TN 12 (07-14)

GN 00210.710 Same-Sex Marriage – Medicare Income-Related Monthly Adjustment Amount (IRMAA)

A. Same-sex marriage – Medicare Income-Related Monthly Adjustment Amount (IRMAA) - introduction

The law requires Medicare beneficiaries with incomes over a certain amount to pay an adjustment to their monthly Medicare Part B (medical insurance), and Medicare prescription drug coverage premiums, as explained in HI 01101.001. SSA calls the adjustment amount the income-related monthly adjustment amount (IRMAA).

The Internal Revenue Service (IRS) electronically provides SSA with tax information to determine which enrollees must pay an IRMAA. SSA does not evaluate the basis of the tax data that IRS provides. Due to the Windsor decision, IRS now recognizes same-sex marriages that were valid in the state (or foreign jurisdiction) where they were entered into, regardless of the married couple’s place of domicile, and allows same-sex married couples to use a tax filing status of married filing jointly and married filing separately.

Under certain circumstances, beneficiaries can request a new initial determination that can lower or remove the IRMAA completely. For information on new initial determinations, see HI 01120.001 through HI 01120.065.

The instructions in this section provide guidance on requests for a new initial determination that involve a same-sex marriage or spouse. The domicile of the beneficiary or his or her spouse is not a factor when making a new initial determination.

For other Medicare issues, see subchapter GN 00210.000 to determine if instructions for your issue have been published. If instructions for your issue are not available, follow the instructions in GN 00210.005 to hold the claim.

B. Life changing events

For IRMAA purposes, there are eight circumstances that we consider to be life-changing events (LCEs). The list of these events is in HI 01120.005C. Procedures for processing new initial determinations are in HI 01120.001 through HI 01120.065.

All life-changing events allow for consideration of a spouse or a spouse’s action as a cause for the loss of income. For example, for the life-changing event of work stoppage, either the beneficiary or the spouse could be the person who stopped working. For all LCEs other than the LCE of marriage (HI 01120.015), follow the processing instructions appropriate for the LCE.

The following list is a quick reference to find the appropriate LCE and the appropriate instructions:

If a beneficiary requests a new initial determination based on an LCE of marriage, you must determine if the same-sex marriage was valid in the state (or foreign jurisdiction) where it was entered into, regardless of the married couple’s place of domicile.

To process an LCE of marriage when a same-sex marriage is involved, follow the processing instructions in HI 01120.015. To determine if the same-sex marriage was valid in the state where it was entered into, consult the chart in GN 00210.003. Use the “Date Same-Sex Marriages Were Permitted in the State” column to confirm that the couple was married within the period the state permitted same-sex marriages. Only the states on the list permit same-sex marriages. If the ceremonial marriage occurred outside the U.S., follow instructions in GN 00210.006 to request a legal opinion to determine marriage validity.

C. Amended tax returns

If a beneficiary alleges being in a same-sex marriage and requests a new initial determination based on an amendment of a tax return that was used to make an IRMAA determination, process the request following the instructions in HI 01120.045. The reason for the amended return, including that the beneficiary entered into a same-sex marriage, is not material to the request for a new initial determination.

D. Corrected IRS tax data

If a beneficiary alleges being in a same-sex marriage and requests a new initial determination because of an error in the information IRS provided to us to determine the IRMAA, process the request following the instructions in HI 01120.050. The reason for the correction of the IRS data, including that the beneficiary entered into a same-sex marriage, is not material to the request for a new initial determination.

E. Request to use two-year old tax data over three-year old tax data

If a beneficiary alleges being in a same-sex marriage and requests a new initial determination using the two-year old filed tax return over the three-year old tax data provided by IRS, process the request following the instructions in HI 01120.055. The same-sex marriage is not material to the request for a new initial determination.

F. Married filing separately, living apart all year

If a beneficiary alleges being in a same-sex marriage, used the tax filing status of married filing separately, and alleges living apart from his or her spouse all year, process the request following the instructions in HI 01120.060. The same-sex marriage is not material to the request for a new initial determination.


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http://policy.ssa.gov/poms.nsf/lnx/0200210710
GN 00210.710 - Same-Sex Marriage - Medicare Income-Related Monthly Adjustment Amount (IRMAA) - 07/18/2014
Batch run: 07/18/2014
Rev:07/18/2014