If you’re enrolled in Medicare and make above a certain amount of money each year, you’ll pay higher Part B (medical insurance) and Part D (prescription drug) premiums. This surcharge,known as the income-related monthly adjusted amount, or IRMAA, is based on your modified adjusted gross income (MAGI) from your tax return two years prior and doesn’t apply to Part A premiums.
Paying these additional charges can be frustrating, especially if you believe your IRMAA is calculated using incorrect or outdated information. If you want to appeal your decision, here’s what you need to know.
Understanding your IRMAA determination
IRMAA ensures that Medicare beneficiaries who can shoulder higher payments pay higher Part B and Part D premiums. Individual enrollees who made over $109,000 a year — or couples who earned above $218,000 — in 2024 will pay more than the standard monthly premium ($202.90 for Part B) in 2026. Those who made less will not pay IRMAA.
Until the IRS shares MAGI data with the SSA, new Medicare filers will pay standard Part B and Part D premiums. Once the IRS confirms that you earn above the threshold, the SSA will send a pre-determination notice to tell you that IRMAA applies and explain:
- What information was used to calculate IRMAA
- What to do if the IRS or SSA’s information is wrong
- What to do if there’s been a life-changing event resulting in a loss of income
- What to do if you filed separately from a spouse while living apart
The SSA will also send a cost-of-living adjustment (COLA) notice that provides similar information to that in the pre-determination letter. The COLA notice counts as an initial determination notice, but unlike the pre-determination, it contains appeal rights.
Do you qualify for an IRMAA appeal?
If the IRS reports that your MAGI is above $109,000 as an individual or $218,000 as a couple in 2024, your pre-determination and initial notices will reflect this, and you’ll be required to pay higher Part B and Part D premiums in 2026.
However, suppose you recently received a notice that you’ll owe IRMAA in 2026, but can prove that your income was actually lower. In that case, it’s important to act quickly and appeal to avoid unnecessary additional charges.
You can appeal your initial determination if you can prove that:
- You experienced one of these seven life-changing events affecting your MAGI:
- Death of a spouse
- Marriage
- Divorce or annulment
- Work reduction
- Work stoppage
- Loss of income from producing property
- Loss or reduction of certain kinds of pension income
- The IRS shared incorrect 2024 tax return data with the SSA. For example:
- You experienced a life-changing event that reduced your income
- The IRS provided the SSA with older tax return data
- A beneficiary filed an amended tax return, but the IRS shared the original
How to appeal an IRMAA determination
To start the appeal process, request a reconsideration of the initial determination. Submit the IRMAA appeal form (SSA-44) to report a life-changing event by mail or through the SSA’s online portal. In the case of inaccurate tax information, call the SSA at 800-772-1213 to let them know that there’s an amendment.
If the SSA accepts your appeal, your premiums will reflect the changes. If you paid the surcharges before the decision was made in your favor, the SSA will retroactively refund your excess IRMAA payments.
What to do if your IRMAA appeal is denied
The good news is that if your appeal is denied, you have more options to escalate. The next steps in the appeal process are:
- Request a hearing with the Office of Medicare Hearings and Appeals (OMHA) within 60 days of the reconsideration denial. This list details locations and contact information for beneficiaries and others to contact OMHA.
- Request a review by the Medicare Appeals Council within 60 days of receiving OMHA’s decision or dismissal. Their toll-free, local, and fax numbers are listed here.
- Request judicial review in a Federal district court. This is the final course of action available.
This process can be particularly tedious, so claimants can choose to hire legal counsel to navigate it. During the IRMAA appeal process, it’s important to have all your documentation ready to prove your claims and to act quickly to avoid higher costs. Understanding your rights can save you thousands in Medicare premiums.
