Lumaktaw sa pangunahing content

How to appeal on high premiums


Due to the law changing over the years and requiring higher earners to pay more, about 4.3 Million Medicare beneficiaries are subject to so-called income-related monthly adjustment. While the standard monthly premium for Medicare Part B is $144.60 this year, some beneficiaries pay as much as $491.60. If your income is different from what Social Security used to determine, there is a process for asking the agency a reconsideration. 

Note: If you are unsure why you are paying an IRMAA, you can call Social Security, 800-772-1213.

The process involves asking the agency either through a phone call or through writing to reconsider their assessment.


You will have to fill out a form and provide supporting documents such as:


  • a recent tax returns
  • a letter from your former employer stating that you have retired
  • recent pay stubs showing evidence that your income has dropped. 



The required form includes a list of life-changing events that qualify as reasons for reducing or eliminating the IRMAAs:

  • marriage
  • death of a spouse
  • divorce
  • loss of pensions
  • you've stopped working or reduced your hours

You can also make the case that Social Security used outdated or incorrect information when calculating your IRMAA, if example, you;
  • Filed an amended tax return with the IRS
  • Have a more recent tax return that shows you are receiving a lower income than previously reported
As long as you meet one of the listed qualifying reasons and submitted the remaining pertinent documents, most likely you will get an adjustment. If it doesn't and you still won't agree with the decision, you can still file an appeal to reconsider.

Keep in mind that there are no strict timeframes in which Social Security must respond to a reconsideration request. 

  • You can appeal to the Office of Medicare Hearings and Appeals (OMHA) level within 60 days of the date on the reconsideration denial. You can contact legal services organization or a lawyer to help you with this or any further levels of appeal, but this is not required. You must submit new evidence within 10 days of filing your OMHA level appeal. (Contact OMHA for further instructions). If you cannot comply right, you can still ask for an extension.
  •  If your OMHA appeal again gets denied, you can still file on your Council level. If your Council level is successful, your Part B premium amount will automatically get adjusted. 
  • If the Council denies, you can choose to appeal to the Federal District Court within 60 days of the date of the Council denial.


Mga etiketa:

Mga Komento

Mag-post ng isang Komento

Mga sikat na post sa blog na ito

Durable Medical Equipment and Medicare

Medicare   Part B  covers the D urable Medical Equipment (DME).   These are equipment that serves a medical purpose, able to withstand repeated use, and is appropriate for use in at home.  There are many important things to know about Medicare’s coverage for DME. Below are pieces of information that will help you know whether/how you are covered. Eligible equipment Medicare’s DME benefit does not cover all medical equipment.  Medicare only covers DME if your  provider  says it is  medically necessary for use in the home . You also must order your DME from suppliers who contract with  Original Medicare  or your  Medicare Advantage  Plan . However, Medicare Advantage Plans may have additional requirements you need to meet before your DME is covered. DME coverage Depending on what type of equipment you need, Medicare will require that you either rent or buy DME. There are also special rules when you need oxygen equipment...
Mag-post ng isang Komento
Magbasa nang higit pa

Everything you need to know: Medicare Dental Coverage

ADA, The American Dental Association said that individuals 60 and over face some rather unique dental concerns. Approximately one in four seniors have gone five years or more since their last dental visit and 16 percent in this age range consider their oral health as poor. Also, for instance, there are more than 500 medications that cause dry mouth, some of which were prescribed for high blood pressure, high cholesterol, Parkinsons's and Alzheimer's disease. This is now the common cause of cavities in older adults. Unfortunately, Medicare doesn't always help with this issue. In fact, according to Medicare.gov , this federal health insurance program typically does not cover dental care, procedures, or supplies. They don't provide benefits toward regular cleanings or services designed to treat and/or correct problematic oral issues, such as fillings or tooth extractions and they don't generally offer benefits for dental devices, including dentures and dent...
Mag-post ng isang Komento
Magbasa nang higit pa

The Doughnut Hole

What is a Doughnut Hole? The  Medicare  Part D donut hole  is a temporary coverage gap in how much a  Medicare  prescription drug plan will pay for your prescription drug costs. Starting in  2020 ,  Medicare  Part D plan beneficiaries pay 25 percent of their brand name and generic drug costs while they're in the coverage gap. How does the donut hole work? The donut hole closed for all drugs in 2020, meaning that when you enter the coverage gap you will be responsible for 25% of the cost of your drugs. In the past, you were responsible for a higher percentage of the cost of your drugs. Although the donut hole has closed, you may still see a difference in cost between the initial coverage period and the donut hole. For example, if a drug’s total cost is $200 and you pay your plan’s $40 copay during the initial coverage period, you will be responsible for paying $25 (25% of $200) during the coverage gap. How do I get out of the ...
Mag-post ng isang Komento
Magbasa nang higit pa