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This is probably going to happen to me in 2021. For 2020, my net monthly SS benefit will be $8.00 (eight dollars). A little more IRMAA (income related monthly adjustment amount, which is a surcharge on Medicare) and I will be in the red in 2021.

I know this doesn't happen to many people, but my SS benefit is quite small, because much of my working life was in a job not covered by SS.

So what happens? Do I pay the Social Security Administration every month or does the benefit never go below zero?

Note: Medicare deductions are the only deductions on my SS check.

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Several FAQs state that you can be disenrolled for not paying your IRMAA, e.g.

https://www.cms.gov/Outreach-and-Education/Outreach/Partnerships/downloads/11338-P.pdf

Since presumably people who are having their IRMAA paid out of SS deductions wouldn't be able to not pay their IRMAA, this strongly implies that it is possible for there to be a net amount due.

Which makes sense: Medicare is a subsidized medical plan. The more money you make, the less it's subsidized, and the more you have to pay the premiums yourself. Your term "surcharge" isn't exactly accurate. It's more a reduction in subsidy, than a surcharge. It can be paid for out of your SS check, but if it's not paid for that way, it's still owed.

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