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Medicare Penalty SURCHARGES  IRMAA for  high Income
on Part B Doctor Visits & Part D Rx Premiums

what to do if your income is wrong?

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Fortunate to earn a Good Living?

If you earn a lot of money, be thankful.  Then open up your wallet as it will cost you a little more for Part B – Outpatient – Doctor Visits and Part D Rx.  Medi Gap premiums stay the same.  No surcharge for Medicare Advantage, but for the Rx portion.  See the chart below and the publications on the right.

Note that MAGI for Social Security is a little different here that from the definition for those under 65 in Obamacare.   MAGI is the total of your adjusted gross income [line 8 b 1040] and tax-exempt interest income.

Here’s an Explanation in a Specimen MAPD Evidence of Coverage  page 20

Most Medicare beneficiaries pay the standard monthly premium, which is set to cover 25 percent of Part B and Part D program costs, but a relatively small share of beneficiaries (around 6 percent in 2015) with incomes above $87,000 for single people and $174,000 for married couples are required to pay higher premiums for Medicare Part B and Part D—ranging from 35 percent to 80 percent of program costs,  that means that your $144/month Part B premium, costs Medicare more than $429/month! and the average $36 Part D premium costs Medicare $112/month, click on footnote KFF.org to view charts! depending on your  income (Figure 1).    KFF.org

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Prescription Drug 2022 #RxGuide
PDF # 11109

part d video explanation

 

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Coverage Gap - Donut Hole $2,000 Cap

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Calculate your  Covered CA MAGI Income

take #Line8b 11 Adjusted Gross income then add line 2a, 6a &   8 (Foreign Income)

 

MAGI Income from 1040

High Income Surcharge – #Waiver Form  SSA 44 

Life Changing Event

high income surcharge waiver form ssa 44

VIDEO Seminar - Introduction to #MediGap

by Steve

Medi Gap Introductory Video

What year’s income is #used?

The surcharge is based on income from your tax return two years ago—the most recent IRS data the government has when premiums are set in late fall. To determine 2017 premiums, for instance, income reported on your 2015 return filed in early 2016 was used. If your income exceeded the thresholds in 2016, you’ll probably owe the surcharges in 2018, and so on.

What if my income has gone down?

That’s the reason for the word probably in the previous answer. If you got hit with the surcharge this year, but your income has fallen since 2015, you may qualify for a waiver. If you experienced a qualifying “life-changing event,” you can easily get the surcharge waived—but you have to ask. It’s my understanding that the IRS will use a tax return ACTUALLY FILED and not just that you project or ask them nicely that your income has gone down!  § 418.1201 (b)   Those events include retirement, divorce or death of a spouse.   2022 Kiplincer *  kiplinger.com 2017

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To determine if you’ll pay higher premiums, Social Security uses the most recent federal tax return the IRS gives them.

Actual CFR Code of Federal Regulations

(a) In general, we will use your modified adjusted gross income provided by IRS for the tax year 2 years prior to the effective year of the income-related monthly adjustment amount determination. Modified adjusted gross income is based on information you provide to IRS when you file your Federal income tax return. 418.1135

If your income has gone down, however, due to certain specific circumstances, or if you filed an amended tax return, you can ask for a new decision without having to file an appeal. https://www.ssa.gov/pubs/EN-05-10125.pdf

  1. Determinations Using a More Recent Tax Year’s Modified Adjusted Gross Income (§§ 418.1201 – 418.1270)
    1. § 418.1201 When will we determine your income-related monthly adjustment amount based on the modified adjusted gross income information that you provide for a more recent tax year?
    2. § 418.1205 What is a major life-changing event?
    3. § 418.1210 What is not a major life-changing event?
    4. § 418.1215 What is a significant reduction in your income?
    5. § 418.1220 What is not a significant reduction in your income?
    6. § 418.1225 Which more recent tax year will we use?
    7. § 418.1230 What is the effective date of an income-related monthly adjustment amount initial determination that is based on a more recent tax year?
    8. § 418.1235 When will we stop using your more recent tax year’s modified adjusted gross income to determine your income-related monthly adjustment amount?
    9. § 418.1240 Should you notify us if the information you gave us about your modified adjusted gross income for the more recent tax year changes?
    10. § 418.1245 What will happen if you notify us that your modified adjusted gross income for the more recent tax year changes?
    11. § 418.1250 What evidence will you need to support your request that we use a more recent tax year?
    12. § 418.1255 What kind of major life-changing event evidence will you need to support your request for us to use a more recent tax year?
    13. § 418.1260 What major life-changing event evidence will we not accept?
    14. § 418.1265 What kind of significant modified adjusted gross income reduction evidence will you need to support your request?
    15. § 418.1270 What modified adjusted gross income evidence will we not accept?

Request for Reconsideration ssa-561

Understanding the Medicare Premium Bill
#cms500  11061 pdf

understanding medicare bill

HTML - Medicare Webpage on Billing

 

 

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9 comments on “High Income Surcharge IRMAA Parts D Rx & B Doctor Visits”

    • See our webpages on:

      Part B late enrollment penalty
      Medicare & Dual Coverage
      Blue Shield under 65 webpage

      Blue Shield under 65 EOC Limitation for duplicate coverage Medicare

      If you receive Medicare, Blue Shield will provide your Benefits but Medicare will
      typically be the primary payor and Blue Shield will be the secondary payor as determined by Medicare regulations.

      When Blue Shield is the secondary payor, your combined Benefits from Medicare and Blue Shield will equal but not exceed what Blue Shield would pay if you were not eligible for Medicare. Blue Shield’s payment will be based on an amount that may be lower than the Medicare allowed amount but will not exceed the Medicare allowed amount. You must pay any applicable Deductibles, Copayments, and Coinsurance for your Blue Shield plan before Blue Shield will provide Benefits.

      Blue Shield’s rate chart doesn’t charge extra for being over 65. Silver 70 PPO Santa Barbara Region 12 is $1,240.95 for 64+

      If you are only a high earner for 2020, see the Plain English explanation we answered for another website visitor, about it taking two years for your tax return to show.

      Check out about asking for a Waiver. See FAQ above on annual verification in the box with the rules for high income beneficiaries.

      So, if you wait to sign up… Then you’ll have the Part B late enrollment penalty and you can only sign up at certain times.

      Reply

  2. Where does one get the bill for the higher amount?

    From Medicare?

    Medi Gap?

    Medicare Advantage?

    Prescription Company?

    Reply

    • The standard Part B premium amount in 2021 is $148.

      Most people pay the standard Part B premium amount. If your modified adjusted gross income as reported on your IRS tax return from 2 years ago is above a certain amount, you’ll pay the standard premium amount and an Income Related Monthly Adjustment Amount (IRMAA).

      IRMAA is an extra charge added to your premium. https://www.medicare.gov/your-medicare-costs/part-b-costs

      Part D Rx

      If you have a higher income, you might pay more for your Medicare drug coverage. If your income is above a certain limit ($87,000 if you file individually or $174,000 if you’re married and file jointly), you’ll pay an extra amount in addition to your plan premium (sometimes called “Part D-IRMAA”). You’ll also have to pay this extra amount if you’re in a Medicare Advantage Plan that includes drug coverage. This doesn’t affect everyone, so most people won’t have to pay an extra amount. If you have Part B and you have a higher income, you may also have to pay an extra amount for your Part B premium, even if you don’t have drug coverage. The chart below lists the extra amount costs by income.

      Social Security will contact you if you have to pay Part D IRMAA, based on your income. The amount you pay can change each year. If you have to pay a higher amount for your Part D premium and you disagree (for example, if your income goes down), use this form to contact Social Security [PDF, 125 KB]. If you have questions about your Medicare drug coverage, contact your plan.

      Note

      The extra amount you have to pay isn’t part of your plan premium. You don’t pay the extra amount to your plan. Most people have the extra amount taken from their Social Security check. If the amount isn’t taken from your check, you’ll get a bill from Medicare or the Railroad Retirement Board. You must pay this amount to keep your Part D coverage. You’ll also have to pay this extra amount if you’re in a Medicare Advantage Plan that includes drug coverage. https://www.medicare.gov/drug-coverage-part-d/costs-for-medicare-drug-coverage/monthly-premium-for-drug-plans

      Reply

  3. Question

    Why do I have to pay so much for Medicare Part B Doctor Visits?
    I worked hard for over 40 years and paid taxes for it!

    Our Reply

    The Monthly premiums for Part B Dr. Visits and Part D Rx Prescriptions for most people on Medicare only pays 1/4 of what Medicare pays out! That just doesn’t hold up considering Medical Loss Ratio, where Insurance Companies & Government need to take in a dollar to pay out 80c.

    Kaiser Foundation on high income surcharges KFF.org

    See also our webpage section on how Medicare is funded.

    Again, See our webpage on how Medicare is Funded

    Reply

  4. How do I tell from my bill from Medicare if I have hospitalization Part A and am I paying double for a Part D Rx plan that I have with a private company?

    Reply

    • See our excerpts of 2020 Medicare Costs above and you’ll see that the $70 charge on part D Rx along with the $462 charge on Part B Doctor Visits is because you are fortunate to earn over $163k

      I can’t tell from this bill if you have Medicare Part A Hospital. There is generally no charge for Part A if you worked and paid into Medicare for 10 years.

      Take a look at your Medicare ID Card and that will tell you if you have Part A. Also, we wouldn’t be able to get you a Medi Gap Plan or Medicare Advantage unless you had both.

      Check out our webpage on getting a Medicare and Social Security Account, so that you can check with the government directly on what your benefits, claims and payments are.

      The $70 surcharge is for Part D. Thanks for sending the bill. I was under the impression that the surcharge was billed by what ever company you had your prescription coverage with. Maybe it’s only the surcharge if you didn’t buy prescription coverage when you were supposed to.

      Here’s our webpage on what Medicare A & B Cover. You can also check out Medicare and You above and for Rx that guide too above.

      Here’s our webpage on what Blue Cross Medi Gap Plans pay in addition to Medicare.

      United Health Care doesn’t allow us to post their brochures. I’ve sent those to you via email.

      Reply

  5. I just retired

    Why does Medicare use income from my tax return – 2 years prior.

    How to I get the surcharge to be lower now that I’m retired?

    Reply

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