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Can I be assessed an Income Related Monthly Adjustment Amount (IRMAA) for Medicare Part D if I am enrolled in a Medicare Advantage (MAPD) plan?



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Question: Can I be assessed an Income Related Monthly Adjustment Amount (IRMAA) for Medicare Part D if I am enrolled in a Medicare Advantage (MAPD) plan?
Category: IRMAA: Higher Incomes and Costs

Answer: Yes.   If your annual income exceeds certain limits - and you are enrolled in a Medicare Advantage plan (HMO, PPO, or PFFS) that includes prescription drug coverage  (MAPD), then your MAPD actually includes Medicare Part D drug coverage (along with Medicare Part A and Medicare Part B coverage) - and you can be charged an Income-Related Monthly Adjustment Amount (IRMAA) for both your Medicare Part D and Medicare Part B coverage.

However, if you are enrolled in a Medicare Advantage plan that does not include prescription drug coverage (MA) and you do not have any other Medicare Part D prescription drug coverage, then you will not be charged Medicare Part D IRMAA -- but you will still pay Medicare Part B IRMAA.

What if you are enrolled in an MAPD with a $0 premium?
Even if you are enrolled in a Medicare Advantage plan (MAPD) with a $0 premium, when your income exceeds the IRMAA limits (such as $85,000 for an individual in 2019), you will need to pay Medicare Part D IRMAA (and Medicare Part B IRMAA).

More on IRMAA
As noted, if you are a Medicare beneficiary who earns a higher income, the government will assess an Income-Related Monthly Adjustment Amount (IRMAA) that you must pay in addition to your Medicare Part D premium (if you are enrolled in a Medicare prescription drug plan (PDP) or Medicare Advantage plan that includes prescription drug coverage (MAPD)) and your Medicare Part B premium.

IRMAA limits can change each year (although they have remained relatively stable for the past several years).

The 2019 IRMAA limits can be found online in our article: "2019 IRMAA: 5% decrease in Medicare Part D IRMAA for individual earning incomes between $85,000 - $500,000 and couples earning $170,000 - $750,000."

The 2018 IRMAA limits can be found online in our article: "2018 IRMAA: 35% to 58% Medicare Part D IRMAA payment increases for individual earning incomes between $133,500 - $214,000 and couples earning $267,000 - $428,000."

We have the 2017 IRMAA limits online here: "Roughly a 4.5% increase in the 2017 Income Related Monthly Adjustment Amounts (IRMAA) for Medicare beneficiaries with higher annual incomes"

And as reference, we also have the 2016 IRMAA limits online here: "Roughly a 3% increase in the 2016 Income Related Monthly Adjustment Amounts (IRMAA) for Medicare beneficiaries with higher annual incomes"

Determining whether IRMAA applies to you
You may also wish to read our FAQ: "What tax returns does the Social Security Administration use to determine my 2016 Medicare Part B and Medicare Part D Income-Related Monthly Adjustment Amount (IRMAA)?"

For more information about your IRMAA (income-related monthly adjustment amount), you can visit www.ssa.gov/benefits/medicare/mediinfo.html, or call Social Security at 1-800-772-1213 (TTY 1-800-325-0778).

Appealing IRMAA
If the Social Security Administration has made an error and wrongly assessed you an IRMAA, you might consider appealing the IRMAA payments. We have information online about appealing IRMAA here: https://q1medicare.com/q1group/MedicareAdvantagePartDQA/FAQ.php?faq_id=544

What happens if you do not pay your Part D IRMAA?
If you do not pay your Medicare Part D IRMAA, Medicare will notify your Medicare plan and your Part D plan can “involuntarily" disenroll you from your Medicare plan and you can be without prescription drug coverage for the remainder of the year unless you can use a Special Enrollment Period to join another Medicare Part D or Medicare Advantage plan.

Also, if you lose your Medicare Part D coverage, you may accumulate a permanent late-enrollment premium penalty for every month that you are without some form of creditable prescription drug coverage.

You can read more about being disenrolled from your Medicare plan for failing to pay IRMAA:
Can I be disenrolled from my Medicare prescription drug plan if I refuse to pay my Medicare Part D IRMAA?


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  • 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.
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  • 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
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