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Your Medicare surcharge letter, explained
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WHAT THE LETTER SAYS
The letter tells you that you will pay more than the standard amount for Medicare Part B, and often Part D.
That extra amount is the income-related monthly adjustment amount, or IRMAA. Social Security calls this letter an initial determination.
It is not a bill from a hospital and it is not a mistake. It is a decision based on your income.
WHY THE FIGURE IS TWO YEARS OLD
Social Security sets the surcharge from your tax return two years back. Your 2026 premium uses your 2024 return.
They use the modified adjusted gross income on that return. For most people that is close to their total income.
The two-year gap is the point that trips people up. Your income today can be far lower than the figure the letter used.
IF YOUR INCOME HAS SINCE CHANGED
There are two different routes, for two different situations. Do not mix them up.
A life-changing event. If your income fell because of one of eight events Social Security recognizes, such as retirement, use Form SSA-44. It asks them to use your real, lower income. It is a new initial determination, not an appeal, and it is free to file.(/free/irmaa-start-to-finish).
You think the figures are wrong. If instead you disagree with the decision itself, that is a reconsideration, on Form SSA-561-U2, a separate form. You have 60 days from receiving the notice. If that window has passed, Social Security may still consider a late request when you show good cause, such as a serious illness, a family emergency, or records lost.
Whichever fits, the evidence is the part people get wrong. Gather your proof before you file.
PatientStand prepares documents and explains the process. We do not give legal, financial, medical or tax advice, we do not act on your behalf, and we cannot promise any outcome. We are not a law firm, a debt adjuster, or a credit repair organization. We are not affiliated with Medicare, any government program, any hospital, any insurer, or any collection agency. Deadlines are set by Medicare, your provider or the collector and never by us.
Nothing here is advice about your situation. It is general information, and it carries no guarantee or assurance of any outcome. Your circumstances may differ from the examples given. Where your situation calls for advice, speak to a qualified professional. Our full terms are at patientstand.com/terms.
Medicare's own information is at medicare.gov.
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