Effective Dates: 10/14/2026 - Present Previous | Next

TN 56 (10-26)

NL 00730.126 “M” Paragraphs and Captions

List of “M” Paragraphs and Captions

A. “MAN” - Manual

MAN001 – MANUAL NOTICE NEEDED TO EXPLAIN TITLE II REDESIGN ACTION(S)

MANUAL NOTICE NEEDED – (1)

Fill-in values:
Fill-in (1)
Choice 1	LIMITED GROUP PAYER
Choice 2	THIRD-PARTY WIPEOUT PROCESSED
Choice 3	MEDICARE CLAIM WITHDRAWAL PROCESSED
Choice 4	MBA LESS SMI PAST PREMIUMS
Choice 5	MULTIPLE 3^RD PARTY CLOSED PERIODS
Choice 6	SPA OPA POSTED TO BOUD TERM TO TERM
Choice 7	SUSPENSION FOR WITHDRAWAL CLAIM
Choice 8	NEW OPA AND PRIOR OPA UNDER PROTEST
Choice 9	MULTIPLE FFEL CHANGED OCCURRENCES
Choice 10	WARRANT ISSUING AGENCY IS BLANK
Choice 11	MBR ORI AND WARRANTDT NO MATCH ON FFSCF
Choice 12	WC/PDB STOPS AND NO AMOF DATA PRESENT
Choice 13	FFEL SUSP NO CHANGE IN FFEL OCCURRENCES
Choice 14	ICF INPUT WC DATA DELETED ON POST-MBR
Choice 15	MULTIPLE ARD DATA LINES FOR SAME YEAR (YOER)

B. “MAR” - Marriage

MAR008 – MARRIAGE DOES NOT AFFECT SOCIAL SECURITY ADMINISTRATION BENEFITS

Thank you for telling us that you married. However, this marriage will not affect your benefits.

MAR009 – DIVORCE DOES NOT AFFECT SOCIALSECURITY ADMINISTRATION BENEFITS

Thank you for telling us about your divorce. However, the divorce will not affect your benefits.

C. “MHP” – Medicare Health Plan

MHPC06 – CAPTION

Information About Your Health Plan Premiums

MHPC03 – CAPTION

Information About Your Medicare Prescription Drug Plan Costs

MHPC04 – CAPTION

Information About Your Health Plan Premiums and Medicare Prescription Drug Plan Costs

MHP008 – MEDICARE ADVANTAGE PART B PREMIUM REDUCED

MONTH CCYY MONTH CCYY $$$$$$¢¢ $$$$$$¢¢

NOTE: The fill-ins for MHP008 will be repeated for each occurrence of MARD data that needs to be displayed in the notice.

Fill-in values:
Fill-in (1)	Medicare Advantage Reduction Start Date (MARD-START-REL) for the first occurrence of MARD data that has changed when comparing the pre- and post-MBRs NOTE: for Fill-in (1), the date will be displayed in the numeric format showing the slash after the month and before the year (e.g., 01/2006)
Fill-in (2)	Medicare Advantage Reduction Stop Date (MARD-STOP-REL) that corresponds to the MARD start date NOTE: the MARD stop date may not have a value if there is no stop date on the post-MBR
Fill-in (3)	Medicare Advantage Reduction Amount (MARD-AMOUNT) that corresponds to the start/stop occurrence NOTE: If an MARD occurrence on the pre-MBR is wiped-out, then the value for this fill-in will be zero and displayed as 0.00
Fill-in (4)	Show the Part B premium after the Medicare Advantage Reduction Amount (MARD-AMOUNT) is applied. NOTE: if the MARD occurrence displayed is for a wiped-out occurrence on the pre-MBR, the value for this fill-in will be the Part B SMI rate

NOTE: The decision to display MARD occurrence from the pre-MBR that is wiped-out was made by CMS notice policy when creating the revised language to use for Medicare Advantage reduction of Part B premium amount.

MHP009 – PART C HEALTH PLAN PREMIUMS DEDUCTION FROM SSA BENEFITS STARTS

As you requested, we will begin deducting your health plan premiums from your monthly benefit.

MHP012 – PART C HEALTH PLAN PREMIUMS DEDUCTED FROM A PRIOR MONTHLY ACCRUAL (PMA) OR CURRENT MONTHLY ACCRUAL (CMA)

This represents all health plan premiums due to date.

MHP013 – SUPPLEMENTAL MEDICAL INSURANCE (SMI) PART B PREMIUM REDUCED

Some Medicare plans may reduce your Medicare Part B premium as a plan benefit.

MHP014 – MEDICARE ADVANTAGE PART B PREMIUM REDUCED

Below we show the changes to the monthly deduction to your medical insurance (Part B) premium:

Start Date	Stop Date	Amount of Reduction	Amount of Premium After the Reduction

(1)

Fill-in values:
Fill-in (1)	a blank line is required for Fill-in (2) for formatting purposes

MHP015 – PART C HEALTH PLAN PREMIUM DEDUCTED FROM MONTHLY BENEFIT PAYABLE (MBP) > $0.00

Each month, we will continue to deduct (1) for your health plan premiums.

Fill-in values:
Fill-in (1)	For every Deductions Additions History (DAH) occurrence on the post-MBR with the Deductions Additions History Update Date (DAH-UPDDT) equal to the Run Date that has a Deductions Additions History Type of Payment Code (DAH-TOP) = MBP (M) and has a Deductions Additions History Item Code (DAH-ITEM) = 445, 450, 455 and/or 460, add the Deductions Additions History Amount (DAH-AMOUNT) for each of these occurrences together and show this total as the fill-in value

Fill-in values:

Fill-in (1)

For every Deductions Additions History (DAH) occurrence on the post-MBR with the Deductions Additions History Update Date (DAH-UPDDT) equal to the Run Date that has a Deductions Additions History Type of Payment Code (DAH-TOP) = MBP (M) and has a Deductions Additions History Item Code (DAH-ITEM) = 445, 450, 455 and/or 460, add the Deductions Additions History Amount (DAH-AMOUNT) for each of these occurrences together and show this total as the fill-in value

MHP016 – PART C HEALTH PLAN PREMIUM DEDUCTION AMOUNT CHANGES

There has been a change in the amount withheld for your health plan premiums.

MHP079 – PART C HEALTH PLAN PREMIUMS NO LONGER DEDUCTED FROM SSA BENEFITS

We will no longer deduct money for your health plan premium(s) from your monthly benefits.

MHP077 – ADVISES BENEFICIARY TO CONTACT THEIR HEALTH PLAN ABOUT PART C HEALTH PLAN OR ABOUT THE REDUCTION OF PART B PREMIUM AMOUNT

If you have any questions about your health plan premiums, please contact your health plan(s).

MHP027 – REFUND FOR PART C HEALTH PLAN PREMIUMS ONLY PAID IN THE PRIOR MONTH ACCRUAL AMOUNT (PAMT) OR CURRENT MONTH ACCRUAL AMOUNT (CAMT)

This payment includes a refund of your health plan premiums.

MHP028 – REFUND FOR PART D MEDICARE PRESCRIPTION DRUG PLAN COSTS PAID IN A PRIOR MONTH ACCRUAL AMOUNT (PAMT) OR CURRENT MONTH ACCRUAL AMOUNT (CAMT)

This payment includes a refund of your Medicare prescription drug plan costs.

MHP029 – REFUND FOR PART C HEALTH PLAN PREMIUMS AND ALSO PART D MEDICARE PRESCRIPTION DRUG PLAN COSTS

This payment includes a refund of your health plan premiums and your Medicare prescription drug plan costs.

MHP030 – REFUND FOR PART D ONLY MEDICARE PRESCRIPTION DRUG PLAN COSTS AND NO OTHER TITLE II REDESIGN PARAGRAPH GENERATED AS INTRODUCTORY PARAGRAPH

Based on the information we have you are due a refund for Medicare prescription drug plan costs.

MHP031 – REFUND FOR PART C ONLY HEALTH PLAN PREMIUMS AND NO OTHER TITLE II REDESIGN PARAGRAPH GENERATED AS INTRODUCTORY PARAGRAPH

Based on the information we have you are due a refund for health plan premiums.

MHP032 – REFUND FOR PART C HEALTH PLAN PREMIUMS AND ALSO REFUND FOR PART D MEDICARE PRESCRIPTION DRUG PLAN COSTS AND NO OTHER TITLE II REDESIGN PARAGRAPH GENERATED AS INTRODUCTORY PARAGRAPH

Based on the information we have, you are due a refund for your health plan premiums and your Medicare prescription drug plan costs.

MHP033 – BENEFICIARY REQUESTS THAT ONLY PART D MEDICARE PRESCRIPTION DRUG PLAN COSTS DEDUCTED FROM SOCIAL SECURITY ADMINISTRATION BENEFITS

As you requested, we will begin deducting your Medicare prescription drug plan costs from your monthly benefit.

MHP034 – BENEFICIARY REQUESTS THAT PART C HEALTH PLAN PREMIUMS AND ALSO PART D MEDICARE PRESCRIPTION DRUG PLAN COSTS DEDUCTED FROM SOCIAL SECURITY ADMINISTRATION BENEFITS

As you requested, we will begin deducting your health plan premiums and Medicare prescription drug plan costs from your monthly benefit.

MHP035 – PART C ONLY HEALTH PLAN PREMIUMS DEDUCTED FROM PRIOR MONTH ACCRUAL AMOUNT (PAMT) CHECK

We deducted (1) for your health plan premiums from the check you will receive on or about (2).

Fill-in values:
Fill-in (1)	Total amount of the Part C health plan premiums deducted from the Prior Month Accrual Amount (PAMT) check; this amount includes any Part C arrearages show in Deductions Additions History (DAH) data from the PAMT
Fill-in (2)	Run date plus 15 days as the date in the format Month DD, CCYY

MHP036 – PART D ONLY MEDICARE PRESCRIPTION DRUG PLAN COSTS DEDUCTED FROM PRIOR MONTH ACCRUAL AMOUNT (PAMT) CHECK

We deducted (1) for your Medicare prescription drug plan costs from the check you will receive on or about (2).

Fill-in values:
Fill-in (1)	Total amount of the Part D Medicare prescription drug plan costs deducted from the Prior Month Accrual Amount (PAMT) check; this amount includes any Part D arrearages show in Deductions Additions History (DAH) data from the PAMT
Fill-in (2)	Run date plus 15 days as the date in the format Month DD, CCYY

MHP037 – PART C HEALTH PLAN PREMIUMS AND ALSO PART D MEDICARE PRESCRIPTION DRUG PLAN COSTS DEDUCTED FROM PRIOR MONTH ACCRUAL AMOUNT (PAMT) CHECK

We deducted (1) for your health plan premiums and (2) for your Medicare prescription drug plan costs from the check you will receive on or about (3).

Fill-in values:
Fill-in (1)	Total amount of the Part C health plan premiums deducted from the Prior Month Accrual Amount (PAMT) check; this amount includes any Part C arrearages show in Deductions Additions History (DAH) data from the PAMT
Fill-in (2)	Total amount of the Part D Medicare prescription drug plan costs deducted from the Prior Month Accrual Amount (PAMT) check; this amount includes any Part D arrearages show in Deductions Additions History (DAH) data from the PAMT
Fill-in (3)	Run date plus 15 days as the date in the format Month DD, CCYY

MHP038 – PART C ONLY HEALTH PLAN PREMIUMS DEDUCTED FROM CURRENT AMOUNT (CAMT) CHECK

We deducted (1) for your health plan premiums from the check you will receive for (2) on or about (3).

Fill-in values:
Fill-in (1)	Total amount of the Part C health plan premiums deducted from the Current Amount (CAMT) check; this amount includes any Part C arrearages show in Deductions Additions History (DAH) data from the CAMT
Fill-in (2)	Current Operating Month (COM) in the format Month CCYY
Fill-in (3)	Using the PCI (Payment Cycle Indicator) show the calendar date in which the Current Operating Month (COM) check will be paid in the format Month DD, CCYY

MHP039 – PART D ONLY MEDICARE PRESCRIPTION DRUG PLAN COSTS DEDUCTED FROM CURRENT AMOUNT (CAMT) CHECK

We deducted (1) for your Medicare prescription drug plan costs from the check you will receive for (2) on or about (3).

Fill-in values:
Fill-in (1)	Total amount of the Part D Medicare prescription drug plan costs deducted from the Current Amount (CAMT) check; this amount includes any Part C arrearages show in Deductions Additions History (DAH) data from the CAMT
Fill-in (2)	Current Operating Month (COM) in the format Month CCYY
Fill-in (3)	Using the Payment Cycle Indicator (PCI), show the calendar date in which the Current Operating Month (COM) check will be paid in the format Month DD, CCYY

MHP040 – PART C HEALTH PLAN PREMIUMS AND ALSO PART D MEDICARE PRESCRIPTION DRUG PLAN COSTS DEDUCTED FROM THE CURRENT MONTHLY ACCRUAL (CMA) CHECK

We deducted (1) for your Medicare approved health plan premiums and (2) for your Medicare prescription drug plan costs. We deducted these amounts from the payment you will receive for (3) on or about (4).

Fill-in values:
Fill-in (1)	Total amount of the Part C health plan premiums deducted from the Current Monthly Accrual (CMA) check; this amount includes any Part C arrearages show in Deductions Additions History (DAH) data from the CMA
Fill-in (2)	Total amount of the Part D Medicare prescription drug plan costs deducted from the Current Amount (CAMT) check; this amount includes any Part C arrearages shown in Deductions Additions History (DAH) data from the Current Monthly Accrual (CMA)
Fill-in (3)	Current Operating Month (COM) in the format Month CCYY
Fill-in (4)	Using the Payment Cycle Indicator (PCI) show the calendar date in which the Current Operating Month (COM) check will be paid in the format Month DD, CCYY

MHP041 – PART D MEDICARE PRESCRIPTION DRUG PLAN COSTS FROM THE PRIOR MONTH ACCRUAL AMOUNT (PAMT) AND/OR CURRENT AMOUNT (CAMT)

This represents all Medicare prescription drug plan costs due to date.

MHP042 – PART C HEALTH PLAN PREMIUMS AND ALSO PART D MEDICARE PRESCRIPTION DRUG PLAN COSTS FROM THE PRIOR MONTH ACCRUAL AMOUNT (PAMT) AND/OR CURRENT AMOUNT (CAMT)

This represents all health plan premiums and Medicare prescription drug plan costs due to date.

MHP043 – PART D MEDICARE PRESCRIPTION DRUG PLAN COSTS ONLY DEDUCTED FROM MONTHLY BENEFIT PAYABLE (MBP)

Each month, we will continue to deduct (1) for your Medicare prescription drug plan costs.

Fill-in values:
Fill-in (1)	Amount of the Part D Medicare prescription drug plan costs deducted from the Monthly Benefit Payable (MBP)

MHP044 – PART C HEALTH PLAN PREMIUM AND PART D MEDICARE PRESCRIPTION DRUG PLAN COSTS DEDUCTED FROM THE MONTHLY BENEFIT PAYABLE (MBP)

Each month, we will continue to deduct (1) for your health plan premiums and (2) for your Medicare prescription drug plan costs.

Fill-in values:
Fill-in (1)	Amount of the Part C health plan premium deducted from the Monthly Benefit Payable (MBP)
Fill-in (2)
Choice 1	Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) (possessive)
Choice 2	your
Fill-in (3)	Amount of the Part D Medicare prescription drug plan costs deducted from the Monthly Benefit Payable (MBP)
Fill-in (4)
Choice 1	his
Choice 2	her
Choice 3	your

MHP045 – CHANGE IN THE DEDUCTION AMOUNT FOR PART D MEDICARE PRESCRIPTION DRUG PLAN COSTS FROM SOCIAL SECURITY ADMINISTRATION BENEFITS

There has been a change in the amount withheld for your Medicare prescription drug plan costs.

MHP046 – CHANGE IN THE DEDUCTION AMOUNT FOR PART C HEALTH PLAN PREMIUM AND ALSO A CHANGE IN THE DEDUCTION AMOUNT FOR PART D MEDICARE PRESCRIPTION DRUG PLAN COSTS

There has been a change in the amount withheld for your health plan premiums and your Medicare prescription drug plan costs.

MHP047 – PART D MEDICARE PRESCRIPTION DRUG PLAN COSTS ONLY NO LONGER DEDUCTED FROM SOCIAL SECURITY ADMINISTRATION BENEFITS

We will no longer deduct money for your Medicare prescription drug plan costs from your monthly benefits.

MHP048 – PART C HEALTH PLAN PREMIUMS AND ALSO PART D MEDICARE PRESCRIPTION DRUG PLAN COSTS NO LONGER DEDUCTED FROM SOCIAL SECURITY ADMINISTRATION BENEFITS

We will no longer deduct money for your health plan premiums and your Medicare prescription drug plan costs from (3) monthly benefits.

MHP049 – REFERRAL LANGUAGE USED WHEN PART D MEDICARE PRESCRIPTION DRUG PLAN COSTS ONLY ARE INVOLVED FOR ANY REASON

If you have any questions about your Medicare prescription drug plan costs, please contact your Medicare prescription drug plan.

MHP050 – REFERRAL LANGUAGE USED WHEN PART C HEALTH PLAN PREMIUMS AND ALSO PART D MEDICARE PRESCRIPTION DRUG PLAN COSTS ARE BOTH INVOLVED FOR ANY REASON

Please contact your Medicare health plan or your Medicare prescription drug plan if (3) questions about (4) premiums or costs.

MHP081 – INITIAL ENTITLEMENT TO HOSPITAL INSURANCE (HI)/SUPPLEMENTAL MEDICAL INSURANCE (SMI) WITH NO CURRENT DEDUCTION FOR MEDICARE PART D OR INCOME RELATED MONTHLY ADJUSTMENT AMOUNT (IRMAA) D

Now that (1) (2) eligible for Medicare, (3) can enroll in a Medicare prescription drug plan (Part D).

To learn more about the Medicare prescription drug plans and when (4) can enroll, visit (5) or call 1-800-MEDICARE (1-800-633-4227; TTY 1-877-486-2048). Medicare also can tell (6) about agencies in (7) area that can help (8) choose (9) prescription drug coverage.

If (10) limited income and resources, we encourage (11) to apply for the extra help that is available to assist with Medicare prescription drug costs. The extra help can pay the monthly premiums, annual deductibles and prescription co-payments. To learn more or apply, please contact us.

Fill-in values:
Fill-in (1)
Choice 1	Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN)
Choice 2	you
Fill-in (2)
Choice 1	is
Choice 2	are
Fill-in (3)
Choice 1	he
Choice 2	she
Choice 3	you
Fill-in (4)
Choice 1	he
Choice 2	she
Choice 3	you
Fill-in (5)	www.medicare.gov
Fill-in (6)
Choice 1	him
Choice 2	her
Choice 3	you
Fill-in (7)
Choice 1	his
Choice 2	her
Choice 3	your
Fill-in (8)
Choice 1	him
Choice 2	her
Choice 3	you
Fill-in (9)
Choice 1	his
Choice 2	her
Choice 3	your
Fill-in (10)
Choice 1	he has
Choice 2	she has
Choice 3	you have
Fill-in (11)
Choice 1	him
Choice 2	her
Choice 3	you

D. “MIS” - Miscellaneous

MIS050 – BENEFICIARY DIES IN OR BEFORE THEIR CURRENT DATE OF ENTITLEMENT (DOEC)

We are sorry to learn of your recent loss. Please accept our sincere sympathy.

We are not processing the application for Social Security benefits for (1). This is because (2) could not have been entitled to benefits for any month before (3) death on (4).

Fill-in values:
Fill-in (1)	Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN)
Fill-in (2)
Choice 1	he
Choice 2	she
Fill-in (3)
Choice 1	his
Choice 2	her
Fill-in (4)	Beneficiary Date of Death (BDOD) in format Month CCYY

MIS159 - SUSPECT FRAUD

Suspect Social Security Fraud?

If you suspect Social Security fraud, please visit https://oig.ssa.gov/report or call the Inspector General's Fraud Hotline at 1-800-269-0271 (TTY 1-866-501-2101).

MIS162 – NOTICES ARE DIRECTED TO A THIRD PARTY ON BEHALF OF BENEFICIARY OR A CLAIMANT

This notice is for (1). Please review the notice so you can provide (2) with assistance as needed.

Fill-in values:
Fill-in (1)	Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN)
Fill-in (2)	Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN)

E. “MOE” – Month Of Entitlement

MOE003 – SINGLE ENTITLEMENT RECORD AND MONTH OF ENTITLEMENT (MOE) DATE CHANGE DUE TO WORK AND EARNINGS

We reviewed your record. When you applied for benefits, you asked us to start your benefits in (1). We changed the month your benefits start to (2) because of (3) (4) work and earnings.

Fill-in values:
Fill-in (1)	Date of Entitlement (DOE) start date from the pre-MBR in the format Month CCYY
Fill-in (2)	Date of Entitlement (DOE) new start date from the post-MBR in the format Month CCYY
Fill-in (3)
Choice 1	your
Choice 2	his
Choice 3	her
Fill-in (4)
Choice 1	Year prior to the Date of Entitlement (DOE) start in the format CCYY
Choice 2	Full Retirement Age (FRA) year in the format CCYY
Choice 3	Year prior to the Full Retirement Age (FRA) year in the format CCYY
Choice 4	Date of Entitlement (DOE) start year in the format CCYY

MOE004 – DUAL ENTITLEMENT RECORD AND THE MONTH OF ENTITLEMENT (MOE) DATES CHANGES DUE TO WORK AND EARNINGS FOR A CLOSED YEAR

We reviewed your record. When you applied, you asked us to start your benefits in (1). We changed the month your benefits start to (2) because of your (3) work and earnings.

(10) also receiving benefits on another record. We will send you another letter about those benefits.

Fill-in values:
Fill-in (1)	Date of Entitlement (DOE) start date in the format Month CCYY
Fill-in (2)	Date of Entitlement (DOE) new start date
Fill-in (3)
Choice 1	Year prior to the Date of Entitlement (DOE) start in the format CCYY
Choice 2	Full Retirement Age (FRA) year in the format CCYY
Choice 3	Year prior to the Full Retirement Age (FRA) year in the format CCYY
Choice 4	Date of Entitlement (DOE) start year in the format CCYY

MOE005 – DUAL ENTITLEMENT RECORD AND MONTH OF ENTITLEMENT (MOE) CHANGES DUE TO WORK AND EARNINGS FOR A CLOSED YEAR FOR A BENEFICIARY WHO CHOSE AN EARLY MOE WITHOUT REDUCTION

We reviewed your record. When you applied, you asked us to start your benefits in (1). We changed the month your benefits start to (2) because of your (3) work and earnings. The change lets you get payments without permanently reducing your monthly benefits.

(12) also receiving benefits on another record. We will send you another letter about those benefits.

Fill-in values:
Fill-in (1)	Original Date of Entitlement (DOE) start date in the format Month CCYY
Fill-in (2)	New Month of Entitlement (MOE) start date
Fill-in (3)	Enforcement year in the format CCYY

MOE006 – NEW MONTH OF ENTITLEMENT (MOE) TO AN AUXILIARY WHEN THE MOE CHANGED BASED ON THE NUMBER HOLDER'S MOE CHANGING

We changed the month your benefits start on (1) record from (2) to (3). We changed the month because of (4) (5) work and earnings. (6) is the earliest month you can get benefits on (7) record. (8) benefits must start before your benefits can start.

Fill-in values:
Fill-in (1)	Date of Entitlement (DOE) start date
Fill-in (2)	New Date of Entitlement (DOE) start date
Fill-in (3)	NH First Name plus NH Last Name
Fill-in (4)	Year of enforcement in the format CCYY
Fill-in (5)	Date of Entitlement (DOE) start date
Fill-in (6)
Choice 1	Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN)
Choice 2	you
Fill-in (7)	NH First Name plus NH Last Name
Fill-in (8)	NH First Name plus NH Last Name

MOE007 – SINGLE ENTITLEMENT RECORD AND THE MONTH OF ENTITLEMENT (MOE) DATE CHANGES DUE TO WORK AND EARNINGS FOR A CLOSED YEAR FOR A BENEFICIARY WHO CHOSE AN EARLY MOE WITHOUT REDUCTION

We reviewed your record. When you applied, you asked us to start your benefits in (1). We changed the month your benefits start to (2) because of (3) (4) work and earnings. This change lets you get payments without permanently reducing your monthly benefits.

Fill-in values:
Fill-in (1)	Original Month of Entitlement (MOE) in the format Month CCYY
Fill-in (2)	New Month of Entitlement (MOE) in the format Month CCYY
Fill-in (3)
Choice 1	Beneficiary’s Given Name (BGN) plus Beneficiary’s Last Name (BLN) (possessive)
Choice 2	First name of NH plus Last name of NH
Choice 3	your
Fill-in (4)	Year of enforcement in the format CCYY

F. “MPD” – Medicare Prescription Drug Plan

MPDC19 – Caption

Medicare Prescription Drug Plan Enrollment

MPDC31 – Caption

Information About The Prescription Drug Coverage Income-Related Monthly

Adjustment Amount

MPD346 – INCOME-RELATED MONTHLY ADJUSTMENT AMOUNT (IRMAA) D PREMIUMS REFUND IN PRIOR MONTH ACCRUAL AMOUNT (PAMT) OR CURRENT AMOUNT (CAMT) - NO OTHER INTRODUCTORY UTI APPLIES

Based on the information, we have you are due a refund for prescription drug coverage income-related monthly adjustment amounts.

MPD347 – INCOME-RELATED MONTHLY ADJUSTMENT AMOUNT (IRMAA) D PREMIUMS REFUND IN PRIOR MONTH ACCRUAL AMOUNT (PAMT) OR CURRENT AMOUNT (CAMT)

This payment includes a refund of your prescription drug coverage income-related monthly adjustment amount.

MPD348 – INCOME-RELATED MONTHLY ADJUSTMENT AMOUNT (IRMAA) D PREMIUM DEDUCTED FROM CURRENT AMOUNT (CAMT)

We deducted (1) for your prescription drug coverage income-related monthly adjustment amount from the check you will receive for (2) on or about (3).

Fill-in values:
Fill-in (1)	Total Income Related Monthly Adjustment Amount (IRMAA) D amounts deducted from Current Amount (CAMT)
Fill-in (2)	Current Operating Month (COM)
Fill-in (3)	Using the Payment Cycle Indicator (PCI), show the calendar date in which the Current Operating Month (COM) check will be paid

MPD349 - INCOME-RELATED MONTHLY ADJUSTMENT AMOUNT (IRMAA) D CONTINUES TO BE DEDUCTED FROM THE MONTHLY BENEFIT PAYABLE (MBP)

The monthly deduction for your prescription drug coverage income-related monthly adjustment amount is (1).

Fill-in values:
Fill-in (1)	Total Income Related Monthly Adjustment Amount (IRMAA) D amounts deducted from Monthly Benefit Payable (MBP)

MPD350 – INCOME-RELATED MONTHLY ADJUSTMENT AMOUNT (IRMAA) D PREMIUM DEDUCTED FROM PRIOR MONTH ACCRUAL AMOUNT (PAMT)

We deducted (1) for your prescription drug coverage income-related monthly adjustment amount from the check you will receive on or about (2).

Fill-in values:
Fill-in (1)	Total Income-Related Monthly Adjustment Amount (IRMAA) D amounts deducted from Prior Month Accrual Amount (PAMT)
Fill-in (2)	Run date plus 15 days

MPD351 – INCOME-RELATED MONTHLY ADJUSTMENT AMOUNT (IRMAA) D NO LONGER DEDUCTED FROM BENEFITS

We will no longer deduct your prescription drug coverage income-related monthly adjustment amount from your monthly benefits.

MPD352 – INCOME-RELATED MONTHLY ADJUSTMENT AMOUNT (IRMAA) D ARREARAGES DEDUCTED FROM PRIOR MONTH ACCRUAL AMOUNT (PAMT) OR CURRENT AMOUNT (CAMT)

We are deducting past-due prescription drug coverage income-related monthly adjustment amounts from your check.

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0900730126

NL 00730.126 - “M” Paragraphs and Captions - 10/14/2026
Batch run: 10/14/2026
Rev:10/14/2026

Program Operations Manual System (POMS)