The following list contains the sequencing of captions and paragraphs for Income-Related
Monthly Adjustment Amount (IRMAA) Annual Verification Correction Notices for T2 beneficiaries.
An “R” indicates a required paragraph, while an “O” indicates an optional paragraph.
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•
Introductory (no caption)
MIR050 O
Or MIR101 O
Or MIR118 & MIR119 O
NOTE: If MIR118 generates, MIR119 is required.
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•
MIRC02 – Another Letter
MIR011 R
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•
MIRCO4 – How We Decided Your Income-Related Premium Amount
MIR108 R
MIR019 R
MIR020 R
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•
ALSC19 – If You Disagree With This Decision
ALS162 R
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•
REPC01 – If You Want Help With Your Appeal
REP031 R
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•
REFC01 – If You Have Any Questions
REF103 O
REF104 O
REF106 O