18 Feb Medicare & IRMAA: Do You Know if it Applies to You?
Do you have Medicare? Do you know if IRMAA applies to you? Do you know if it will make Medicare cost more for you?
Medicare coverage is broken up into different parts. Part A covers your care when you are hospitalized. Part B coverage includes out-patient care, doctors’ visits, and preventive services. Part D covers most prescription drugs. You must pay a monthly premium for Medicare Part B and Part D coverage.
Did you know that what you pay is actually based on your income level? This blog explains what are the different parts of Medicare, what is IRMAA, what you will pay for Medicare in 2025, and what to do if your income changes.
What are the different parts of Medicare?
Medicare is divided into four different parts:
- Part A: Hospital Insurance:hospitalization, hospice, and limited coverage for skilled nursing facilities, nursing homes, and home health services.
- Part B: Medical Insurance:services from doctors, preventive care, outpatient care, lab tests, mental health care, ambulance services, and durable medical equipment.
- Part C: Advantage Plans:an alternative to Parts A & B and includes the benefits and services covered under Parts A & B, and usually Part D. You can select a PPO or HMO plan that is run by a Medicare-approved private insurance company.
- Part D: Prescription Drug Coverage:covers most outpatient prescription drugs.
What is IRMAA?
IRMAA stands for “Income-Related Monthly Adjustment Amount.” It is an additional amount that is added to your monthly premium for Medicare Parts B and D, based on your income level.
Why does IRMAA only apply to certain parts of Medicare?
IRMAA does not apply to Medicare Part A because what you pay is based on your work history, not your income. Medicare Part A is usually free if you (or your spouse) worked for at least 10 years and paid Medicare taxes.
IRMAA does apply to all other Parts – B, C, and D – because what you pay for these parts is based on your income. Part B uses set premiums for different income levels. Part D plans are sold by private insurance companies, so the premium amounts differ based on where you live as well as your income.
Part C Medicare Advantage plans include Parts A, B, and usually D. This means that if you have a higher income, your Part C premium that includes Parts B and D would be increased by IRMAA.
How do I know if my income is high enough to pay IRMAA?
IRMAA surcharges are based on the modified gross adjusted income (MAGI) you reported on your taxes two years ago. That means that in 2025, Medicare will use the income you reported in 2023 to decide if IRMAA applies to you.
Those who had incomes of $106,000 or higher in 2023, will have to pay IRMAA surcharges on Parts B and D.
Will Medicare notify me if I have to pay IRMAA?
If the Social Security Administration (SSA) decides that you have to pay a higher premium, they will send you a notice called an “initial determination.”
All IRMAA surcharges are paid directly to Medicare. If you receive Social Security benefits, SSA will automatically deduct any IRMAA surcharges you owe on Parts B and D from your benefits each month.
What will I pay for Medicare in 2025?
The chart below shows what you will pay for Parts B and D in 2025, depending on your income.
If you have a Part C plan, the chart below also shows how much you will pay for the portions of your premium for Parts B and D. Your Part C plan may charge you an additional amount.
What can I do if I think my premium is wrong?
If you think that SSA made a mistake in calculating your Medicare premium, you can follow the instructions in your notice of initial determination. This is the letter that you received from SSA telling you about your higher Medicare premium. You can request a new initial determination from SSA.
Medicare may have made a mistake in charging you a higher premium if you filed an amended tax return for the year that SSA used to make the IRMAA decision or if there was an error in IRS data used to determine your IRMAA amount.
What if my income has changed in the last 2 years?
You can also apply for a new initial determination of your Medicare premium amounts if you have experienced one or more “life-changing events” in the last two years that lowered your income. Medicare considers these to be life-changing events:
- Marriage
- Divorce
- Death of a spouse
- Loss of income
- Employer settlement payment
- Work stoppage or reduction
- Loss of income-producing property
- Pension plan termination, reorganization, or scheduled cessation
How can I request a refund because of a life-changing event?
If you have experienced one of these life-changing events and now have a lower income, there are several ways you can request an IRMAA refund from SSA.
First, you can fill out Medicare’s Form SSA-44 , which will ask you to provide information about the life-changing event and the reduction in your income because of that event. Mail, fax, or deliver the form to your local SSA office .
You can also call SSA at 1-800-772-1213 and ask to lower your Medicare IRMAA. You can call to schedule an in-person appointment at a local SSA office if you need help completing Form SSA-44.
For all of these options, you will need to provide evidence of the life-changing event and your reduction in income. If you mail or fax the Form SSA-44, you should attach any documents that show that you experienced a life-changing event and the reduction in income. If you schedule an in-person appointment at a local SSA office, you should bring any necessary documents with you to your appointment.
If my spouse and I are both covered by Medicare, do we both need to request a refund?
Yes, if you are married and your spouse is also covered by Medicare, your spouse should also apply for an IRMAA refund.
How long do IRMAA refunds take to be processed?
The length of time SSA takes to approve IRMAA refund requests varies depending on your request, and can take several months. However, once you receive a letter from SSA notifying you that you will receive an IRMAA refund, you should receive the refund within 30 days.
If 30 days have passed after receiving a refund letter and you have not received that refund, you should call SSA at 1-800-772-1213.
Can I appeal an IRMAA refund decision?
Yes, you have the right to make an appeal of an IRMAA decision. These appeals are called “requests for reconsideration.” There are two ways you can request a reconsideration.
First, you can complete SSA Form SSA-561-U2 . This form will require you to explain why you disagree with SSA’s decision to charge you a higher Medicare premium. You can mail or fax the form to your local SSA office.
You can also call SSA at 1-800-772-1213 to request this form or request an in-person appointment at your local SSA office , where a representative will help you complete the form.
Learn more about Medicare here .
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