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.
, 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:
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
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).
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?