Can You Have a Medicare Savings Program and Pay IRMAA Surcharges?
By Sharon Ben-Moshe · Founder & Editor
A beneficiary can qualify for a Medicare Savings Program while technically facing Income-Related Monthly Adjustment Amount surcharges. This unusual situation occurs because the Social Security Administration calculates IRMAA based on federal tax returns from two years prior, whereas state Medicaid programs assess Medicare Savings Program eligibility based on your current monthly income and liquid resources.
Why two-year tax lookbacks conflict with current income
In 2026, Social Security bases Part B and Part D IRMAA determinations on your 2024 modified adjusted gross income reported to the Internal Revenue Service. If you experienced a significant life transition in 2025 or 2026, such as retirement, reduction in work hours, divorce, or the death of a spouse, your current monthly income might drop enough to satisfy QMB, SLMB, or QI criteria despite high historical tax returns.
How state buy-in interacts with IRMAA charges
When a state Medicaid agency approves your Medicare Savings Program application, it agrees to pay your standard Medicare Part B monthly premium ($185.00 in 2026) through the state buy-in agreement. State buy-in agreements do not automatically eliminate federal IRMAA surcharges for Part B or Part D.
- The state pays the base Medicare Part B monthly premium directly to the federal government.
- Social Security continues deducting any remaining IRMAA surcharge from your monthly benefit check until your federal tax records are updated.
- Enrolling in an MSP automatically grants federal Extra Help, which covers base Part D plan premiums but does not cancel Part D IRMAA surcharges.
Eliminating IRMAA by filing Form SSA-44
Beneficiaries experiencing this income gap should immediately submit Form SSA-44 (Life-Changing Event) to their local Social Security office. Social Security can recompute your IRMAA tier using your current year estimated income if your income drop resulted from qualifying events:
- Marriage, divorce, or annulment.
- Death of a spouse.
- Work reduction or complete retirement.
- Loss of income-producing property or termination of a defined benefit pension.
Filing Form SSA-44 eliminates the IRMAA surcharge, allowing your state MSP buy-in to cover 100% of your remaining Part B premium liability.
To check your current qualification for state premium help, use our free MSP eligibility tool and review guidance on lowering your IRMAA surcharge.
Frequently asked questions
Frequently Asked Questions
Does QMB pay my Part B IRMAA surcharge?
No. State buy-in programs pay the standard baseline Medicare Part B monthly premium. To remove the IRMAA surcharge, you must submit Form SSA-44 to Social Security citing a qualifying life-changing event.
Can I qualify for an MSP if my tax return from two years ago was high?
Yes. State Medicaid agencies assess your current monthly gross income and resources, not your tax returns from two years ago.
What happens to Part D IRMAA if I receive Extra Help through an MSP?
Extra Help pays the basic monthly premium for your benchmark Part D plan, but federal law requires you to pay the Part D IRMAA surcharge until Social Security approves an SSA-44 appeal.
How quickly does Social Security process Form SSA-44?
Social Security typically processes life-changing event determinations within 30 to 60 days, refunding any surcharges erroneously withheld during the recomputation window.
Your next steps
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