OMHA handles appeals of the Medicare program’s determination of a beneficiary’s Income Related Monthly Adjustment Amount (IRMAA), which determines a Medicare beneficiary’s total monthly Part B insurance premium.
The Social Security Administration (SSA) notifies a beneficiary of his or her Part B insurance premium and any IRMAA with the beneficiary’s annual notice of Social Security benefits (referred to as an initial determination). SSA is responsible for issuing all initial and reconsideration determinations. It is important to remember that IRMAAs apply for only one year. A beneficiary will be notified by SSA near the end of the current year if he or she has to pay an IRMAA for the upcoming year.
Appealing Your Part B PremiumAs a beneficiary, you have the right to appeal if you believe that an Income Related Monthly Adjustment Amount (IRMAA) is incorrect for one of the qualifying reasons. First, you must request a reconsideration of the initial determination from the Social Security Administration. A request for reconsideration can be done orally by calling the SSA 1-800 number (800.772.1213) as well as by writing to SSA.
Below are the situations which may qualify a beneficiary for a new Part B determination:
|Tax return inaccurate or out of date||
|Life-changing event that affects the beneficiary’s modified adjusted gross income||
There are 7 qualifying life-changing events:
Events that result in the loss of dividend income or affect a beneficiary's expenses, but do not affect the beneficiary's modified adjusted gross income are not considered qualifying life-changing events.
Components of Your Part B Premium
Beneath the following equation is specific information on each component of your premium.
Equation to Determine Your Part B Premium
Medicare Part B Standard Monthly Premium* + Your Income-Based Adjustment** = Your Total Monthly Part B Premium
*Set by the Centers for Medicaid and Medicare Services (CMS).
**Income Related Monthly Adjustment Amount (IRMAA)
|Part B Premium Component||Description|
Annual Part B Rate
Set by the Centers for Medicaid and Medicare Services (CMS)
|The Part B insurance premium is set annually by the CMS. Effective January 1, 2007, Part B beneficiaries with incomes above a certain threshold amount (about 4% to 5% of all Part B beneficiaries) are subject to an adjustment of the amount of the premium that they must pay for Part B insurance.|
Your Income-Based Adjustment
The Social Security Administration determines your Income Related Monthly Adjustment Amount (IRMAA).
The IRMAA is based on information from the individual’s income tax return obtained from the Internal Revenue Service (IRS) and calculated according to a mathematical formula established by law. The IRMAA is then added to the standard premium amount to calculate the beneficiary’s total monthly Part B insurance premium.