TN 1 (03-07)

HI 01194.025 IRMAA Non-Annual Notices Overview

HI 01194.030 through HI 01194.075 contains samples of the notices we will send to beneficiaries affected by IRMAA (see HI 01101.001). Each section contains an overview of the notice type and a sample(s) of each notice type. Fill-in text is underlined, including pronouns and verbs that will change when the notice is sent to a beneficiary’s representative payee. These sections contain samples of all of the IRMAA notices except for the notices sent to Medicare beneficiaries as part of the annual COLA notice operation. See HI 01194.001 through HI 01194.020 for samples of the annual IRMAA notices.

HI 01190.025 provides instructions for the proper sequencing of universal text identifiers (UTIs) in IRMAA notices. See those instructions for guidance on completion of notices to Railroad Retirement beneficiaries, Civil Service Annuitants, and direct-billed beneficiaries, since some captions and UTIs will vary from these samples for those groups. Notices to RRB beneficiaries and Civil Service annuitants and beneficiaries who are directly billed will not provide information about the total withholding, because we do not have that information. Notices to Medicare beneficiaries in these groups will provide information only about the IRMAA component of the Medicare Part B premium.

IRMAA notices will be printed in Spanish for all beneficiaries with a Spanish language indicator. Spanish language versions of all UTIs are available in the Language Development facility in PolicyNet.