Appealing the Medicare Part B Premium Means Testing Decision

The Medicare Modernization Act of 2003 (MMA) is known for establishing Medicare Part D, a prescription drug benefit managed by private insurance and drug companies. However, the MMA also made far-reaching changes to other parts of Medicare that are not as well known or understood. These changes will have dramatic long-term impacts on how the program operates, and on its relationship to the millions of seniors who depend on the universal, affordable health insurance coverage Medicare provides. As one example, for the first time in the program's history, Medicare Part B premiums were subjected to means testing in 2007. Over time, linking premium levels to beneficiaries' incomes erodes the social insurance nature of the Medicare program, resulting in increased costs for all seniors.

In 2009, Medicare beneficiaries will face higher Part B premiums if they have an income of $85,000 for an individual or $170,000 for a couple. Beneficiaries receiving a letter from the Social Security Administration informing them that their Part B premiums will increase due to their income level should carefully examine their circumstances and tax-related documents, and verify the information that SSA is utilizing. According to the Center for Medicare Advocacy, there are a couple of methods for beneficiaries to challenge higher premiums.

1. 1. Request a New Initial Determination

If your income has gone down for any of a number of reasons since filing your last tax return and that reduction would affect the premium calculation, then you may ask SSA to recalculate your Premium

Five conditions when SSA may make a new determination without filing an appeal

Circumstance	Explanation	Action
Life Changing Event	Marriage, divorce or annulment, death of a spouse, work reduction, lost income from income-producing property due to disaster or an event beyond your control, or stoppage/ a reduction in your or your spouse's insured pension plan.	File a "Life-Changing Event Form" (Form SSA-44) available at www.ssa.gov/online/ssa-44.pdf , or can be requested at any Social Security Office. Evidence of the life-changing event must be attached to the form.
Amended Tax Return	At your request, SSA can use an amended tax return to determine your Modified Adjusted Gross Income (MAGI).	You must file a request within 3 calendar years following the close of the tax year for which the amended return was filed. Also, you must attach a receipt letter, a transcript from the IRS, or a copy of the amended return from the IRS to your request.
Correction of IRS Information	If inaccurate information was provided to SSA from the IRS, you may request a new initial determination.	Requests must be made within 60 days of your notice of premium adjustment by SSA and you must provide proof of the error. In order to provide proof, you should obtain, from the IRS, a letter documenting the erroneous information and the correction. If you claim that the tax-exempt interest income the IRS provided to SSA is incorrect, you need only submit a signed copy of the tax return as proof of the error.
More Recent Tax Return than Used by SSA	You may request a redetermination when two year old tax data is available, and SSA used three year old data provided by the IRS.	In support of your claim, SSA will accept a signed copy of your filed Federal income tax return for the tax year that is two years prior to the premium year in question.
Change in Living Arrangements	If you change from "Married, Filing Separately" to any IRS "Single" filing status at any point during the year you may request a new initial determination.	SSA will accept, under penalty of perjury, an attestation to the effect that your filing status changed during the year.



2. 2. Appealing an Increased Premium  

If you have not experienced any of the life-changing events listed above, but are still dissatisfied with your Initial Determination, you have the right to appeal your Medicare Part B premium amount. In order to do so you should submit, within 60 days of your SSA Initial Determination, a "Request for Reconsideration" (Form SSA-561-U2). The form is available online at www.ssa.gov/online/ssa-561.pdf , or it can be obtained at any Social Security Office. You may request a new Initial Determination if you want Social Security to use different information about your modified adjusted gross income.

Hearings before Administrative Law Judges

If you disagree with Social Security's Reconsideration decision you can request a hearing by a Medicare Administrative Law Judge (ALJ). In order to do so, you should make the request within 60 days of receiving your redetermination. A request can be made by completing a "Request for Hearing by Administrative Law Judge" form. The form can be found online at www.ssa.gov/online/ha-501.pdf , or you may request a form at any Social Security office.

In order to request a hearing, SSA will need to disclose your tax information to the ALJ for the hearing. For SSA to make this disclosure, you should complete the "Authorization for SSA to Disclose Tax Information for Your Appeal of Your Medicare Part B Income-related Monthly Adjustment Premium Amount" (Form SSA-54). Form SSA-54 is available online at www.ssa.gov/online/ssa-54.pdf , or can be requested at any Social Security office.

In addition to the resources above, the SSA Programs Operations Manual (POMS) also has detailed information including timeline for taking action, required information for submissions, and more. This information is available online at www.ssa.gov/apps10/poms.nsf/subchapterlist!openview&restricttocategory=06011 .

Government Relations and Policy, May 2009