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How does the Social Security Administration (SSA) determine whether I pay a higher Medicare Part B and Medicare Part D premium?


Your most recent Federal income tax returns are used to determine whether you pay an income-related monthly adjustment amount or IRMAA - however, this means that your current IRMAA is determined by your income from two years ago.

For example, your 2019 Income Related Monthly Adjustment Amount (IRMAA) is based on the most recent tax return that the IRS provides to the Social Security Administration (SSA) and in general, the IRS will report the financial information provides on your 2017 federal tax returns that were filed in 2018.

However, in some cases the SSA determined your IRMAA using earlier tax returns --- for instance, your 2019 IRMAA may be determined by 2016 federal tax returns that were filed in 2017 if the IRS only provided the SSA.

As noted by the Social Security Administration:


To determine if you will pay higher Medicare Part B and Medicare Part D premiums, Social Security uses the most recent Federal tax return that the IRS provides.

If you must pay higher premiums, the Social Security Administration uses a sliding scale to make the adjustments. bases the sliding scale on your modified adjusted gross income (MAGI).

Your MAGI is the total of your adjusted gross income and tax-exempt interest income.

If you file your taxes as “married, filing jointly” and your MAGI is greater than $170,000, you need to pay higher premiums for your Part B and Medicare prescription drug coverage.

If you file your taxes using a different status and your MAGI is greater than $85,000, you also need to pay higher premiums.

If you must pay higher premiums, the Social Security Administration will send you a letter with your premium amount(s) and the reason.

If you have Medicare Part B and Medicare prescription drug coverage, you will pay higher premiums for both Part B and Part D.

If you have only one - Medicare Part B or Medicare Part D prescription drug coverage - you will pay an income-related monthly adjustment amount only on the benefit you have.

If you decide to enroll in the other program later in the same year and you already are paying an income-related monthly adjustment amount, the Social Security Administration will apply an adjustment automatically to the other program when you enroll. In this case, the Social Security Administration will not send you another letter explaining how the Social Security Administration made this determination.

Remember, if your income is not greater than the limits described above, this law does not apply to you.

Example:
2019 Medicare Part D IRMAA information: 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.   (https://Q1News.com/705.html.)

For more information about IRMAA and current IRMAA limits see our Latest Medicare News (or Blog):
https://q1medicare.com/q1group/ MedicareAdvantagePartD/Blog.php? cat=IRMAA---for-Higher-Incomes &category_id=16

Remember:
The amount you pay can change each year depending on your income. If you have to pay a higher amount for your Part B premium and you disagree, you can appeal your IRMAA.





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Tips & Disclaimers
  • 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.
  • 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.