What to know about IRMAA and Medicare
The income-related monthly adjustment amount (IRMAA) applies to people enrolled in Medicare with incomes above a certain amount.
IRMAA applies to Medicare parts B and D.
This article explains Medicare and the IRMAA. It also looks at how Medicare calculates the IRMAA, who must pay it, and how to appeal against the decision.
What is the IRMAA?
This article originally appeared on Medical News Today
The IRMAA is a surcharge, derived from a person’s annual income, which Medicare adds to the basic Medicare Part B and Part D premiums. The IRMAA depends on someone’s income bracket and whether they filed their taxes individually or jointly.
The Centers for Medicare & Medicaid Services (CMS) calculates the IRMAA annually and publishes it in the Federal Register.
The Social Security Administration (SSA) will then work out a person’s IRMAA based on information from the Internal Revenue Service relating to the person’s modified adjusted gross income.
It will take the income tax information from the tax returns the person filed 2 years previously. The calculations indicate whether someone must pay an IRMAA in addition to the basic premiums for Medicare Part B and Part D.
An individual can appeal the decision, but only if there is an error in the tax information the SSA used or due to a life changing and income-reducing event in the individual’s life.
Which parts of Medicare will IRMAA affect?
The federal government provides health insurance through the Medicare program. Medicare benefits are available to people 65 years of age and older and those younger than 65 but with certain health conditions.
Medicare has four different parts covering different areas of healthcare services:
Medicare Part A: Part A is hospital insurance covering inpatient stays in hospitals, skilled nursing facilities, and mental health facilities.
Medicare Part B: Part B is medical insurance that covers outpatient health services, preventive care, and durable medical equipment, such as wheelchairs.
Part C: Private insurance companies offer Medicare Part C, or Medicare Advantage, plans. These plans offer the same coverage as Original Medicare (parts A and B) and may also cover dental, vision, hearing, and prescription drugs.
Part D: Private insurance companies offer Part D plans that cover prescription drugs. It is an add-on plan available for people with Original Medicare.
The IRMAA does not affect Medicare parts A and C but will affect parts B and D. The SSA will calculate the surcharge based on an individual’s annual income and add it to the standard monthly premium for these plans.
IRMAA calculations
The IRMAA applies to premiums for both Medicare Part B and Part D, though the calculations are different.
Medicare Part B
The SSA will use the income tax information from the tax return a person filed 2 years previously to calculate the IRMAA surcharge. Medicare will then add the additional cost to the standard monthly premium, which is $185 in 2025.
An individual’s income bracket and how they filed their taxes will both affect the IRMAA calculation.
The table below gives some examples of Part B surcharge amounts for 2025:
Filed as individual | Filed jointly | Filed as married, filing separately | 2025 Part B monthly premium |
|---|---|---|---|
less than or equal to $106,000 | less than or equal to $212,000 | less than or equal to $106,000 | $185 |
$106,000 to $133,000 | $212,000 to $266,000 | N/A | $259 |
$133,000 to $167,000 | $266,000 to $334,000 | N/A | $370 |
$167,000 to $200,000 | $334,000 to $400,000 | N/A | $480.90 |
$200,000 to $500,000 | $400,000 to $750,000 | greater than 106,000 to $394,000 | $591.90 |
greater than or equal to $500,000 | greater than or equal to $750,000 | greater than or equal to $394,000 | $628.90 |
Medicare Part D
Unlike Part B, Medicare Part D plans do not have a standard monthly premium, and costs vary among plans.
As with Medicare Part B, the SSA will use the income tax information from the tax return a person filed 2 years previously to calculate the IRMAA surcharge. Again, someone’s income bracket and how they filed their taxes will affect the IRMAA.
Although private insurance companies administer Part D plans, a person must pay the additional surcharge to Medicare.
The table below gives some examples of Part D surcharge amounts for 2025:
Filed as individual | Filed jointly | Filed as married, filing separately | 2025 Part D monthly premium |
|---|---|---|---|
Less than or equal to $106,000 | Less than or equal to $212,000 | Less than or equal to $106,000 | plan premium |
$106,000 to $133,000 | $212,000 to $266,000 | N/A | plan premium + $13.70 |
$133,000 to $167,000 | $266,000 to $334,000 | N/A | plan premium + $35.50 |
$167,000 to $200,000 | $334,000 to $400,000 | N/A | plan premium + $57 |
$200,000 to $500,000 | $400,000 to $750,000 | $106,000 to $394,000 | plan premium + $78.60 |
Greater than or equal to $500,000 | Greater than or equal to $750,000 | Greater than or equal to $394,000 | plan premium + $85.80 |
What is in the IRMAA notice?
The SSA will mail someone their IRMAA predetermination notice, which outlines the details of their specific IRMAA.
Typically, these notices tell people how the SSA calculated the IRMAA. They also outline the steps that someone should take if they think the SSA used incorrect information to calculate the IRMAA. They also explain what they should do if they now have a lower income or have experienced a life changing event that would affect their income.
The SSA reviews IRMAA surcharges annually. This means it may add an IRMAA, update the amount, or remove the surcharge entirely depending on an individual’s income.
A person will receive an initial determination around 20 days after the first IRMAA notice, which contains more information about paying the surcharge and the appeals process.
If an individual agrees to pay the IRMAA, they do not need to do anything else. Medicare will automatically add the IRMAA surcharges to an individual’s monthly premium.
How to appeal the decision
If a person disagrees with the IRMAA, they can appeal the decision within 60 days of receiving the notice. If they delay their appeal, the SSA will evaluate whether or not they had a good reason for a late request.
Reasons for appeal
A person can appeal an IRMAA for several reasons.
One of these is if the tax information the SSA used to decide the IRMAA was incorrect due to using inaccurate or out-of-date figures to determine the surcharge.
Alternatively, a person may have had a life changing event, such as a change to their marital status, loss of work, or loss of other income types.
Documents
The appeal requires documentation. The exact documentation will depend on the reasons for the appeal and could include:
federal income tax return documentation
marriage, divorce, or death certificates
copies of pay stubs
a signed employer’s statement showing work reduction or stoppage
a statement showing a loss or reduction of a pension
a statement from an insurance adjuster showing loss of income-generating property
To begin an appeal, a person will need to contact the SSA at 800-772-1213. They may also need to complete the Medicare IRMAA: Life-Changing Event form.
Decision
If the SSA approves the appeal, it will adjust the person’s monthly Medicare premiums. If it denies the appeal, it will explain why, generally in a hearing.
Summary
The income-related monthly adjustment amount (IRMAA) is a surcharge that Medicare can add to an individual’s Part B and Part D monthly premiums. The surcharge amount relates to a person’s annual income that they filed with the Social Security Administration (SSA) 2 years previously.
A person can appeal an IRMAA decision under certain circumstances. If an individual receives an IRMAA notice and disagrees with the decision, they should contact the SSA for more details.
View the original article on Medical News Today
