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Appeals involving Determinations of the Income Related Monthly Adjustment Amount (IRMAA)

The Medicare Part D IRMAA or Income Related Monthly Adjustment Amount is determined based on tax returns just as the Medicare Part B IRMAA. Life events can cause changes to income levels and therefore make it necessary to have Social Security re-determine your IRMAA level. The following are some questions and answers about Reconsiderations and Appeals regarding IRMAA.

What if I disagree with the Income Related Monthly Adjustment Amount (IRMAA) determination?

If you disagree with Social Security's determination of your income-related monthly adjustment amount (IRMAA), you may ask for a new decision or appeal.

You can ask for a new decision without having to file an appeal if
  • You married, divorced, or became widowed;
  • You or your spouse stopped working or reduced your work hours;
  • You or your spouse lost income-producing property due to a disaster or other event beyond your control;
  • You or your spouse experienced a scheduled cessation, termination, or reorganization of an employer’s pension plan; or
  • You or your spouse received a settlement from an employer or former employer because of the employer’s closure, bankruptcy, or reorganization.
You will need to show SSA evidence of the event and provide proof or an estimate of your lower income. Evidence of the event could be an original or certified marriage certificate, death certificate or divorce decree. Proof of a change in your income could be a copy of your return for the tax year or an estimate if you have not yet filed your taxes. If you expect your income will not change until the current year, you can give SSA an estimate of what you think your income will be.

If one of these events affects your income, complete form SSA-44 at http://www.socialsecurity.gov/online/ssa-44.pdf or visit your local Social Security office.

You also have the right to request an appeal (also known as a reconsideration). You have 60 days to ask for an appeal, beginning with the date you receive the letter notifying you that you owe Part D-IRMAA. SSA will assume you receive your notice 5 days after the date of the letter, unless you show that you did not get it within the 5-day period. You must have a good reason for waiting more than 60 days to ask for an appeal.

You can request an appeal in writing by completing a Request for Reconsideration form (SSA-561-U2). There are three ways to get the form:
There are limited situations that may qualify a beneficiary for a new initial determination that are not life-changing events, such as:
  • If a beneficiary filed an amended tax return for the year SSA is using to make an IRMAA decision;
  • If there is an error in the IRS data;
  • If the IRS provided SSA with older data and the beneficiary wants to use newer information; or
  • If an IRMAA decision was processed using tax filing status "married - filing separately" but the beneficiary lived apart from his or her spouse all year.

Do I have to pay IRMAA while I am appealing?

Yes. If you file an appeal of an income-related- monthly adjustment amount (IRMAA) determination, you will continue to be billed for your Part B and Part D IRMAA until they make a decision on your appeal. If they change their decision about your IRMAA, you will be refunded for any incorrect amounts paid.

Can I still appeal the IRMAA determination if I have not experienced any life-changing event?

Yes. You will need to request an appeal in writing by completing a request for reconsideration form (SSA-561-U2). There are three ways to get the form:
Can I file an appeal over the phone?

No. If you want to file an appeal of an income related monthly adjustment amount (IRMAA) determination, you must do so in writing by completing a request for reconsideration form (SSA-561-U2). There are three ways to get the form:

What if I disagree with the decision of my IRMAA reconsideration?

If you are dissatisfied with SSA’s reconsideration determination, you may request further review, including a hearing before an OMHA Administrative Law Judge (ALJ). If you are dissatisfied with the ALJ’s decision, you can proceed to Level 4 of the Medicare appeals process and on to Level 5 of the appeals process if you remain dissatisfied with the IRMAA determination. See: Appeals Process Chart

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