We send this notice to Medicare beneficiaries who must pay an Income-Related Monthly Adjustment Amount (IRMAA) and who have their SMI premiums withheld from their Railroad Retirement benefits and to those who have both Part B and Medicare prescription drug coverage. We mail these notices at the same time we do annual IRMAA-BRI mailings to title II beneficiaries. RRB is responsible for notices to their annuitants about changes in benefits, including IRMAA.

Social Security Administration

Important Information

 

Date: November xx, 2018

BNC#:

 

BENEFICIARY NAME

ADDRESS

CITY ST ZIP CODE

 

The Social Security Act requires some people to pay higher premiums for their Medicare Part B (Medical Insurance) and Part D (Prescription Drug Plan) based on their income. We will increase your premiums because of your income. The information in this letter about your premiums is for one year only.

If you currently do not have Medicare Part B or Part D and enroll in 20xx, those premiums will also be increased based on your income.

If you have Medicare Part B the total 20xx premium includes:

- $XXX.xx for the standard Medicare premium, plus

- any surcharges you may owe for late enrollment, plus;

- $XXX.xx for the income-related monthly adjustment amount (IRMAA) based on your 20xx income tax return

Your Medicare Part D IRMAA based on your 2017 income tax return is $99.99.

You will get a separate notice from the Railroad Retirement Board about how this change will affect you.

 

Your Medicare Premiums

If you are enrolled in Medicare Part B, your monthly Part B premium for 20xx includes any surcharges for late enrollment or reenrollment, plus an IRMAA. If you have Part D, you will get a separate bill for the IRMAA, no matter how you normally pay your Part D plan premium. The law requires you to pay this amount in addition to your Part D plan premium. You must pay the amounts owed to keep your Part B and Part D coverage.

Each year to decide if you must pay IRMAAs, we use your Federal income tax information for the most recent tax year that is available. However, we do not use any information that is more than three years old. We ask the Internal Revenue Service (IRS) for your tax filing status, your adjusted gross income, and your tax-exempt interest income. We then add your adjusted gross income together with your tax-exempt interest income to get an amount that we call modified adjusted gross income (MAGI). We compare your MAGI with the income thresholds set by Medicare law.

MAGI may include one-time only income, such as capital gains, the sale of property, withdrawals from an Individual Retirement Account (IRA) or conversion from a traditional IRA to a Roth IRA. One-time income will affect your Medicare premium for only one year.

 

How We Figured Your IRMAAs

The IRS told us that for tax year 2017 you filed your taxes as married, filing jointly. You had an adjusted gross income of $999,999.99 plus $999.99 in tax-exempt interest income. We added these amounts together to get your MAGI of $999,999,99.

We used the following table to decide IRMAAs for the Medicare Part B and Part D premiums:

These IRMAAs are effective for 20xx only. Next year when we receive updated information from the IRS, we will make a new decision about any IRMAAs owed.

 

Some Special Situations That May Apply To You

If your tax filing status was married, filing separately, and you lived apart from your spouse throughout the tax year we used, please call us about your living arrangement. It could lower your IRMAAs. We will set up an appointment to discuss that information. You will need to bring a copy of the most recent income tax return you filed with IRS to the appointment.

 

If Your Income Has Gone Down

In some situations, we can make a new decision about your IRMAAs. Contact us to request a new decision if your MAGI has gone down at least one range in the table above or has gone below the lowest amounts in the table since the 2017 tax year, AND the decrease in MAGI was caused by any of the following life-changing events:

• •

  You married;

• •

  You divorced, or your marriage was annulled;

• •

  You became a widow or widower;

• •

  You or your spouse stopped working or reduced work hours;

• •

  You or your spouse lost income from income-producing property due to a disaster or other event beyond your control;

• •

  You or your spouse experienced a scheduled cessation, termination, or reorganization of an employer's pension plan; or

• •

  You or your spouse received a settlement from an employer or former employer because of the employer's closure, bankruptcy, or reorganization.

We will use the new lower MAGI to see if we can make a new decision about your IRMAAs. We cannot make a new decision if your income has changed for a reason other than those listed above, such as receiving one-time income from capital gains.

You will need to submit proof of the event listed above that caused your income to go down (such as a death certificate, a letter from your pension fund administrator, or a letter from your employer about your retirement). If you filed an amended or corrected tax return for the year you want changed, you will also need to submit a copy of the tax return with proof the IRS has received it.

If your MAGI has gone down at any time during January through September, you will need to tell us before the end of that year so we can correct your IRMAAs in that year. However, if the event that makes your MAGI go down did not occur until October 1 or later in the year, we can correct IRMAAs for that year if you tell us before the end of March of the following year.

 

If The Information We Used Is Incorrect

We based the IRMAAs on information we received from the IRS. If you have proof that the information we received from the IRS was not correct, please contact us to ask for a new decision about your income-related Medicare premiums. If you filed an amended tax return for that year, you will need to show us a copy of your amended Federal income tax return. You also will need to show us a letter or transcript from the IRS acknowledging receipt of your amended return. If the IRS corrected their records of your tax information for the year we used, you will need to show us the letter you received from the IRS. If you do not have all this information, the IRS can help you get it.

If we have included an IRMAA for your Part D, and you do not have Medicare Part D coverage, please contact the Centers for Medicare & Medicaid Services (CMS) at 1-800-MEDICARE (1-800-633-4227; TTY 1-877-486-2048). CMS is the only agency that can correct the information about your Part D coverage.

 

If You Disagree With Our Decision

If you disagree with our decision about your IRMAAs, you have the right to:

• •

  Request a new decision if your income has gone down due to any of the life-changing events listed above; or

• •

  Request a new decision using more recent tax information if you have amended or corrected tax information for 2017, or if we used tax information for 2016.

If you qualify for a new decision on your IRMAAs, we will make a new decision using your tax information. If we make a new decision, you will be able to file an appeal on the new decision.

 

If You Want To Appeal This Decision

If you disagree with this decision about your IRMAAs, you have the right to appeal. We will review the decision we made to verify that it is correct. A person who did not make the first decision will decide your case.

If you do appeal, we may start withholding your increased premiums before we make our decision on your appeal. If we change our decision about your IRMAAs, we will correct the amounts and refund any incorrectly withheld premiums.

We based the IRMAAs of your Medicare Part B and Part D premiums on information we received from the IRS. If you request an appeal because you believe that the IRS information is incorrect, we will give you information on how you can contact the IRS to obtain evidence to support your request for a new decision. If you request an appeal because we included amounts for your Part D premium and you do not have Medicare Part D coverage, you need to contact the Centers for Medicare & Medicaid Services (CMS) at 1-800-MEDICARE (1-800-633-4227; TTY 1-877-486-2048). CMS is the only agency that can correct the information about your Part D coverage.

• •

  You have 60 days to ask for an appeal.

• •

  The 60 days start the day after you get this letter. We will assume you received this letter 5 days after the date of the letter, unless you show us that you did not get it within the 5-day period.

• •

  You must have good reason for waiting more than 60 days to ask for an appeal.

• •

  You may contact one of our offices to file your appeal. You may also visit www.ssa.gov/non-medical/appeal to appeal online, or you can call 1-800-772-1213 for help.

 

If You Want Help With Your Appeal

You may choose to have a representative help you. We will work with this person just as we would work with you. If you decide to have a representative, you should find one quickly so that person can start preparing your case.

Many representatives charge a fee only if you receive benefits. Others may represent you for free. Usually, your representative may not charge a fee unless we approve it. Your local Social Security office can give you a list of groups that can help you find a representative.

If you get a representative, you or that person must notify us in writing. You may use our Form SSA-1696 "Appointment of Representative." Any local Social Security office can give you this form.

To Access “my Social Security” Online Services

Go to www.socialsecurity.gov/myaccount to create a my Social Security online account to check your benefits and make sure your contact information is up to date. If you have Medicare, it is important that you keep your address up to date with us. You can change your address or telephone number, start or change direct deposit of your benefits, get a replacement Medicare card, and get a benefit verification letter online.

 

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).

 

Help Prevent Identity Theft

Be aware of scams through the mail, Internet, telephone, or in person. You should be careful when someone asks for personal information, especially your Social Security number. Please visit www.usa.gov/identity-theft to find out more.

 

Other Help For Seniors

Call the Eldercare Locator service of the U.S. Administration on Aging at 1-800-677-1116 or visit their website at www.eldercare.acl.gov to learn about a wide variety of services that may be helpful to you.

If You Have Questions

If you have questions about payment of your Medicare premiums or about how this change affects benefits you may be receiving, call the Railroad Retirement Board at 1-877-772-5772. If you have questions about your Medicare Part B premium, please visit www.medicare.gov. To contact us, call at 1-800-772-1213 (TTY 1-800-325-0778) or visit any Social Security office.

If you have questions about your Medicare coverage, visit www.medicare.gov or call 1-800-MEDICARE (1-800-633-4227; TTY 1-877-486-2048).

 

 

Social Security Administration