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October 06, 2021 at 04:06 PM
What You Need to Know
- The project could affect Medicare beneficiaries who get income-linked benefits and are victims of fraud.
- Some high-income fraud victims can already cite the impact of the fraud when asking regulators to cut their Medicare Part B bills.
- Regulators could make victims of more types of fraud eligible for Medicare Part B cost cuts.
The Social Security Administration could change the way it handles the effects of fraud and theft on people who are using income-linked Medicare features.
The agency already considers certain types of fraud when calculating the “income-related monthly adjustment amount,” or IRMAA, for a Medicare beneficiary.
The agency is now thinking about building new types of fraud into IRMAA calculations.
The federal Office of Management and Budget has given the public a glimpse of the IRMAA fraud definition project in a project review item published on a government regulation tracking website.
Medicare and IRMAA
Most Medicare enrollees have paid their Medicare Part A hospitalization benefits premiums by paying payroll taxes in their working years, or they are getting Medicare Part A coverage at no charge because of the payroll taxes their spouses or former spouses have paid.
Some relatively high-income enrollees do have to pay income-adjusted amounts for Medicare Part B hospitalization and physician services coverage, and for Medicare Part D prescription drug coverage.
This year, for example, a single client with modified adjusted gross income of $88,000.01 to $111,000 would face a $59.40 Medicare Part B monthly premium adjustment, according to a Social Security Administration form that explains how to address “life-changing events” when calculating an IRMAA.
A married client who files separately, lives with a spouse during part of the tax year, and has modified adjusted gross income over $411,999.99 could face a monthly adjustment of $356.40.
Monthly income-related adjustments for Medicare Part D prescription drug premiums could range from $12.30 to $77.10.
Life-Changing Events
The Social Security Administration handles Medicare eligibility determinations.
Medicare beneficiaries can ask the agency to change the monthly premium adjustments to reflect the impact of “life-changing events.”
The list of life-changing events now includes marriage; divorce or annulment; the death of a spouse; work stoppage; work reduction; loss of pension income; an employer settlement payment; or loss of income-producing property.
