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You can also make the case that Social Security used outdated or incorrect information when calculating your IRMAA, if example, you;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

NCOV -19 and MEDICARE 2020

Medicare Part B , which includes a variety of outpatient services cover medically necessary clinical diagnostic laboratory tests when a doctor or other practitioner orders them. Medically necessary clinical diagnostic laboratory tests are generally not subject to coinsurance or deductible. It will cover medically necessary imaging tests, such as computed tomography (CT) scans, as needed for treatment purposes for lung infections, however not for screening asymptomatic patients. For those imaging tests paid by Part B, beneficiary coinsurance and deductible would apply. If the Part B deductible ($198 in 2020) applies to the Part B services, beneficiaries must pay all costs - up to the approved amount of Medicare until the beneficiary meets the yearly Part B deductible. Once it is met, Medicare pays its share, and beneficiaries typically pay 20% of the approved amount of the service, except laboratory tests. There’s no yearly limit for what a beneficiary pays out-of-pocket tho
Mag-post ng isang Komento
Magbasa nang higit pa

Cardiovascular Disease Risk Reduction

Cardiovascular disease generally refers to conditions that can lead to a heart attack or stroke. Cardiovascular disease risk reduction visits can help detect and prevent this disease. How to know if I am Eligible? Medicare   Part B  covers an annual cardiovascular disease risk reduction visit with your primary care  provider . You do not need to show any signs or symptoms of cardiovascular disease to qualify for screening, but you must be considered competent and alert when counseling is provided.  During the screening, your provider may; Encourage aspirin use if the benefits outweigh the risks You are a man  of age 45-79 Or a woman of age 55-79 Screen for high blood pressure if you are age 18+ Provide behavioral counseling and tips to encourage a healthy diet Note: Men under 45 and women under 55 are not encouraged to use aspirin as a tool to reduce cardiovascular disease. How much will it cost? If you are eligible,  Original Medicare  will cover your cardiovascular disease risk red
Mag-post ng isang Komento
Magbasa nang higit pa

Lifetime Reserve Days

There are  90 days of  inpatient  hospital care coverage on Original Medicare for each  benefit period , In addition, you also have an additional 60 days of coverag e , called LIFETIME RESERVE DAYS .   These Lifetime Reserved Days  can be used only ONCE, and you will pay a  coinsurance  for each of it. To have a better understanding of it, let’s imagine an individual who had a 120-day  Medicare -covered inpatient stay, this means that they used 30 lifetime reserve days. After they have been out of the hospital for 60 days in a row, they will be eligible for another 90 days of hospital coverage because they will be in a new  benefit period . However, if they need  inpatient care  beyond the benefit period maximum, they will only have 30 of their 60 lifetime reserve days remaining. The above example illustrates that lifetime reserve days do not have to be applied to the same hospital stay. If you need to stay in the hospital twice for 120 days each time during different benefit
Mag-post ng isang Komento
Magbasa nang higit pa