How to Appeal Medicare Surcharges When Your Income Changes
March 14, 2023 at 7:17 p.m.
...by Jim Miller
Is there anything I can do to reduce my high Medicare premium surcharges? Because of my past income, I pay $329.70 per month for my Part B premium and $64.50/month for Part D, but my income has dropped since I retired. Do I have any options?
--Overcharged AndyDear Andy,
If you’re getting hit with a higher premium for Medicare Part B and Part D and you think it’s unjustified, you can ask Social Security to revisit its decision and perhaps reduce your cost. Here’s what you should know.
Many retirees don’t realize that monthly premiums for Medicare Part B (coverage for doctor’s services and outpatient care) and Part D (prescription drug coverage) are based on your modified adjusted gross income from two years earlier. So, to determine your 2023 Medicare premium, Social Security uses your 2021 tax return. In those two years, however, your life can change in ways your 2021 tax return and current Medicare premium don’t reflect. Sometimes, those changes are enough to convince Social Security that your Medicare premium should be reduced.
Part B’s standard monthly premium in 2023 is $164.90 for individuals earning $97,000 or less; it’s $194,000 or less for joint filers. Anyone whose income exceeds those thresholds pays a higher premium, also known as an Income-Related Monthly Adjustment Amount (IRMAA), or surcharge.
The higher monthly premiums rise steadily from $230.80 to $560.50 through five income tiers. The same tiers apply to IRMAAs for Medicare Part D, with enrollees paying an extra $12.20 to $76.40 per month depending on their income.
About 7 percent, or 4.4 million higher-income Medicare beneficiaries pay a surcharge on their monthly Part B and/or Part D premiums.
Reasons for Appealing
In certain situations, Social Security will recalculate your premiums – known as a redetermination – for Part B and Part D, particularly if the agency based the cost on a tax return that was later amended.
Otherwise, there are seven life-changing events that qualify for a redetermination if they hurt your income: marriage, death of a spouse, divorce or annulment, reduced work hours or retirement, involuntary loss of income-producing property, the loss or reduction of some types of pension income, and an employer settlement payment because the company went bankrupt or reorganized.
How to File a Claim
To ask Social Security for a redetermination, you’ll need to complete Form SSA-44 (SSA.gov/forms/ssa-44-ext.pdf) and include supporting documents, such as the death certificate for a spouse or a letter from a former employer stating that you’re now retired. If you filed your federal income tax return for the year that your income was reduced, you will also need to provide a signed copy.
A decision usually takes a few weeks, but if you had one of the events that Social Security considers life-changing, you should win the appeal. In that case, Social Security will reimburse you for the additional premiums by adding it to your benefit one month. If you are on Medicare but haven’t started collecting Social Security, you should see a credit on a future invoice.
If your request for a redetermination is denied, there are three additional levels of appeals you could try: to the Office of Medicare Hearings and Appeals, to the Medicare Appeals Council and finally to the federal district court where you live.
For more information on the premium rules for high-income beneficiaries see SSA.gov/benefits/medicare/medicare-premiums.html.
Send your senior questions to: Savvy Senior, P.O. Box 5443, Norman, OK 73070, or visit SavvySenior.org. Jim Miller is a contributor to the NBC Today show and author of “The Savvy Senior” book.