Powered by Q1Group LLC
Education and Decision Support Tools for the Medicare Community

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 https://www.ssa.gov/forms/ssa-44-ext.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

Tips & Disclaimers
  • Q1Medicare®, Q1Rx®, and Q1Group® are registered Service Marks of Q1Group LLC and may not be used in any advertising, publicity, or for commercial purposes without the express authorization of Q1Group.
  • The Medicare Advantage and Medicare Part D prescription drug plan data on our site comes directly from Medicare and is subject to change.
  • Medicare has neither reviewed nor endorsed the information on our site.
  • We provide our Q1Medicare.com site for educational purposes and strive to present unbiased and accurate information. However, Q1Medicare is not intended as a substitute for your lawyer, doctor, healthcare provider, financial advisor, or pharmacist. For more information on your Medicare coverage, please be sure to seek legal, medical, pharmaceutical, or financial advice from a licensed professional or telephone Medicare at 1-800-633-4227.
  • We are an independent education, research, and technology company. We are not affiliated with any Medicare plan, plan carrier, healthcare provider, or insurance company. We are not compensated for Medicare plan enrollments. We do not sell leads or share your personal information.
  • Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year. Our PDP-Compare.com and MA-Compare.com provide highlights of annual plan benefit changes.
  • The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan.
  • Limitations, copayments, and restrictions may apply.
  • We make every effort to show all available Medicare Part D or Medicare Advantage plans in your service area. However, since our data is provided by Medicare, it is possible that this may not be a complete listing of plans available in your service area. For a complete listing please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.
    Statement required by Medicare:
    "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."
  • When enrolling in a Medicare Advantage plan, you must continue to pay your Medicare Part B premium.
  • Medicare beneficiaries with higher incomes may be required to pay both a Medicare Part B and Medicare Part D Income Related Monthly Adjustment Amount (IRMAA). Read more on IRMAA.
  • Medicare Advantage plans that include prescription drug coverage (MAPDs) are considered Medicare Part D plans and members with higher incomes may be subject to the Medicare Part D Income Related Monthly Adjustment Amount (IRMAA), just as members in stand-alone Part D plans. In certain situations, you can appeal IRMAA.
  • You must be enrolled in both Medicare Part A and Part B to enroll in a Medicare Advantage plan. Members may enroll in a Medicare Advantage plan only during specific times of the year. Contact the Medicare plan for more information.
  • If you are enrolled in a Medicare plan with Part D prescription drug coverage, you may be eligible for financial Extra Help to assist with the payment of your prescription drug premiums and drug purchases. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or your state Medicaid Office.
  • Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.
  • A Medicare Advantage Private Fee-for-Service plan (PFFS) is not a Medicare supplement plan. Providers who do not contract with the plan are not required to see you except in an emergency.
  • Disclaimer for Institutional Special Needs Plan (SNP): This plan is available to anyone with Medicare who meets the Skilled Nursing Facility (SNF) level of care and resides in a nursing home.
  • Disclaimer for Dual Eligible (Medicare/Medicaid) Special Needs Plan (SNP): This plan is available to anyone who has both Medical Assistance from the State and Medicare. Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.
  • Disclaimer for Chronic Condition Special Needs Plan (SNP): This plan is available to anyone with Medicare who has been diagnosed with the plan specific Chronic Condition.
  • Medicare MSA Plans combine a high deductible Medicare Advantage Plan and a trust or custodial savings account (as defined and/or approved by the IRS). The plan deposits money from Medicare into the account. You can use this money to pay for your health care costs, but only Medicare-covered expenses count toward your deductible. The amount deposited is usually less than your deductible amount, so you generally have to pay out-of-pocket before your coverage begins.
  • Medicare MSA Plans do not cover prescription drugs. If you join a Medicare MSA Plan, you can also join any separate (stand-alone) Medicare Part D prescription drug plan
  • There are additional restrictions to join an MSA plan, and enrollment is generally for a full calendar year unless you meet certain exceptions. Those who disenroll during the calendar year will owe a portion of the account deposit back to the plan. Contact the plan provider for additional information.
  • Medicare beneficiaries may enroll through the CMS Medicare Online Enrollment Center located at www.medicare.gov.
  • Medicare beneficiaries can file a complaint with the Centers for Medicare & Medicaid Services by calling 1-800-MEDICARE 24 hours a day/7 days or using the medicare.gov site. Beneficiaries can appoint a representative by submitting CMS Form-1696.