For a bit of background, Medicare is a federal healthcare insurance plan for those who are over 65 or have certain disabilities. Medicare is made up of in-patient coverage (Part A), out-patient coverage (Part B), and prescription drug coverage (Part D). Medicare Part B generally covers outpatient services and Medicare Part D covers prescription drugs.
The income-related monthly adjustment amount (IRMAA) is based on your client’s tax filing status, the current year’s adjustment amount, and their modified adjusted gross income from two years prior. In 2024, the standard base monthly premium for Part B is $174.90. For Part D, clients will pay the premium of their chosen drug plan, and an additional IRMAA surcharge, if applicable. To calculate 2024 IRMAA, which is added to these base premiums, the Social Security Administration (SSA) will look at your client’s tax return from 2022. Their Medicare premiums and IRMAA determination are sent to them every year in the fall. Below is a table of expected total costs, which include both the base amount and IRMAA charge:
If your client receives an IRMAA determination and they believe there is an error on their tax forms from two years ago or they’ve had a life-changing event, they can request a new initial determination. Examples of life-changing events include, but are not limited to, marriage or divorce, death of a spouse, and loss or reduction of work. They can start this process by submitting an IRMAA Life-Changing Event Form to SSA or visiting your local SSA office.
If they do not agree with IRMAA, they have 60 days from receipt of their IRMAA determination notice to appeal. They can also concurrently submit a new initial determination and appeal. After 60 days, they may still appeal if they have a good cause such as serious illness, or if the claim was submitted and not received by the SSA. They may start the appeal process by submitting a Request for Reconsideration Form to SSA or visiting your local SSA office. There are four levels of appeal in total.
Caribou can help you understand the new initial determination or appeal process. Please note, that if you are granted the appeal or new initial determination, the excess IRMAA will be retroactively refunded.
Please check back for updated dates each year!
Learn More:
What is an IRMAA in Medicare? | Healthline
Last Revised January 18th, 2024
