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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 $97,000 Less than or equal to $194,000 $0.00 $164.90
Greater than $97,000 and less than or equal to $123,000 Greater than $194,000 and less than or equal to $246,000 $65.90 $230.80
Greater than $123,000 and less than or equal to $153,000 Greater than $246,000 and less than or equal to $306,000 $164.80 $329.70
Greater than $153,000 and less than or equal to $183,000 Greater than $306,000 and less than or equal to $366,000 $263.70 $428.60
Greater than $183,000 and less than $500,000 Greater than $366,000 and less than $750,000 $362.60 $527.50
Greater than or equal to $500,000 Greater than or equal to $750,000 $395.60 $560.50

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 $97,000 $0.00 $164.90
Greater than $97,000 and less than $403,000 $362.60 $527.50
Greater than or equal to $403,000 $395.60 $560.50

 

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 $97,000

Less than or equal to $194,000

$0.00

Greater than $97,000 and less than or equal to $123,000

Greater than $194,000 and less than or equal to $246,000

12.20

Greater than $123,000 and less than or equal to $153,000

Greater than $246,000 and less than or equal to $306,000

31.50

Greater than $153,000 and less than or equal to $183,000

Greater than $306,000 and less than or equal to $366,000

50.70

Greater than $183,000 and less than $500,000

Greater than $366,000 and less than $750,000

70.00

Greater than or equal to $500,000

Greater than or equal to $750,000

76.40

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 $97,000

$0.00

Greater than $97,000 and less than $403,000

70.00

Greater than or equal to $403,000

76.40

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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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