If your income exceeds a certain threshold, you may be required to pay an Income-Related Monthly Adjustment Amount (IRMAA) in addition to your Medicare Part B and/or Part D premiums.
The Social Security Administration (SSA) determines whether you owe an IRMAA based on the income you reported on your IRS tax return from two years prior. For example, Social Security would use your 2023 tax return to determine your IRMAA for 2025. If you’re unsure why you’re being charged an IRMAA, you can contact the Social Security hotline at 800-772-1213.
Requesting a New Initial Determination
If Social Security decides that you owe an IRMAA, they will send you an initial determination notice, which includes instructions on how to request a new initial determination. This is a revised decision that Social Security can make regarding your IRMAA. You may request a new determination if you have experienced a life-changing event that reduced your income or if you believe the income information used to calculate your IRMAA was incorrect or outdated.
Social Security considers the following situations to be life-changing events:
- Death of a spouse
- Marriage
- Divorce or annulment
- You or your spouse stopping work or reducing work hours
- Involuntary loss of income-producing property due to a natural disaster, disease, fraud, or other circumstances
- Loss of pension
- Receipt of a settlement payment from a current or former employer due to the employer’s closure or bankruptcy
You can also argue that Social Security used outdated or incorrect information to calculate your IRMAA if, for instance:
- You filed an amended tax return with the IRS
- You have a more recent tax return that shows a lower income than previously reported
To request a new initial determination, submit a Medicare IRMAA Life-Changing Event form or schedule an appointment with Social Security. You’ll need to provide documentation of your correct income or evidence of the life-changing event that caused your income to decrease.
Appealing an IRMAA Decision
If you don’t qualify to request a new initial determination but still disagree with Social Security’s IRMAA decision, you have the right to appeal, also known as requesting a reconsideration. Note that Social Security does not have a strict timeline for responding to reconsideration requests. If you have questions about your appeal status, contact the agency reviewing your appeal.
To initiate the appeal process, submit a request for reconsideration to SSA. If your reconsideration is successful, your premium amounts will be adjusted accordingly. If it is denied, you can appeal to the Office of Medicare Hearings and Appeals (OMHA) within 60 days of the reconsideration denial. Follow the instructions on the denial notice to proceed with your OMHA-level appeal. You may consider seeking assistance from a legal services organization or attorney for this or any subsequent levels of appeal, although it’s not required.
You must submit any new evidence within 10 days of filing your OMHA-level appeal. If you need more time, you can request an extension from OMHA.
If your OMHA appeal is successful, your premium will be corrected. If denied, you can appeal to the Council within 60 days of the OMHA denial.
If the Council grants your appeal, your Part B premium will be adjusted. If the Council denies your appeal, you may appeal to the Federal District Court within 60 days of the Council’s decision.