--- kind: "range" citation: "20 C.F.R. §§ 418.1101–418.1150" title: "20" from: "418.1101" to: "418.1150" count: 11 url: "https://uscodex.org/cfr/20/418.1101..418.1150" --- # §418.1101. What is the income-related monthly adjustment amount? - (a) The income-related monthly adjustment amount is an amount that you will pay in addition to the Medicare Part B standard monthly premium plus any applicable increase in that premium as described in [42 CFR 408.22](/cfr/42/408.22.md) for your Medicare Part B coverage when your modified adjusted gross income is above the threshold described in [§ 418.1105](/cfr/20/418.1105.md). - (b) Your income-related monthly adjustment amount is based on your applicable modified adjusted gross income as described in [§ 418.1115](/cfr/20/418.1115.md) and your tax filing status. - (c) We will determine your income-related monthly adjustment amount using the method described in [§ 418.1120](/cfr/20/418.1120.md). # §418.1105. What is the threshold? - (a) The threshold is a level of modified adjusted gross income above which the beneficiary will have to pay the income-related monthly adjustment amount. - (b) From January 1, 2011 through December 31, 2019, the modified adjusted gross income threshold is $170,000 for individuals with a Federal income tax filing status of married filing jointly. The threshold is $85,000 for individuals with any other filing status. - (c) Starting on January 1, 2020, the threshold amounts will resume adjustment for inflation as required by [section 1839(i)(5)](/cfr/20/1839.md?p=i-5) of the Act. In each year thereafter, CMS will set all modified adjusted gross income threshold amounts for the following year by increasing the preceding year's threshold amounts by any percentage increase in the Consumer Price Index rounded to the nearest $1,000. CMS will publish the amounts in the Federal Register in September of each year. Published threshold amounts will be effective January 1 of the next calendar year, for the full calendar year. # §418.1110. What is the effective date of our initial determination about your income-related monthly adjustment amount? - (a) Generally, an income-related monthly adjustment amount will be effective for all months that you are enrolled in Medicare Part B during the year for which we determine you must pay an income-related monthly adjustment amount. We will follow the rules in [42 CFR part 408](/cfr/42/part408.md), [subpart C](/cfr/20/subpartC.md), regarding premium collections to withhold your income-related monthly adjustment amount from a benefit payment or to determine if you will be billed directly. - (b) When we have used modified adjusted gross income information from IRS for the tax year 3 years prior to the effective year to determine your income-related monthly adjustment amount and modified adjusted gross income information for the tax year 2 years prior later becomes available from IRS, we will review the new information to determine if we should revise our initial determination. If we revise our initial determination, the effective date of the new initial determination will be January 1 of the effective year, or the first month you were enrolled or re-enrolled in Medicare Part B if later than January. - (c) When we use your amended tax return, as described in [§ 418.1150](/cfr/20/418.1150.md), the effective date will be January 1 of the year(s) that is affected, or the first month in that year that you were enrolled or reenrolled in Medicare Part B if later than January. - (d) When we use evidence that you provide which proves that the IRS modified adjusted gross income information we used is incorrect, as described in [§ 418.1335](/cfr/20/418.1335.md), the effective date will be January of the year(s) that is affected or the first month in that year that you were enrolled or reenrolled in Medicare Part B if later than January. - (e) When we use information from a more recent tax year that you provide due to a major life-changing event, as described in [§ 418.1201](/cfr/20/418.1201.md), the effective date is described in [§ 418.1230](/cfr/20/418.1230.md). # §418.1115. What are the modified adjusted gross income ranges? - (a) We list the modified adjusted gross income ranges for the calendar years 2011 through and including 2017, 2018, and for years beginning in 2019 for each Federal tax filing category in paragraphs [(b)](#b), [(c)](#c) and [(d)](#d) of this section. We will use your modified adjusted gross income amount together with your tax filing status to determine the amount of your income-related monthly adjustment for these calendar years. - (b) The modified adjusted gross income ranges for individuals with a Federal tax filing status of single, head of household, qualifying widow(er) with dependent child, and married filing separately when the individual has lived apart from his/her spouse for the entire tax year for the year we use to make our income-related monthly adjustment amount determination are as follows. - (1) **For calendar years 2011 through and including 2017—** - (i) Greater than $85,000 but less than or equal to $107,000; - (ii) Greater than $107,000 but less than or equal to $160,000; - (iii) Greater than $160,000 but less than or equal to $214,000; and - (iv) **Greater than $214,000.** - (2) **For calendar year 2018—** - (i) Greater than $85,000 but less than or equal to $107,000; - (ii) Greater than $107,000 but less than or equal to $133,500; - (iii) Greater than $133,500 but less than or equal to $160,000; and - (iv) Greater than $160,000 - (3) **For calendar years beginning with 2019—** - (i) Greater than $85,000 but less than or equal to $107,000; - (ii) Greater than $107,000 but less than or equal to $133,500; - (iii) Greater than $133,500 but less than or equal to $160,000; - (iv) Greater than $160,000 but less than $500,000; and - (v) **Greater than or equal to $500,000.** - (c) The modified adjusted gross income ranges for individuals who are married and filed a joint tax return for the tax year we use to make the income-related monthly adjustment amount determination are as follows. - (1) **For calendar years 2011 through and including 2017—** - (i) Greater than $170,000 but less than or equal to $214,000; - (ii) Greater than $214,000 but less than or equal to $320,000; - (iii) Greater than $320,000 but less than or equal to $428,000; and - (iv) **Greater than $428,000.** - (2) **For calendar year 2018—** - (i) Greater than $170,000 but less than or equal to $214,000; - (ii) Greater than $214,000 but less than or equal to $267,000; - (iii) Greater than $267,000 but less than or equal to $320,000; and - (iv) **Greater than $320,000.** - (3) **For calendar years beginning in 2019—** - (i) Greater than $170,000 but less than or equal to $214,000; - (ii) Greater than $214,000 but less than or equal to $267,000; - (iii) Greater than $267,000 but less than or equal to $320,000; - (iv) Greater than $320,000 but less than $750,000; and - (v) **Greater than or equal to $750,000.** - (d) The modified adjusted gross income ranges for married individuals who file a separate return and have lived with their spouse at any time during the tax year we use to make the income-related monthly adjustment amount determination are as follows. - (1) **For calendar years 2011 through and including 2017—** - (i) Greater than $85,000 but less than or equal to $129,000; and - (ii) **Greater than $129,000.** - (2) **For calendar year 2018—** Greater than $85,000. - (3) **For calendar years beginning in 2019—** - (i) Greater than $85,000 but less than $415,000; and - (ii) **Greater than or equal to $415,000.** - (e) - (1) Subject to [paragraph (e)(2)](#e-2) of this section, in 2019, CMS will set the modified adjusted gross income ranges for 2020 and publish them in the Federal Register. In each year thereafter, CMS will set the modified adjusted gross income ranges by increasing the preceding year's ranges by any percentage increase in the Consumer Price Index rounded to the nearest $1,000 and will publish the amounts for the following year in September of each year. - (2) The amounts listed in paragraphs [(b)](#b), [(c)](#c), and [(d)](#d) of $415,000, $500,000, and $750,000 will not be adjusted under [paragraph (e)(1)](#e-1) of this section until 2028. Beginning in 2027, and in each year thereafter, CMS will adjust these range amounts for the following year under [paragraph (e)(1)](#e-1) of this section and publish the updated ranges in the Federal Register. # §418.1120. How do we determine your income-related monthly adjustment amount? - (a) We will determine your income-related monthly adjustment amount by using your tax filing status and modified adjusted gross income. - (b) **Tables of applicable percentage.** The tables in [paragraphs (b)(1) through (b)(3)](#b-1..b-3) of this section contain the modified adjusted gross income ranges for calendar years 2011 through and including 2017, 2018, and beginning in 2019 in the column on the left in each table. The middle column in each table shows the percentage of the unsubsidized Medicare Part B premium that will be paid by individuals with modified adjusted gross income that falls within each of the ranges. The column on the right in each table shows the percentage of the Medicare Part B premium that will be subsidized by contributions from the Federal Government. We use your tax filing status and your modified adjusted gross income for the tax year to determine which income-related monthly adjustment amount to apply to you. The dollar amount of income-related monthly adjustment for each range will be set annually for each year after 2019 as described in [paragraph (c)](#c) of this section. The modified adjusted gross income ranges will be adjusted annually after 2019 as described in [§ 418.1115(e)](/cfr/20/418.1115.md?p=e). - (1) **General tables of applicable percentages.** If, for the tax year, we use your filing status for your Federal income taxes for the tax year is single; head of household; qualifying widow(er) with dependent child; or married filing separately and you lived apart from your spouse for the entire tax year, we will use the general tables of applicable percentages. When your modified adjusted gross income for the year we use is in the range listed in the left column in the following tables, then the Federal Government's Part B premium subsidy of 75 percent is reduced to the percentage listed in the right column. You will pay an amount based on the percentage listed in the center column. - (2) **Tables of applicable percentages for joint returns.** If, for the tax year, we use your Federal tax filing status is married filing jointly for the tax year and your modified adjusted gross income for that tax year is in the range listed in the left column in the following tables, then the Federal Government's Part B premium subsidy of 75 percent is reduced to the percentage listed in the right column. You will pay an amount based on the percentage listed in the center column. - (3) **Tables of applicable percentages for married individuals filing separate returns.** If, for the tax year, we use your Federal tax filing status is married filing separately, you lived with your spouse at some time during that tax year, and your modified adjusted gross income is in the range listed in the left column in the following tables, then the Federal Government's Part B premium subsidy of 75 percent is reduced to the percentage listed in the right column. You will pay an amount based on the percentage listed in the center column. - (c) For each year after 2019, CMS will annually publish in the Federal Register the dollar amounts for the income-related monthly adjustment amount described in [paragraph (b)](#b) of this section. # §418.1125. How will the income-related monthly adjustment amount affect your total Medicare Part B premium? - (a) If you must pay an income-related monthly adjustment amount, your total Medicare Part B premium will be the sum of: - (1) The Medicare Part B standard monthly premium, determined using the rules in [42 CFR 408.20](/cfr/42/408.20.md); plus - (2) Any applicable increase in the Medicare Part B standard monthly premium as described in [42 CFR 408.22](/cfr/42/408.22.md); plus - (3) **Your income-related monthly adjustment amount.** - (b) The nonstandard Medicare Part B premium amount described in [42 CFR 408.20](/cfr/42/408.20.md) does not apply to individuals who must pay an income-related monthly adjustment amount. Such individuals must pay the full Medicare Part B standard monthly premium plus any applicable penalties for late enrollment or reenrollment plus the income-related adjustment. # §418.1130. Reserved # §418.1135. What modified adjusted gross income information will we use to determine your income-related monthly adjustment amount? - (a) In general, we will use your modified adjusted gross income provided by IRS for the tax year 2 years prior to the effective year of the income-related monthly adjustment amount determination. Modified adjusted gross income is based on information you provide to IRS when you file your Federal income tax return. - (b) We will use your modified adjusted gross income for the tax year 3 years prior to the effective year of the income-related monthly adjustment amount determination when IRS does not provide the information specified in [paragraph (a)](#a) of this section. If IRS can provide modified adjusted gross income for the tax year 3 years prior to the income-related monthly adjustment amount effective year, we will temporarily use that information to determine your income-related monthly adjustment amount and make adjustments as described in [§ 418.1110(b)](/cfr/20/418.1110.md?p=b) to all affected income-related monthly adjustment amounts when information for the year specified in [paragraph (a)](#a) of this section is provided by IRS. - (c) When we have used the information in [paragraph (b)](#b) of this section, you may provide us with evidence of your modified adjusted gross income for the year in [paragraph (a)](#a) of this section. You must provide a retained copy of your signed Federal income tax return for that year, if available. If you filed a return for that year, but did not retain a copy, you must request a transcript or a copy of your return from IRS and provide it to us. When we use this evidence, we will later confirm this information with IRS records. - (d) When you meet the conditions specified in [§ 418.1150](/cfr/20/418.1150.md) because you have amended your Federal income tax return, or when you believe we have used information provided by IRS which is incorrect, as described in [§ 418.1335](/cfr/20/418.1335.md), we will use information that you provide directly to us regarding your modified adjusted gross income. - (e) We may use information that you give us about your modified adjusted gross income for a more recent tax year than those discussed in paragraphs [(a)](#a) or [(b)](#b) of this section as described in [§§ 418.1201 through 418.1270](/cfr/20/418.1201..418.1270.md). - (f) If you fail to file an income tax return for any year after 2004 and IRS informs us that you had modified adjusted gross income above the threshold applicable 2 years after the tax year when you failed to file an income tax return, we will impose the highest income-related adjustment percentage applicable to your income filing status for the effective year. If we later determine that the amount of the income-related monthly adjustment amount imposed was inconsistent with your modified adjusted gross income, we will correct it. The rules in [42 CFR 408.40 through 408.92](/cfr/42/408.40..408.92.md) will apply to the collection of any retroactive premiums due. # §418.1140. What will happen if the modified adjusted gross income information from IRS is different from the modified adjusted gross income information we used to determine your income-related monthly adjustment amount? In general, we will use modified adjusted gross income information from IRS to determine your income-related monthly adjustment. We will make retroactive adjustments to your income-related monthly adjustment amount as described in paragraphs [(a)](#a), [(b)](#b), and [(d)](#d) of this section. - (a) When we have used modified adjusted gross income from the tax year 3 years prior to the effective year as described in [§ 418.1135(b)](/cfr/20/418.1135.md?p=b), and IRS provides modified adjusted gross income information from the tax year 2 years prior to the effective year, we will use the new information to make an initial determination for the effective year. We will make retroactive adjustments back to January 1 of the effective year, or the first month you were enrolled or reenrolled in Medicare Part B if later than January. - (b) When we have used the modified adjusted gross income information that you provided for the tax year 2 years prior to the effective year and the modified adjusted gross income information we receive from IRS for that same year is different from the information you provided, we will use the modified adjusted gross income information provided to us by IRS to make a new initial determination. We will make retroactive adjustments back to January 1 of the effective year, or the first month you were enrolled or reenrolled in Medicare Part B if later than January. - (c) When we have used information from your amended Federal tax return that you provide, as explained in [§ 418.1150](/cfr/20/418.1150.md), or you provide proof that the information IRS provided to us is incorrect as described in [§ 418.1335](/cfr/20/418.1335.md), we will not make any adjustments to your income-related monthly adjustment amount for the effective year or years based on IRS information we receive later from IRS. - (d) When we use modified adjusted gross income information that you provided due to a qualifying life-changing event and we receive different information from IRS, we will use the IRS information to make retroactive corrections to all months in the effective year(s) during which you were enrolled in Medicare Part B, except when [paragraph (c)](#c) of this section applies. - (e) When we used the table in [§ 418.1120(b)(3)](/cfr/20/418.1120.md?p=b-3) to determine your income-related monthly adjustment amount, and you lived apart from your spouse throughout that year, we will ask you for a signed statement or attestation that you lived apart from your spouse throughout that year. We will also ask you to provide information about the addresses of you and your spouse during that year. If you provide a signed statement or attestation that you lived apart from your spouse throughout that year, and information about your respective addresses that year, we will use the table in [§ 418.1120(b)(1)](/cfr/20/418.1120.md?p=b-1) to determine your income-related monthly adjustment amount. # §418.1145. How do we determine your income-related monthly adjustment amount if IRS does not provide information about your modified adjusted gross income? In general, if we do not receive any information for you from IRS showing that you had modified adjusted gross income above the threshold in the tax year we request, we will not make an income-related monthly adjustment amount determination. # §418.1150. When will we use your amended tax return filed with IRS? You may provide your amended tax return for a tax year we used within 3 calendar years following the close of the tax year for which you filed the amended tax return. You must provide us with your retained copy of your amended U.S. Individual Income Tax Return on the required IRS form and a copy of the IRS letter confirming the amended tax return was filed or a transcript from IRS if they did not send a letter. If you cannot provide your retained copy of the amended tax return, you must obtain a copy of the return from IRS. We will then make any necessary retroactive corrections as defined in [§ 418.1110(c)](/cfr/20/418.1110.md?p=c) to your income-related monthly adjustment amount.