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Part B IRMAA / Part D IRMAA

Part B IRMAA / Part D IRMAA

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Full Part B Coverage
Beneficiaries who file individual tax returns with modified adjusted gross income: Beneficiaries who file joint tax returns with modified adjusted gross income: Income-Related Monthly Adjustment Amount

Total Monthly

 Premium Amount

Less than or equal to $103,000 Less than or equal to $206,000 $0.00 $174.70
Greater than $103,000 and less than or equal to $129,000 Greater than $206,000 and less than or equal to $258,000 $69.90 $244.60
Greater than $129,000 and less than or equal to $161,000 Greater than $258,000 and less than or equal to $322,000 $174.70 $349.40
Greater than $161,000 and less than or equal to $193,000 Greater than $322,000 and less than or equal to $386,000 $279.50 $445.20
Greater than $193,000 and less than $500,000 Greater than $386,000 and less than $750,000 $384.30 $559.000
Greater than or equal to $500,000 Greater than or equal to $750,000 $419.30 $594.00

Premiums for high-income beneficiaries with full Part B coverage who are married and lived with their spouse at any time during the taxable year, but file a separate return, are as follows:

Full Part B Coverage
Beneficiaries who are married and lived with their spouses at any time during the year, but who file separate tax returns from their spouses, with modified adjusted gross income: Income-Related Monthly Adjustment Amount Total Monthly Premium Amount
Less than or equal to $103,000 $0.00 $174.70
Greater than $103,000 and less than $397,000 $384.30 $559.00
Greater than or equal to $397,000 $419.30 $594.00

 

Medicare Part D (Drugs) Income-Related Adjustment Amount (IRMAA)

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Beneficiaries who file individual tax returns with modified adjusted gross income: Beneficiaries who file joint tax returns with modified adjusted gross income: Income-related monthly adjustment amount
Less than or equal to $103,000 Less than or equal to $206,000 $0.00
Greater than $103,000 and less than or equal to $129,000 Greater than $206000 and less than or equal to $258,000 $12.90
Greater than $129,000 and less than or equal to $161,000 Greater than $258,000 and less than or equal to $322,000 $33.30
Greater than $161,000 and less than or equal to $193,000 Greater than $322,000 and less than or equal to $386,000 $53.80
Greater than $193,000 and less than $500,000 Greater than $386,000 and less than $750,000 $74.20
Greater than or equal to $500,000 Greater than or equal to $750,000 $81.00

Premiums for high-income beneficiaries who are married and lived with their spouse at any time during the taxable year, but file a separate return, are as follows:

Beneficiaries who are married and lived with their spouses at any time during the year, but file separate tax returns from their spouses, with modified adjusted gross income: Income-related monthly adjustment amount
Less than or equal to $103,000 $0.00
Greater than $103,000 and less than $397,000 $74.20
Greater than or equal to $397,000 $81.00

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Special Events (Loss of Employer Coverage)

  • You will need these two forms to be filled out if you already have Part A.
  • Click the links below and download the forms.

 

CMS 40B

Form #
CMS 40B
Form Title
Application for Enrollment in Medicare – Part B (Medical Insurance)
40b

CMS L564

Form #
CMS L564
Form Title
REQUEST FOR EMPLOYMENT INFORMATION
l546

SSA – 44

Form #
SSSA-44
Form Title
Medicare Income-Related Monthly Adjustment Amount-Life-Changing Event
40b

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