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The truth is, if your IRMAA draws on information from two years ago, much could have changed since then. That’s frequently the starting point for pleading your case, and the SSA agrees in principle that life-changing events warrant consideration. So, if you’ve had a life-changing event, you can request a new initial determination about your IRMAA.
Keep in mind, however, that the SSA has its own definition of life-changing events, and it includes:
There are other factors that might work in your favor if you want to appeal. For example, if you have proof that Social Security used outdated or incorrect information when it calculated your IRMAA, that might help your case. Perhaps you filed an amended tax return with the IRS that shows you’re receiving a lower income than shown on the records it has on file.
If any of the listed circumstances applies to you, you can request a new initial determination, submit a Medicare IRMAA Life-Changing Event form SSA-44, or schedule an appointment with Social Security.
Even if you haven’t experienced a life-changing event, you can still appeal an IRMAA. Request an appeal in writing by completing a Request for Reconsideration form SSA-561. You can also go into a nearby Social Security office or call 800-772-1213.
The following are considered non-life-changing limited situations:
You’ll also need to provide documentation of the life-changing event that caused your income to decrease or of your correct income, whichever applies. If you can demonstrate a change in your income, it does not hurt to try to file an appeal. An appeal will not cost you anything, and if you state your case well enough, you may save yourself some money.
Documentation is an essential thing in any appeal. You should write a cover letter explaining how you think you’re being overcharged. Then you will need to provide backup documentation.
Gather the following backup documentation:
If you have a successful appeal, Social Security will automatically correct your Medicare Part B premium amount. If you’re denied, they will provide instructions on how to appeal the denial to an Administrative Law Judge. While you are in the process of the appeal, you will continue to pay the higher Medicare Part B premium.
If you’re dissatisfied with the SSA’s reconsideration determination, you still have more options. You may request a further review, including a hearing before an Office of Medicare Hearings and Appeals (OMHA) Administrative Law Judge.
If you’re dissatisfied with the ALJ’s decision, you can proceed to Level 4 of the Medicare appeals process and then on to Level 5 of the appeals process if you remain unhappy with the IRMAA determination. To help you understand the process, check out the Appeals Process Chart .
Keep in mind that you must appeal to OMHA within 60 days of the date on the reconsideration denial. Follow the directions on the denial to file an appeal at the OMHA level. If you decide to appeal at the OMHA level, you may want to contact a legal services organization or lawyer to help you with this or any further levels of appeal, but that’s not required.
After filing your OMHA level appeal, you must submit any new evidence within 10 days. Contact OMHA for further instructions on submitting. If you’re not able to submit new evidence within 10 days, you can ask OMHA for an extension.
A successful OMHA level appeal will result in your premium amount being corrected. If your appeal is denied, you can choose to appeal to the Medicare Appeals Council within 60 days of the date on the OMHA level denial.
If your Council appeal is successful, your premium amount will be corrected. If the Council denies your appeal, you can choose to appeal to the Federal District Court within 60 days of the date on the Council denial.
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