All calculations for IRMAA are done through an automated process. A manual adjustment will only be used in limited situations. These situations are:

1. 1. 

   An appeal decision is received without all necessary elements to input into the regular process, (Adjusted Gross Income (AGI), Tax Exempt Interest income (TEI), and filing status).

2. 2. 

   An appeal decision is received that does not agree with the Sliding Scale Tables (HI 01101.020C.).

3. 3. 

   A systems error in which the calculation does not agree with the Sliding Scale Tables, for example an input of “Married Filing Jointly” with Modified Adjusted Gross Income (MAGI) of $165,000 resulting in level 3 IRMAA.

Determinations processed based on a manual adjustment associated with an appeal can only be changed by another manual adjustment that is also associated with an appeal that affects the same premium year (PY). These determinations will also be excluded from the annual verification process.

If a manual adjustment is processed based on a systems error with no appeal involved, the determination can be changed by using either the automated process or another manual adjustment that affects the same PY(s).

Once you determine that a manual adjustment is necessary, you will need to contact your Regional Office Medicare Coordinator. All information regarding the case must be provided, so the manual adjustment can be completed.

All Manual Adjustments require the same documentation of the proof for the IRMAA change as described in HI 01120.005 through HI 01120.065. When using the Manual Adjustment Process it is also necessary to record why the manual adjustment process was used in the Remarks of the Manual IRMAA Adjustment Screen (IRIA). The Remarks of IRIA screen must contain a brief statement explaining why the change could not be completed through the automated IRMAA process.