How to Appeal Higher Medicare Premiums

The annual income for older Americans can fluctuate from life events such as retirement or death of a spouse. It is during these times of transition where the problem with Medicare premiums comes into play leaving about 4.3 million paying monthly surcharges. It can take years for Medicare to adjust when incomes shift and fall below the threshold. Medicare charges higher earners more for their premiums, much like how taxes are handled by the government. 

Social Security considers any of the following situations to be life-changing events:

  • Death of a spouse
  • Marriage
  • Divorce or annulment
  • Reduction of hours at work
  • Involuntary loss of income-producing property due to: natural disaster, disease, fraud, or other circumstances
  • Pension loss
  • Receipt of settlement payment from a current or former employer due to the employer’s closure or bankruptcy

Things to know

If you are a Medicare beneficiary and your income has recently dropped, you will need to contact the Social Security Administration (SSA). The SSA determines if you owe an income-related monthly adjustment amount, or IRMAAs, which can easily be up to hundreds of dollars a month. The surcharge is based on your tax return from two years prior, which may no longer reflect your current finances. For example, Social Security would use tax returns from 2018 to determine your IRMAA in 2020.

While the standard monthly premium for Medicare Part B is $144.60 this year, some beneficiaries pay as much as $491.60.

For individuals, IRMAAs kick in if your modified adjusted gross income is more than $87,000; for married couples filing joint tax returns, they start above $174,000.

The Appeal Process

The process to appeal unnecessarily high premiums involves contacting the agency (either over the phone or in writing) to reconsider their assessment. You, also, have to fill out a form and provide supporting documents. While it depends on your situation, suitable proof may include: most recent tax return, letter from your former employer stating that you retired, more recent pay stubs, or something similar showing evidence that your income has dropped.

If you are unsure why you are paying an IRMAA, you can call the Social Security hotline at 800-772-1213.

If you are an individual whose income is different from what Social Security has in their records and are a beneficiary of Medicare, it is an important thing to take action. Take control of your finances and your health!


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