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Appeal Medicare Charges – Information for Consumers
Individuals on Medicare (Medicare beneficiaries) have the right to appeal the amount you are paying for your Medicare Part B coverage. This is the monthly amount either paid directly – or deducted from your Social Security benefits.
The Social Security Administration (SSA) notifies all individuals of the Part B premium. This comes with your annual notice of Social Security benefits.
As a Medicare beneficiary, you can appeal if you believe you meet one of the qualifying reasons. The first step is to request a reconsideration of the Social Security Administration’s initial determination (the amount being charged or deducted).
You can make the request by calling SSA at 1-800-772-1213. You can submit a Medicare IRMAA Life-Changing event form. Or, schedule an appointment with your local Social Security office.
If your income is above a certain amount (set by the government) you may have to pay an Income-Related Monthly Adjustment Amount (IRMAA). This is in addition to your Medicare Part B and/or Medicare Part D premiums.
The Social Security Administration determines if you own IRMAA based on what income you reported on your Federal tax return two years before the year when you pay the IRMAA. More simply put, the IRMAA amount for 2021 is based on your 2019 tax returns.
You can appeal for two reasons. First, you believe that the income information used was incorrect or outdated. For example, you filed an amended (corrected) tax return.
Second, if any of the following life-changing events caused an income decrease:
Marriage is a life changing event.
So is the death of your spouse.
You got divorced or your marriage was annulled.
A pension or pension income was reduced.
You stopped working or had your work hours reduced.
Your spouse stopped working (joint returns) or had hours reduced.
You owned an income-producing property and experienced a loss/reduction of income
Even if you don’t qualify based on the reasons above, but you still disagree with the IRMAA amount, you can request a ‘reconsideration’. You do this by contacting the Social Security hotline or make an appointment at your local office.
SUCCESS: If your request for reconsideration is successful, your premium will be corrected (reduced).
DENIAL: If your request is denied, you can appeal to the Office of Medicare Hearings and Appeals. You must do this within 60 days of the date of the denial. If this attempt is denied, there are two additional avenues you can pursue including an appeal to the Federal District Court.
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The American Association for Medicare Supplement Insurance works to provide the best information designed to help individuals make good decisions regarding their Medicare insurance protection. This webpage was posted March 2021. Please let us know if you have questions or find any of the information or links need updating.
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