TN 3 (11-10)

HI 01101.020 IRMAA Sliding Scale Tables

Citations:

Sections 1839(i) and 1860D-13(i) of the Social Security Act

20 CFR 418.1115 and 418.2115

A. Policy for IRMAA Medicare Part B and prescription drug coverage premiums sliding scale tables

The income-related monthly adjustment amount (IRMAA) sliding scale is a set of statutory percentage-based tables to adjust Medicare Part B and prescription drug coverage premiums. The higher the beneficiary’s range of modified adjusted gross income (MAGI), the higher the IRMAA will be. There are three sets of tables. Each table is based on the beneficiary’s tax filing status.

NOTE: The IRMAA screens contain a calculator which takes all the factors, such as filing status, sliding scale, and premium year into account so that an estimate can be provided to the beneficiary upon request. (See MSOM T2PE 008.013, Income Related Monthly Adjustment Amount Calculator (IRCA)).

B. IRMAA tables, Medicare Part B premium year 2017

1. Tax filing status: single, head–of–household or qualifying widow(er) with dependent child

If MAGI in 2015 (or 2014 if 2015 is not available) was:

Then the Part B Premium* is:

Prescription Drug

Coverage Premium** is:

More than $85,000 but less than or equal to $107,000

$187.50

$13.30

+ Plan premium

More than $107,000 but less than or equal to $160,000

$267.90

$34.20

+ Plan premium

More than $160,000 but less than or equal to $214,000

$348.30

$55.20

+ Plan premium

More than $214,000

$428.60

$76.20

+ Plan premium

* Plus any applicable surcharges, minus any Medicare Advantage Reduction. (See SM 03040.335 for Medicare Advantage Reduction)

2. Tax filing status: married, filing jointly

If MAGI in 2015 (or 2014 if 2015 is not available) was:

Then the Part B Premium* is:

Prescription Drug

Coverage Premium** is:

More than $170,000 but less than or equal to $214,000

$187.50

$13.30

+ Plan premium

More than $214,000 but less than or equal to $320,000

$267.90

$34.20

+ Plan premium

More than $320,000 but less than or equal to $428,000

$348.30

$55.20

+ Plan premium

More than $428,000

$428.60

$76.20

+ Plan premium

* Plus any applicable surcharges, minus any Medicare Advantage Reduction. (See SM 03040.335 for Medicare Advantage Reduction)

**Plus any late enrollment or reenrollment fees for prescription drug coverage

3. Tax filing status: married, filing separately

If MAGI in 2015 (or 2014 if 2015 is not available) was:

Then the Part B Premium* is:

Prescription Drug

Coverage Premium** is:

More than $85,000 but less than or equal to $129,000

$348.30

$55.20

+ Plan premium

More than $129,000

$428.60

$76.20

+ Plan premium

C. IRMAA tables, Medicare Part B premium year 2016

1. Tax filing status: single, head–of–household or qualifying widow(er) with dependent child

If MAGI in 2014 (or 2013 if 2014 is not available) was:

Then the Part B Premium* is:

Prescription Drug

Coverage Premium** is:

More than $85,000 but less than or equal to $107,000

$170.50

$12.70

+ Plan premium

More than $107,000 but less than or equal to $160,000

$243.60

$32.80

+ Plan premium

More than $160,000 but less than or equal to $214,000

$316.70

$52.80

+ Plan premium

More than $214,000

$389.80

$72.90

+ Plan premium

* Plus any applicable surcharges, minus any Medicare Advantage Reduction. (See SM 03040.335 for Medicare Advantage Reduction)

2. Tax filing status: married, filing jointly

If MAGI in 2014 (or 2013 if 2014 is not available) was:

Then the Part B Premium* is:

Prescription Drug

Coverage Premium** is:

More than $170,000 but less than or equal to $214,000

$170.50

$12.70

+ Plan premium

More than $214,000 but less than or equal to $320,000

$243.60

$32.80

+ Plan premium

More than $320,000 but less than or equal to $428,000

$316.70

$52.80

+ Plan premium

More than $428,000

$389.80

$72.90

+ Plan premium

* Plus any applicable surcharges, minus any Medicare Advantage Reduction. (See SM 03040.335 for Medicare Advantage Reduction)

**Plus any late enrollment or reenrollment fees for prescription drug coverage

3. Tax filing status: married, filing separately

If MAGI in 2014 (or 2013 if 2014 is not available) was:

Then the Part B Premium* is:

Prescription Drug

Coverage Premium** is:

More than $85,000 but less than or equal to $129,000

$316.70

$52.80

+ Plan premium

More than $129,000

$389.80

$72.90

+ Plan premium

* Plus any applicable surcharges, minus any Medicare Advantage Reduction. (See SM 03040.335 for Medicare Advantage Reduction)

**Plus any late enrollment or reenrollment fees for prescription drug coverage.

NOTE: When the Internal Revenue Service (IRS) provides the Social Security Administration (SSA) with the tax filing status of Married Filing Separately, SSA assumes the couple lived together at some point in the tax year. The law provides that beneficiaries in this situation are subject to higher IRMAA levels. If one or both of the members allege they lived apart throughout the entire tax year, see HI 01120.060.

D. IRMAA tables, Medicare Part B premium year 2015

1. Tax filing status: single, head–of–household or qualifying widow(er) with dependent child

If MAGI in 2013 (or 2012 if 2013 is not available) was:

Then the Part B Premium* is:

Prescription Drug

Coverage Premium** is:

More than $85,000 but less than or equal to $107,000

$146.90

$12.10

+ Plan premium

More than $107,000 but less than or equal to $160,000

$209.80

$31.80

+ Plan premium

More than $160,000 but less than or equal to $214,000

$272.70

$51.30

+ Plan premium

More than $214,000

$335.70

$70.80

+ Plan premium

* Plus any applicable surcharges, minus any Medicare Advantage Reduction. (See SM 03040.335 for Medicare Advantage Reduction)

2. Tax filing status: married, filing jointly

If MAGI in 2012 (or 2011 if 2012 is not available) was:

Then the Part B Premium* is:

Prescription Drug

Coverage Premium** is:

More than $170,000 but less than or equal to $214,000

$146.90

$12.30

+ Plan premium

More than $214,000 but less than or equal to $320,000

$209.80

$31.10

+ Plan premium

More than $320,000 but less than or equal to $428,000

$272.70

$51.30

+ Plan premium

More than $428,000

$335.70

$70.80

+ Plan premium

* Plus any applicable surcharges, minus any Medicare Advantage Reduction. (See SM 03040.335 for Medicare Advantage Reduction)

**Plus any late enrollment or reenrollment fees for prescription drug coverage

3. Tax filing status: married, filing separately

If MAGI in 2011 (or 2010 if 2011 is not available) was:

Then the Part B Premium* is:

Prescription Drug

Coverage Premium** is:

More than $85,000 but less than or equal to $129,000

$272.70

$51.30

+ Plan premium

More than $129,000

$335.70

$70.80

+ Plan premium

* Plus any applicable surcharges, minus any Medicare Advantage Reduction. (See SM 03040.335 for Medicare Advantage Reduction)

**Plus any late enrollment or reenrollment fees for prescription drug coverage.

NOTE: When the Internal Revenue Service (IRS) provides the Social Security Administration (SSA) with the tax filing status of Married Filing Separately, SSA assumes the couple lived together at some point in the tax year. The law provides that beneficiaries in this situation are subject to higher IRMAA levels. If one or both of the members allege they lived apart throughout the entire tax year, see HI 01120.060.

E. IRMAA tables, Medicare Part B premium year 2014

1. Tax filing status: single, head–of–household or qualifying widow(er) with dependent child

If MAGI in 2012 (or 2011 if 2012 is not available) was:

Then the Part B Premium* is:

Prescription Drug

Coverage Premium** is:

More than $85,000 but less than or equal to $107,000

$146.90

$12.10

+ Plan premium

More than $107,000 but less than or equal to $160,000

$209.80

$31.10

+ Plan premium

More than $160,000 but less than or equal to $214,000

$272.70

$50.20

+ Plan premium

More than $214,000

$335.70

$69.30

+ Plan premium

* Plus any applicable surcharges, minus any Medicare Advantage Reduction. (See SM 03040.335 for Medicare Advantage Reduction)

2. Tax filing status: married, filing jointly

If MAGI in 2012 (or 2011 if 2012 is not available) was:

Then the Part B Premium* is:

Prescription Drug

Coverage Premium** is:

More than $170,000 but less than or equal to $214,000

$146.90

$12.10

+ Plan premium

More than $214,000 but less than or equal to $320,000

$209.80

$29.90

+ Plan premium

More than $320,000 but less than or equal to $428,000

$272.70

$50.20

+ Plan premium

More than $428,000

$335.70

$69.30

+ Plan premium

* Plus any applicable surcharges, minus any Medicare Advantage Reduction. (See SM 03040.335 for Medicare Advantage Reduction)

**Plus any late enrollment or reenrollment fees for prescription drug coverage

3. Tax filing status: married, filing separately

If MAGI in 2012 (or 2011 if 2012 is not available) was:

Then the Part B Premium* is:

Prescription Drug

Coverage Premium** is:

More than $85,000 but less than or equal to $129,000

$272.70

$50.20

+ Plan premium

More than $129,000

$335.70

$69.30

+ Plan premium

* Plus any applicable surcharges, minus any Medicare Advantage Reduction. (See SM 03040.335 for Medicare Advantage Reduction)

**Plus any late enrollment or reenrollment fees for prescription drug coverage.

NOTE: When the Internal Revenue Service (IRS) provides the Social Security Administration (SSA) with the tax filing status of Married Filing Separately, SSA assumes the couple lived together at some point in the tax year. The law provides that beneficiaries in this situation are subject to higher IRMAA levels. If one or both of the members allege they lived apart throughout the entire tax year, see HI 01120.060.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0601101020
HI 01101.020 - IRMAA Sliding Scale Tables - 11/23/2016
Batch run: 11/23/2016
Rev:11/23/2016