BASIC (10-07)

HI 01130.030 IRMAA Annual Verification Notices

A. Policy

Each year, SSA will verify IRMAA records using beneficiary-supplied data (estimates and their own copies of PY-2 returns), attestations that no tax return was required in PY-2 and records when IRS supplied PY-3 data because PY-2 was not available. Beneficiaries will receive proper notification with information about SSA’s planned actions, determinations, and their appeal rights if annual verification results in a change in the amount of IRMAA. These notices will be stored on the Online Retrieval System. See HI 01194.105 through HI 01194.130 for sample IRMAA Annual Verification notices.

B. Predetermination Notice

This notice informs the beneficiary that SSA plans to collect an arrearage of IRMAA as a result of MAGI information received from IRS during the verification data exchange. This notice will explain:

  • That a higher IRMAA will apply for the premium year verified,

  • What MAGI information was received from IRS,

  • What the IRMAA will be for Medicare Part B and Medicare prescription drug coverage as applicable for the premium year verified,,

  • What the total Medicare Part B premium will be for Title II beneficiaries,

  • When SSA plans to make the IRMAA change effective,

  • How SSA made the determination, and

  • What the beneficiary can do if the tax information provided by IRS is wrong or the beneficiary filed an amended tax return or has an IRS letter of correction for the verified year.

This notice does not contain appeal rights but will invite beneficiaries to contact SSA within 10 days if the information is incorrect before SSA makes a change to the verified premium year.

After 20 days (5 days mailing time, 10 days for the beneficiary to contact SSA and 5 more days of mailing time), SSA sends an IRMAA Annual Verification Correction notice with appeal rights.

NOTE: A beneficiary who disagrees with the information in a predetermination notice may request a new initial determination under certain circumstances. See HI 01120.001 for more information on new initial determinations. If the beneficiary insists on filing an appeal based on a predetermination notice, we must accept his or her appeal request. Follow the appeals instructions in HI 01140.001D and HI 01140.005C through HI 01140.005E.

C. Overage Notice

This notice informs the beneficiary that SSA will refund an IRMAA as a result of MAGI information received from IRS during the verification data exchange. This notice includes appeal rights. If the notice is to a title II beneficiary, it states there will be another notice about the impact on benefits. The other notice will be a title 11 redesign (T2R) notice.

Affected CSRS annuitants will receive a similar notice, which does not promise any separate notification but does advise the beneficiary to contact the Office of Personnel Management (OPM) if they have any questions about the refund of the excess IRMAA. Affected RRB annuitants also will receive a similar notice which tells them they will receive a letter from RRB about the refund of the excess IRMAA. CMS will be responsible for notifying Medicare-only beneficiaries who are direct billed for their premiums. The Overage notice will explain:

  • That higher IRMAA than required was paid for the premium year verified,

  • What MAGI information was received from IRS,

  • What the IRMAA is for Medicare Part B and Medicare prescription drug coverage as applicable for the premium year verified,

  • What the total Medicare Part B premium is for Title II beneficiaries,

  • When the change will be effective,

  • How SSA made the determination,

  • That another notice will be sent explaining how this will affect benefits and any refund due, and

  • Appeal rights.

D. Correction Notice

This notice is sent to those who do not contact SSA within 20 days from the date of the Predetermination notice. It includes appeal rights. If the notice is sent to a title II beneficiary, it states that there will be another notice about the impact on benefits. The other notice will be a T2R notice.

Affected CSRS annuitants will receive a similar notice, which does not promise any separate notification but does advise the beneficiary to contact OPM if they have any questions about how to pay the past-due IRMAA. OPM has indicated that they will send notification of withholding. Affected RRB annuitants will also receive a similar notice which tells them they will receive a letter from RRB about how to pay the past-due IRMAA. CMS will be responsible for notifying Medicare-only beneficiaries who are direct billed for their premiums. The Correction notice contains appeal rights. It will explain:

  • That the beneficiary owes additional IRMAA for the premium year verified,

  • What MAGI information was received from IRS,

  • What the