Crotchety Aunt IRMAA

Marla McCune

HOW MUCH DO WE PAY for Medicare? You might think that premiums would be fixed, like the prices on a restaurant menu. But instead, the correct answer is “it all depends”—on your income, which isn’t necessarily a good thing in our case.

It’s a fact of life: The more you make, the more you may have to pay for Medicare, the health insurance program for older Americans. Medicare calls its variable pricing system the income-related monthly adjustment amount, or IRMAA for short. The ins and outs of IRMAA remind me of dealing with a crotchety old aunt who’s hard of hearing and slow to respond. Still, my experience may help those approaching age 65 to avoid her or at least minimize her impact.

The income level that affects Medicare premiums is what you earned two years ago. Confusing but true. I knew ahead of time that our income in 2021 would potentially bump me into the Medicare premium stratosphere. That’s because, to simplify our lives in preparation for retirement, my husband and I sold two homes that year.

For a married couple filing jointly, our 2021 income could not be one penny above $194,000 or I’d be on the hook for higher Medicare premiums. Even though the two home sales were a one-time gain, they were still counted as regular income by Aunt IRMAA.

Fortunately, in the same year, my husband and I also both reduced our work hours. Unlike the home sales, a change in job status does allow you to ask for a reduction in IRMAA premium surcharges based on changed circumstances. But as I discovered, the appeal process isn’t always easy.

Our 2021 income was going to escalate my premiums by two levels with Aunt IRMAA—or so I was initially informed. My total Medicare Part B premium for 2023 was set to climb from the standard $164.90 a month to $329.70. Then there was another $31.50 a month extra for Part D drug coverage, although I take no medications. In all, my monthly Medicare premium would potentially be $361.20 a month.

My husband is not yet on Medicare. Still, we’re purposely keeping our income low so he can qualify for a low-cost Washington State health plan until he reaches age 65 and becomes eligible for Medicare—and so, in the future, both of us stay below Aunt IRMAA’s super-premium limits.

The tricky part is you don’t know what the income limits will be in the future because they change every year. It’s terribly confusing and yet important because, if you’re close to the edge of a premium increase and, say, make a Roth conversion, it could make a big difference to your premiums two years from now. All you know for sure is that this year’s income will affect your 2025 premiums—but you don’t know what the IRMAA income thresholds will be.

On the very day I got my notice of increased premium for 2023, I attempted to file an appeal explaining that our work situation had changed—and hence our ongoing income was far lower than it had been in 2021. I knew I was in the right, but it turns out appealing Aunt IRMAA’s ruling is neither easy nor fast. Here’s a timeline of how the process went.

Nov. 26, 2022. Received my Medicare premium notification in the mail on Saturday, informing me I had to pay $361.20 a month in 2023.

Nov. 28. On Monday, after three hours of trying to get through to a representative, I mailed my appeal form to my local Medicare office.

Dec. 5. No update on the Social Security or Medicare site, or even a record of receiving my appeal. I called a Medicare phone number and was given a different number to call at Social Security for appeals. After an hour on hold, I finally hung up.

Dec. 8. Called Social Security again and this time got through. The rep told me that my paperwork had been received but had no comment as to whether it was satisfactory. I was told I must pay the higher premium until I was notified in writing of a problem or acceptance of my appeal.

Jan. 10, 2023. I was given all kinds of confusing information on the phone with Social Security. No information had been updated, except that my appeal had been received. Finally, I was given a direct number to call at my local office.

Feb. 22. After multiple attempts, I got through to the local office. A harried employee stated they’re short-staffed and “it sucks.” She also found my appeal and said it seemed everything was in order, so someday someone would review it.

 March 15. Called the local office again and was told by a nice but unknowledgeable staff person that, if I met qualifying circumstances, my Medicare premium would be reduced from $361.20 to $164.90 a month. She had me verify my last year’s taxable income and said she would try to expedite things.

April 3. I talked to Robert at my local Social Security office who said, “Everything looks in order.” He said he would send it to the folks responsible for making a ruling, whom he identified as Jessica and her manager. He said, “It has been too long, call back next week to check on things.” By this time, I was asking for names when I called.

April 11. I called my local office back—repeatedly. Finally, someone named Irina answered, and she was the angel who helped me. She was the first person who knew what to do and took care of it in minutes. Irina said I would get a letter in the mail confirming that I qualified for the baseline Medicare premium of $164.90 a month. She also said I would get a refund of $785.20 for the four months I’d been paying excessive premiums to Aunt IRMAA.

April 17. I received a letter adjusting my payment to $164.90. No word on my refund. An interaction with the Medicare site’s chat function said I wouldn’t get a refund. Instead, my overpayments would be applied against my future premiums and I wouldn’t be billed again until I owed Medicare more than $10.

May 7. The Medicare site still shows I owe a premium for May of $361.20

May 22. The Medicare site finally shows I owe the standard premium of $164.90 a month. I was done. Meanwhile, my neighbor, who faxed her IRMMA appeal in January and did nothing else, received an actual refund.

Just for fun, I kept track of the time I spent trying to resolve this issue. It was at least eight-and-a-half hours. Here’s hoping you spend less time with crotchety old Aunt IRMAA.

Marla McCune is a registered nurse with a career spanning 45 years. She also loves journaling and outdoor activities, including swimming, photography and gardening. Marla’s previous articles were What Do You Want and Finally in Charge.

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