thorough review of your case by the SSA. First use the "Request for Reconsideration" form (SSA-561-U2) to formally request a second review of your case. Submit this form along with any additional supporting documentation to your local SSA office. Next, attend a hearing. If your reconsideration request is denied, you can request a hearing before an Administrative Law Judge (ALJ). This is a more formal process where you can present your case in person. If the ALJ denies your appeal, you can take your case to the Appeals Council. The Appeal Council will review the ALJ's decision for any errors. As a last resort, you can file a lawsuit in federal court if the Appeals Council denies your request.

Tips for a Successful Appeal

Be thorough! Ensure all forms are filled out completely and accurately. Incomplete forms can delay the process. Another important tip is to submit as much supporting documentation as possible to strengthen your case. Be timely, pay attention to deadlines. Appeals must be filed within a certain timeframe from the date of your IRMAA determination letter.  If you are unsure about the process, seek professional from a financial advisor or an attorney who specializes in Medicare issues.

Appealing an IRMAA determination can seem intimidating, but understanding the process and knowing your rights can make it manageable. Whether you believe there is an error or you have experienced a life-changing event, following the proper steps and providing thorough documentation can help you  achieve a fair outcome. Don't hesitate to take action if you believe your IRMAA assessment is incorrect!

To Get Help Now Call Our Office

​Rob Davies
Prairie Grove Insurance
800-254-5200
​608-839-0275