Medicare IRMAA appeal form
If you have a client who receives a IRMAA, they can use the Medicare IRMAA appeal form to try and lower their Medicare Part B adjustment amount. In certain circumstances, your client can file an appeal and have their IRMAA reduced due to a reduction in their income. There are many different circumstances that can effect a beneficiary’s income. They could be recently divorced, widowed or lost a source of income some other way.
If your client falls under any unfortunate circumstance that lowers there income you can help by downloading the following form:
They can also file an appeal by setting up an in-person meeting with their local Social Security office. They can do this by calling 1-800-772-1213.
Please see the chart below for the 2019 IRMAA amounts:
|This is the adjusted Part B amount for 2019, if the yearly income in 2017 was:||You pay each month (in 2019)|
|Individual tax return||File joint tax return||File married & separate tax return|
|$85,000 or less||$170,000 or less||$85,000 or less||$135.50|
|$85,000 up to $107,000||$170,000 up to $214,000||Not applicable||$189.60|
|$107,000 up to $133,500||$214,000 up to $267,000||Is not applicable||$270.90|
|$133,500 up to $160,000||$267,000 up to $320,000||Not applicable||$352.20|
|$160,000 and less than $500,000||$320,000 and less than $750,000||$85,000 and less than $415,000||$433.40|
|$500,000 or above||$750,000 and above||$415,000 and above||$460.50|
If you would like to become a member of our team, please contact us either by phone at (203)796-5403 or by email at [email protected] We are here to help answer your Medicare and other health insurance coverage questions.
If you have a client with low income level, click here for information on special programs available to help them.