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Form Approved OMB No* 0960-0784 Social Security Administration Medicare Income-Related Monthly Adjustment Amount Life-Changing Event If you had a major life-changing event and your income has gone down you may use this form to request a reduction in your income-related monthly adjustment amount. See page 5 for detailed information and line-by-line instructions. If you prefer to schedule an interview with your local Social Security office call 1-800-772-1213 TTY 1-800-325-0778. Name You may use ...

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

Can I mail forms to Social Security?

In most cases, you can take or mail this signed application with your documents to any Social Security office. Any documents you mail to us will be returned to you.

What qualifies as a life-changing event for Medicare?

A change in your situation \u2014 like getting married, having a baby, or losing health coverage \u2014 that can make you eligible for a Special Enrollment Period, allowing you to enroll in health insurance outside the yearly Open Enrollment Period.

How is Irmaa calculated?

IRMAA is determined by income from your income tax returns two years prior. This means that for your 2022 Medicare premiums, your 2020 income tax return was used. This amount is recalculated annually.

What is the income related monthly adjustment amount?

The Medicare Income-Related Monthly Adjustment Amount (IRMAA) is an amount you may pay in addition to your Part B or Part D premium if your income is above a certain level. The Social Security Administration (SSA) sets four income brackets that determine your (or you and your spouse's) IRMAA.

Can I submit SSA forms online?

Adults filing online now can use a click-and-sign process, while those filing by telephone or in person can use our attestation process to sign and submit their SSA-827.

Can I file Form SSA-44 online?

SSA does not provide SSA-44 forms online at this time, so you will need to print out the form from the SSA website. You will then need to mail the form to your local SSA office, along with any other information they request as outlined in step four above.

What is a Form 44?

A standard form 44 (SF-44) is a pocket size purchase order form, designed for on-the-spot, over-the-counter purchases of supplies and non-personal services while away from the purchasing office or at isolated activities or areas.

How do you calculate modified adjusted gross income for Irmaa?

That means your 2021 premiums and IRMAA determinations are calculated based on MAGI from your 2019 federal tax return. MAGI is calculated as Adjusted Gross Income (line 11 of IRS Form 1040) plus tax-exempt interest income (line 2a of IRS Form 1040).

What is an SSA-44 form?

Use Form Medicare Income-Related Monthly Adjustment Amount \u2013 Life-Changing Event to report a major life-changing event. If your income has gone down, you may also use Form SSA-44 to request a reduction in your income-related monthly adjustment amount.

What is SSA-44 form used for?

You should fill out Form SSA-44 if you experience any life-changing event that reduces your income. Life-changing events that qualify are marriage, divorce, death of a spouse, work stoppage, work reduction, loss of income-producing property, loss of pension income and employer settlement payment.

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