865-203-2040 karen@sisgrouptn.com

What is IRMAA?

IRMAA stands for “Income-Related Monthly Adjustment Amount,” which is an extra fee for higher-income beneficiaries because individuals with higher incomes can typically afford to pay more for their Medicare premiums. As a result, this fee is added to the monthly Medicare Part B and Medicare Part D premiums.

As the name implies, this fee is applicable if your annual Modified Adjusted Gross Income (MAGI) exceeds a predetermined amount. This predetermined amount is calculated from your taxes two years ago. For example, your 2024 IRMAA fee will be determined based on your 2022 tax return.

If your income exceeds a certain amount, you may have to pay an IRMAA in addition to your Part B premium and/or Part D premium.

Extra: Do you have a part B or Part D late enrollment penalty? This may also increase your premium.

Want to Request a New Initial Determination?

Initial Determination is a notice that you will receive if Social Security determines that you should pay an IRMAA. In this notice, you will also receive information about how to request a new initial determination. You can request that Social Security revise the decision that was made if you have experienced a life-changing event that caused an income decrease, or if you think the income information Social Security used to determine your IRMAA was incorrect or outdated.

>Related Reading: Need Help? An Independent Agent Helps Find a Plan to Meet Your Individual Needs

What Does Social Security Consider a Life-Changing Event?

Social Security considers any of the following situations to be life-changing events:

  • The death of a spouse
  • Marriage
  • Divorce or annulment
  • You or your spouse stopping work or reducing the number of hours you work
  • Involuntary loss of income-producing property due to a natural disaster, disease, fraud, or other circumstances
  • Loss of pension
  • Receipt of settlement payment from a current or former employer due to the employer’s closure or bankruptcy

Your IRMAA calculation could have been based on outdated or incorrect information if you:

  • Filed an amended tax return with the IRS
  • Have a more recent tax return that shows you are receiving a lower income than previously reported

Appealing an IRMAA Decision

An appeal for IRMAA is for when you do not qualify to request a new initial determination, but you still disagree with Social Security’s decision. Your appeal can also be referred to as “requesting a reconsideration.” To complete a request to SSA for reconsideration you can contact SSA to learn how to file this request. There is no specific turnaround time for them to answer your appeal, so make sure you keep track of your request and contact SS if you have questions.

>IRMA Appeal Form

The form is fairly straightforward, but here are a few notes about the form:

  • Step 1: Check the applicable life-changing event. For most people, the qualifying event is “Work Stoppage” or “Work Reduction.” Make sure you provide the date this happened
    Step 2: Enter your income for the year your income changed
    Step 3: This would be your estimated current year income (It doesn’t have to be exact)
    Step 4: Provide documentation that supports your claim of a life-changing event

Key IRMAA Appeal Considerations

  • If your appeal is accepted, your premium amounts will be modified. However, if it is denied you may appeal to the Office of Medicare Hearings and Appeals (OMHA) level within 60 days of the date on the denial.
  • Follow the instructions on your denial to file an appeal at the OMHA level. If this is the route you choose, you may want to contact a legal representative to assist you, but it isn’t a requirement.
  • If you have new evidence to submit, you have to turn it in within 10 days of filing your OMHA-level appeal. You can ask OMHA for an extension if you are unable to submit your new evidence within that 10-day period.
  • If your OMHA level appeal is accepted, your premium amount will be modified, if it is denied, you can choose to appeal to the Council within 60 days of the date on the OMHA level denial.
  • If your Council appeal is accepted, your Part B premium amount will be modified, if it is denied, you can then appeal to the Federal District Court within 60 days of the date on the Council denial.

Need help navigating an appeal? Give Karen or Matt a call at 865-203-2040 or email us at contact@bigorangemedicare.com!

*Medicare Insurance Specialty Group is Not Approved By, Endorsed By, or Affiliated With A Government Agency. We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.


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