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You can also make the case that Social Security used outdated or incorrect information when calculating your IRMAA, if example, you;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

Medicare & group health plan after you retire

Will my group health plan still work after I retire? It would depend on the terms of your specific plan. Other employers might not offer any health coverage after your retirement and even if you can get one, it might have different rules and might not work the same way with Medicare. When you have retiree coverage from an employer or union, they usually manage this coverage. Employers aren't required to provide retiree coverage, and if they would, they can change benefits or premiums, or even cancel coverage.  They may offer coverage that limits how much it will pay. It might only provide a stop-loss coverage that starts paying your out-of-pocket costs only when they reach of coverage that's covered. What happens to my retiree coverage when I'm eligible for Medicare? When you become eligible for Medicare, you will need to have both Medicare Part A and Medicare Part B to get full benefits from your retiree coverage. If your former employer offers retiree...
Mag-post ng isang Komento
Magbasa nang higit pa

Medicare Part D Costs for 2020

Before 2006, Medicare did not cover prescription medications. There was a limited number of medications that were offered under Medicare Part Band,  and otherwise, you had to pay for your medications out of pocket. In 2003, everything had changed when President George W. Bush passed the Medicare Prescription Drug, Improvement, and Modernization Act (MMA). This is what we now know of as  Medicare Part D , an optional part of Medicare that provides prescription drug coverage. Part D plans are run by private insurance companies and not by the government. However, the federal government sets guidelines on what basic medications are covered and how much you can be charged.  A deductible is the amount of money you spend out of pocket before your prescription drug benefits begin. Your plan may or may not have a deductible. The maximum deductible a plan can charge for 2020 is set at $435. It has increased by  $20 from 2019...
Mag-post ng isang Komento
Magbasa nang higit pa