20 C.F.R. §§ 418.2101–418.2150

§418.2101. What is the income-related monthly adjustment amount?

20 C.F.R. § 418.2101

(a)

The income-related monthly adjustment amount is an amount that you will pay in addition to the Medicare prescription drug coverage plan monthly premium, plus any applicable increase in that premium as described in 42 CFR 423.286, for your Medicare prescription drug coverage plan when your modified adjusted gross income is above the threshold described in § 418.2105.

(b)

Your income-related monthly adjustment amount is based on your applicable modified adjusted gross income as described in § 418.2115 and your tax filing status.

(c)

We will determine your income-related monthly adjustment amount using the method described in § 418.2120.

Notes, amendments, and revision history

Authority

Authority: Secs. 702(a)(5), 1860D-13(a) and (c) of the Social Security Act (42 U.S.C. 902(a)(5), 1395w-113(a) and (c)).

Source

Source: 75 FR 75891, Dec. 7, 2010, unless otherwise noted.

Source

Source: 70 FR 77675, Dec. 30, 2005, unless otherwise noted.

§418.2105. What is the threshold?

20 C.F.R. § 418.2105

(a)

The threshold is a level of modified adjusted gross income above which you will have to pay the income-related monthly adjustment amount.

(b)

For calendar years 2011 through and including 2019, the modified adjusted gross income threshold is $85,000 for individuals with a Federal income tax filing status of single, married filing separately, head of household, and qualifying widow(er) with dependent child. The threshold is $170,000 for individuals with a Federal income tax filing status of married filing jointly.

(c)

Starting at the end of calendar year 2019 and for each calendar year thereafter, CMS will set the threshold amounts for the following year. CMS will publish the threshold amounts annually in the Federal Register. Published threshold amounts will be effective January 1 of the next calendar year, and remain unchanged for the full calendar year.

Notes, amendments, and revision history

Authority

Authority: Secs. 702(a)(5), 1860D-13(a) and (c) of the Social Security Act (42 U.S.C. 902(a)(5), 1395w-113(a) and (c)).

Source

Source: 75 FR 75891, Dec. 7, 2010, unless otherwise noted.

Source

Source: 70 FR 77675, Dec. 30, 2005, unless otherwise noted.

§418.2110. What is the effective date of our initial determination about your income-related monthly adjustment amount?

20 C.F.R. § 418.2110

(a)

Generally, an income-related monthly adjustment amount determination will be effective for all months that you are enrolled in a prescription drug coverage plan during the year for which we determine you must pay an income-related monthly adjustment amount.

(b)

When we have used modified adjusted gross income information from the 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 the IRS, we will review the new information to determine if we should revise our initial determination concerning the income-related monthly adjustment amount. 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 your enrollment or re-enrollment in a Medicare prescription drug coverage plan became effective if later than January.

(c)

When we use your amended tax return, as described in § 418.2150, the effective date will be January 1 of the year(s) that is affected, or the first month in that year that your enrollment or re-enrollment in a Medicare prescription drug coverage plan became effective if later than January.

(d)

When we use evidence that you provide to proves the IRS modified adjusted gross income information we used was incorrect, as described in § 418.2335, the effective date will be January of the year(s) that is affected or the first month in that year that your enrollment or re-enrollment in a Medicare prescription drug coverage plan became effective 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 § 418.2201, the effective date is described in § 418.2230.

Notes, amendments, and revision history

Authority

Authority: Secs. 702(a)(5), 1860D-13(a) and (c) of the Social Security Act (42 U.S.C. 902(a)(5), 1395w-113(a) and (c)).

Source

Source: 75 FR 75891, Dec. 7, 2010, unless otherwise noted.

Source

Source: 70 FR 77675, Dec. 30, 2005, unless otherwise noted.

§418.2112. Paying your income-related monthly adjustment amount.

20 C.F.R. § 418.2112

(a)

We will deduct the income-related monthly adjustment amount from your Social Security benefits if they are sufficient to cover the amount owed. If the amount of your Social Security benefits is not sufficient to pay the full amount of your income-related monthly adjustment amount, CMS will bill you for the full amount owed.

(b)

If you do not receive Social Security or Railroad Retirement Board benefits, but you receive benefits from the Office of Personnel Management, the Office of Personnel Management will deduct the income-related monthly adjustment amount from your benefits if they are sufficient to cover the amount owed. If the amount of your Office of Personnel Management benefits is not sufficient to pay the full amount of your income-related monthly adjustment amount, CMS will bill you for the full amount owed.

(c)

If you do not receive Social Security, Railroad Retirement Board, or Office of Personnel Management benefits, CMS will bill you for your income-related monthly adjustment amount.

Notes, amendments, and revision history

Authority

Authority: Secs. 702(a)(5), 1860D-13(a) and (c) of the Social Security Act (42 U.S.C. 902(a)(5), 1395w-113(a) and (c)).

Source

Source: 75 FR 75891, Dec. 7, 2010, unless otherwise noted.

Source

Source: 70 FR 77675, Dec. 30, 2005, unless otherwise noted.

§418.2115. What are the modified adjusted gross income ranges?

20 C.F.R. § 418.2115

(a)

We list the modified adjusted gross income ranges for the calendar years 2011 through and including 2017, 2018, and beginning in 2019 for each Federal tax filing category in paragraphs (b), (c) and (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 $107,000;

(ii)

Greater than $107,000 but less than $133,500;

(iii)

Greater than $133,500 but less than $160,000; and

(iv)

Greater than $160,000.

(3)

For calendar years beginning in 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 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) 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), (c), and (d) of $415,000, $500,000, and $750,000 will not be adjusted under paragraph (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) of this section and publish the updated ranges in the Federal Register.

Notes, amendments, and revision history

Amendments

[75 FR 75891, Dec. 7, 2010, as amended at 55630, Nov. 7, 2018]

Authority

Authority: Secs. 702(a)(5), 1860D-13(a) and (c) of the Social Security Act (42 U.S.C. 902(a)(5), 1395w-113(a) and (c)).

Source

Source: 75 FR 75891, Dec. 7, 2010, unless otherwise noted.

Source

Source: 70 FR 77675, Dec. 30, 2005, unless otherwise noted.

Amendments

[75 FR 75891, Dec. 7, 2010, as amended at 55630, Nov. 7, 2018]

§418.2120. How do we determine your income-related monthly adjustment amount?

20 C.F.R. § 418.2120

(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) of this section contain the modified adjusted gross income ranges for calendar years 2011 through and including 2017, 2018, and 2019, and the corresponding percentage of the cost of basic Medicare prescription drug coverage that individuals with modified adjusted gross incomes that fall within each of the ranges will pay. The monthly dollar amounts will be determined by CMS using the formula in section 1860D-13(a)(7)(B) of the Act. Based on your tax filing status for the tax year we use to make a determination about your income-related monthly adjustment amount, we will determine which table is applicable to you. We will use your modified adjusted gross income to determine which income-related monthly adjustment amount to apply to you. The dollar amounts used for each of the ranges of income-related monthly adjustment will be set annually after 2019 as described in paragraph (c) of this section. The modified adjusted gross income ranges will be adjusted annually after 2019 as described in § 418.2115(e).

(1)

General tables of applicable percentages. If your filing status for your Federal income taxes for the tax year we use 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, you will pay an amount based on the percentage listed in the right column, which represents a percentage of the cost of basic Medicare prescription drug coverage.

(2)

Tables of applicable percentages for joint returns. If your Federal tax filing status is married filing jointly for the tax year we use and your modified adjusted gross income for that tax year is in the range listed in the left column in the following tables, you will pay an amount based on the percentage listed in the right column, which represents a percentage of the cost of basic Medicare prescription drug coverage.

(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, you will pay an amount based on the percentage listed in the right column, which represents a percentage of the cost of basic Medicare prescription drug coverage.

(c)

For each year after 2019, CMS will announce the modified adjusted gross income ranges for the income-related monthly adjustment amount described in paragraph (b) of this section.

Notes, amendments, and revision history

Amendments

[75 FR 75891, Dec. 7, 2010, as amended at 55631, Nov. 3, 2018]

Authority

Authority: Secs. 702(a)(5), 1860D-13(a) and (c) of the Social Security Act (42 U.S.C. 902(a)(5), 1395w-113(a) and (c)).

Source

Source: 75 FR 75891, Dec. 7, 2010, unless otherwise noted.

Source

Source: 70 FR 77675, Dec. 30, 2005, unless otherwise noted.

Amendments

[75 FR 75891, Dec. 7, 2010, as amended at 55631, Nov. 3, 2018]

§418.2125. How will the income-related monthly adjustment amount affect your total Medicare prescription drug coverage premium?

20 C.F.R. § 418.2125

(a)

If you must pay an income-related monthly adjustment amount, your total Medicare prescription drug coverage premium will be the sum of:

(1)

Your prescription drug coverage monthly premium, as determined by your plan; plus

(2)

Any applicable increase in the prescription drug coverage monthly premium as described in 42 CFR 423.286; plus