Financial Planning
November 14, 2023

How to Appeal IRMAA and Why Do It at All

Stewart Willis

No one likes unnecessary bills or surcharges. Only a few know this, but there is a way to appeal your Income-Related Monthly Adjustment Amount (IRMAA) surcharge. When your income exceeds a particular threshold, you'll have to pay an extra amount on top of your Medicare Part B and Part D premiums.

Suppose you find yourself subject to IRMAA but believe there has been an error or have a qualifying situation for reconsideration. In that case, it is within your rights to appeal IRMAA. This can allow you to avoid paying IRMAA or get a reduced surcharge.

The IRMAA Appeal Process

Before you make an IRMAA appeal, you need to get acquainted with the IRMAA appeal process.

When Social Security determines that you are required to pay an IRMAA, they will promptly send you a notice called an initial determination via mail. This notice will give you the necessary information to request a new initial determination.

If you've had a significant decrease in income due to a life-changing event, or if you believe that Social Security used incorrect or outdated income information to calculate your IRMAA, you have the right to request a review of their decision.

Reasons to Appeal IRMAA

There are several reasons why you should consider a Medicare IRMAA appeal. The Social Security Administration (SSA) will typically reconsider IRMAA if you've experienced a life-changing event that has caused a significant reduction in your income. Some common IRMAA appeal reasons include:

  • Marriage
  • Divorce or annulment
  • Death of a spouse
  • Work stoppage (either you or your spouse)
  • Work reduction (either you or your spouse)
  • Loss of pension
  • Loss of income-producing property due to a natural disaster
  • Receipt or reduction of certain forms of assistance like Supplemental Security Income or Medicaid.

How to Appeal an IRMAA Decision

You should follow these steps to make a successful appeal to IRMAA:

1. Determine If You Are Eligible to Make an IRMAA Appeal

Needing to pay the IRMAA surcharge can be frustrating. However, you need to determine if you have valid grounds for an appeal before taking action.

Understanding the eligibility criteria and carefully evaluating your circumstances will enable you to make a strong case and save yourself from unnecessary financial expenses. It's best to seek guidance from a financial planner to help you with this. An informed view of your finances will help you to make the right decisions.

2. Gather Supporting Documentation

You will need supporting evidence to appeal IRMAA. Various forms fall under this category, such as:

  • A more recent tax return than the one the SSA used to determine your IRMAA.
  • A letter from your employer about your retirement or reduction in work hours.
  • Death certificate, in case of a spouse's death.
  • Documents related to the loss of a pension or loss of property.
  • An amended tax return

3. Fill Out the Required Form

If you're ready to start the appeal process, don't waste any time. You need to appeal IRMAA within 60 days of receiving your notice. You need to fill out Form SSA-44 and get started. This document allows you to explain the life-changing event that caused your income to decrease and provide an estimate of your modified adjusted gross income for the upcoming year.

The word Medicare on a chalkboard

Form SSA-44 makes it easier to appeal IRMAA. Previously, you needed to write a letter explaining your financial situation. However, having a financial planner work with you can make this part of the process easier if you can. Your financial planner would have a better understanding of your true MAGI and tax circumstances to guide you on the best way forward when you appeal IRMAA.

4. Submit the Form and Documentation

Along with Form SSA-44, ensure you include all relevant evidence to your Social Security office to support your claim. If you are working with a financial planner, make sure they understand their role in submitting the form and accompanying evidence to your local Social Security office. Remember, timely submission is essential for a smooth process.

5. Await the Decision

After you submit your request, the SSA will carefully review your application and make a fair decision. If they find your favor, they may adjust your Medicare premium accordingly. There is no set time for how long an IRMAA appeal takes.

If your initial reconsideration request is denied and you believe the decision is incorrect, you can proceed with additional levels of appeal. This includes the option to request a hearing before an Administrative Law Judge. If that fails, you could take it to the DHHS Medicare Appeals Council (MAC). The last resort is a Federal Court Action.

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Stewart Willis is the founder and president of Asset Preservation Wealth & Tax, a financial planning firm in Phoenix, Arizona. Investment advisory services offered through Foundations Investment Advisors, LLC, an SEC registered investment adviser.

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