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According to the Mayo Clinic, most people consume adequate amounts of B vitamins through their diet, though the elderly, particularly those with pernicious anemia, athletes, strict vegetarians, and people who consume a lot of alcohol may be deficient in the B vitamins and may require injections or oral supplementation of B vitamins or vitamin B-12, in particular

So, for example, your 2021 IRMAA is based on your MAGI from 2019

Those with Poor Diets: Individuals who dont consume a balanced diet may be at risk of vitamin B12 deficiency

The good news is that vitamin B12 is a water-soluble vitamin, meaning any excess is naturally excreted by the body

This concentration works well for mid-range to higher doses because it keeps injection volumes smaller

As a cofactor, cobalamins are essential for two cellular reactions: the mitochondrial methylmalonyl-CoA mutase conversion of methylmalonic acid (MMA) to succinate, which links lipid and carbohydrate metabolism, and the activation of methionine synthase, which is the rate-limiting step in the synthesis of methionine from homocysteine and 5-methyltetrahydrofolate