Changes in the law affect how we calculate monthly Medicare Part B (medical insurance) and Medicare prescription drug premiums if you have a higher income.
- Medicare Part B provides coverage for physician services, outpatient hospital services, certain home health services, durable medical equipment, and other items. Most beneficiaries will pay a standard premium for Part B coverage. Some beneficiaries also will pay a late enrollment surcharge. A small number of beneficiaries with higher incomes will pay a higher Part B premium based on their income.
- Medicare prescription drug coverage helps pay for prescription drugs. Plan costs vary depending on the plan, and whether you get Extra Help with your portion of the Medicare prescription drug costs. A small number of beneficiaries with higher incomes will pay a higher prescription drug premium based on their income.
What if I disagree with the decision about an income-related premium amount?
If you are a Medicare beneficiary who must pay more for your Medicare Part B or Medicare prescription drug coverage premium because of your income and you disagree with the decision that you need to pay a higher premium amount, you have the right to request an appeal (also known as a reconsideration). You may request an appeal in writing by completing a Request for Reconsideration (Form SSA-561-U2). If you do not have access to the Internet, you can request a copy of the form by calling us at 1-800-772-1213 (TTY 1-800-325-0778).
However, if your income has gone down due to certain specific circumstances or you filed an amended tax return, you can ask for a new decision without having to file an appeal. See our fact sheet, Medicare Premiums: Rules for Higher Income Beneficiaries (SSA Publication No. 05-10536) for more details. You do not have to file an appeal to get a new initial decision.
What if I disagree with the decision on my reconsideration?
If you disagree with the reconsideration decision, you can ask for a hearing before an Administrative Law Judge (ALJ) in the Department of Health and Human Services’ Office of Medicare Hearings and Appeals. You can request a hearing by completing a Request for Hearing by Administrative Law Judge (Form HA-501-U5).
If you do not have access to the Internet, you can request copy of Form HA-501-U5 by calling Social Security at 1-800-772-1213 (TTY 1-800-325-0778) or visiting your local Social Security office.
If you disagree with the hearing decision, you can request a review by the Department of Health and Human Services’ Medicare Appeals Council. Further appeals would require a Federal court action.
Our website is a valuable resource for information about all of Social Security’s programs. There are a number of things you can do online.
In addition to using our website, you can call us toll-free at 1-800-772-1213. We treat all calls confidentially. We can answer specific questions from 7 a.m. to 7 p.m., Monday through Friday. Generally, you’ll have a shorter wait time if you call during the week after Tuesday. We can provide information by automated phone service 24 hours a day. (You can use our automated response system to tell us a new address or request a replacement Medicare card.) If you are deaf or hard of hearing, you may call our TTY number, 1-800-325-0778.
We also want to make sure you receive accurate and courteous service. That is why we have a second Social Security representative monitor some telephone calls.
