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.

• •

  Introductory (no caption)

  MIR050 O

  Or MIR101 O

  Or MIR118 & MIR119 O

  NOTE: If MIR118 generates, MIR119 is required.

• •

  MIRC02 – Another Letter

  MIR011 R

• •

  MIRCO4 – How We Decided Your Income-Related Premium Amount

  MIR108 R

  MIR019 R

  MIR020 R

• •

  ALSC19 – If You Disagree With This Decision

  ALS162 R

• •

  REPC01 – If You Want Help With Your Appeal

  REP031 R

• •

  REFC01 – If You Have Any Questions

  REF103 O

  REF104 O

  REF106 O

The following list contains the sequencing of captions and paragraphs for IRMAA Annual Verification Correction Notices for Non-T2 beneficiaries. An “R” indicates a required paragraph, while an “O” indicates an optional paragraph.

• •

  Introductory (no caption)

  MIR050 O

  Or MIR101 O

  Or MIR118 OR MIR119 O

• •

  COPC01 – Other Information

  MIR013 (OPM) O

  MIR123 (RRB) O

• •

  MIRC04 – How We Decided Your Income-Related Premium Amount

  MIR108 R

  MIR019 R

  MIR020 R

• •

  ALSC19 – If You Disagree With This Decision

  ALS162 R

• •

  REPC01 – If You Want Help With Your Appeal

  REP031 R

• •

  REFC01 – If You Have Any Questions

  REF093 (RRB) O

  REF103 O

  REF104 O

  REF106 O