TN 2 (08-08)
HI 01190.015 Types of Income-Related Monthly Adjustment Amount (IRMAA) notices
This section is a brief overview of the notices we use to communicate with beneficiaries affected by the Medicare Part B Income-Related Monthly Adjustment Amount (IRMAA). IRMAA notices provide information to beneficiaries about SSA’s IRMAA determination, but with the exception of the annual BRI notices to Title II beneficiaries, they do not provide any information about the effect that IRMAA determinations have on benefit amounts or withholding. A separate notice from the Title II Redesign System (T2R) is sent to beneficiaries whenever an IRMAA determination results in a change in benefits or in a refund or arrearage.
A. IRMAA BRI notices and non-Title II annual IRMAA notices
These notices are sent to Medicare Part B enrollees with modified adjusted gross income (MAGI) above the threshold as reported by the Internal Revenue Service (IRS) or information the beneficiary provided.
1. IRMAA BRI notices
Instead of the standard BRI notice, SSA sends Title II beneficiaries a special letter that meets SSA’s notice standards, including windowpane business envelopes. The notice contains most of the information of the standard BRI mailer, plus information about the higher Medicare Part B premium and how it was determined. The notice also contains information about how beneficiaries can request a new initial determination and includes appeal rights.
2. Annual IRMAA notices for non-Title II medicare beneficiaries
SSA sends a notice about IRMAA to Medicare beneficiaries who are Railroad Retirement Board (RRB) or Civil Service Retirement System (CSRS) annuitants, and those who are directly billed by CMS for their Medicare Part B premium. The notice to RRB and CSRS annuitants refers to a separate notice that annuitants receive about the effect on their annuity payments.
B. IRMAA notices to new medicare enrollees
These notices are sent to individuals who file a new claim for Medicare (new filers), and those already receiving benefits, who attain eligibility and enroll in Medicare Part B (attainers). These individuals include Title II beneficiaries, RRB and Civil Service annuitants, and Medicare-only beneficiaries.
1. Predetermination notice
This is a notice with a field office return address, informing the beneficiary that SSA plans to start to charge an income-related Part B premium amount. Beneficiaries are given 10 days following the receipt of the notice, to contact us and request a new initial determination, if they would like us to use other information to determine their IRMAA (20-day diary from the date that the notice is mailed until SSA starts premium withholding; assumes 5 days mailing to and from). The purpose of the notice is to minimize inappropriate premium withholding by allowing beneficiaries to provide other information that could affect IRMAA before withholding starts. The notice does not have appeal rights.
NOTE: Prior to the predetermination notice, SSA sends a T2R notice to Title II beneficiaries about Medicare enrollment and premium withholding. This notice contains language that tells beneficiaries that if SSA receives information that indicates income exceeds the high-income threshold, they receive another letter.
2. Initial determination notice
This notice is sent to those who do not contact SSA in the 20 days following the predetermination notice. It includes appeal rights and states that beneficiaries receive another notice about the impact the Part B withholding has on benefits. Affected RRB and Civil Service annuitants receive a similar notice which does not promise any separate notification, although RRB and the Office of Personnel Management (OPM) indicate that they send a notification of withholding. The Centers for Medicare and Medicaid Services (CMS) is responsible for notifying Medicare-only beneficiaries who are direct-billed for their premiums.
C. New initial determination notices
When SSA has informed a beneficiary that he or she must pay IRMAA for a given premium year, he or she may request a new initial determination to reduce or eliminate IRMAA (HI 01120.001).
1. New initial determination notice
This is the notice that SSA sends when we make a new initial determination, based on a beneficiary request that SSA use MAGI information for a more recent taxable year, than the data provided by the IRS. This notice has appeal rights. The determination is based on one of the following circumstances:
A qualifying life-changing event which reduced MAGI since the year of the IRS data;
An amended tax return for the tax year that IRS provided;
An IRS data error and beneficiary has proof of correction of the IRS information SSA used;
A beneficiary’s copy of a filed tax return for 2 years prior to the premium year, when IRS provided tax return data for 3 years prior; or
A report of “Married, Filing Separately – Lived Apart All Year” by a beneficiary who filed a tax return with a filing status of married filing separately.
NOTE: If the beneficiary’s information does not substantiate either the circumstance or a significant change in MAGI, we send a dismissal notice.
2. Dismissal of a request for a new initial determination
SSA sends this notice when a beneficiary requests that SSA use alternative tax data for a new initial determination and MAGI has not decreased significantly (i.e., has not changed the IRMAA level), or the event does not meet the regulatory standard (Non-Qualifying event) or both. A dismissal notice is also sent when the beneficiary makes a request outside of acceptable timeframes and good cause is not found. Dismissal notices do not contain appeal rights.
3. New initial determination update
SSA sends this notice to a beneficiary who has provided an update of earlier MAGI information used to set IRMAA. The updated information could be another MAGI estimate or a copy of a filed Federal income tax return. When the beneficiary’s report results in a change in IRMAA, the change is an initial determination, so this notice has appeal rights.
4. New initial determination update dismissal notice
A beneficiary may provide updated information that merely confirms an earlier report (i.e., does not change the IRMAA) or shows an income change that does not result in a change to the IRMAA. SSA sends a notice acknowledging receipt of this information. No appeal rights are included in the notice acknowledging receipt of the information.
D. Reconsideration notices
1. Reconsideration dismissal
This notice is sent to a beneficiary who has requested a reconsideration that we must dismiss. We dismiss requests for reconsiderations when the request is based on a beneficiary’s belief that IRS sent data that is not correct and the beneficiary does not provide proof of corrected tax data. We advise the beneficiary to contact the IRS to obtain proof of the IRS error, and if provided, we use the corrected information to make a new initial determination. SSA also dismisses reconsideration requests that are filed outside of the appeals period without good cause. No appeal rights are included in dismissal notices.
2. Reconsideration affirmation
This notice affirms the original determination following a request for reconsideration of an IRMAA initial determination. This notice contains appeal rights.
3. Reconsideration reversal
This notice is sent when SSA reverses the earlier determination, based on the reconsideration. This notice contains appeals language.
NOTE: Appeals beyond the reconsideration level are subject to the Office of Medicare Hearings and Appeals (OMHA) in the Department of Health and Human Services (DHHS) review. Both reconsideration reversal and reconsideration affirmation notices explain how a beneficiary may file a request for a hearing with an OMHA administrative law judge.
E. Annual verification notices
SSA sends these notices, as a result of our annual data exchange with IRS, when we verify with IRS either a beneficiary estimate or beneficiary provided a copy of a tax return and that verification results in a change to IRMAA. SSA also sends these notices when replacing information that IRS provided about the tax year, 3 years prior to the premium year with 2-year prior information, that results in a change to IRMAA. These notices are sent to title II beneficiaries, RRB and Civil Service annuitants, and Medicare-only beneficiaries.
1. Annual verification predetermination notice
This notice informs the beneficiary that as a result of our annual data exchange with IRS, we received tax information and determined that he or she owes additional IRMAA for the premium year verified. This is a notice of planned action and does not contain appeal rights. The beneficiary is given 10 days following receipt of the notice to contact us, if they disagree with the tax information that IRS provided in the annual data exchange. If the beneficiary does not protest, an Annual Verification Correction notice is sent.
2. Annual verification overage notice
This notice is sent, as a result of the annual data exchange with IRS, we receive tax information and determine that the beneficiary paid too much IRMAA for the premium year being verified. The notice contains appeal rights.
3. Annual verification correction notice
This notice is sent to those who do not contact SSA within 20 days from the date of the Annual Verification Predetermination notice. It includes appeal rights. It explains that the beneficiary owes an additional amount for their Medicare Part B premium for the premium year verified. This notice includes the tax information that was received from IRS, what the IRMAA should have been for the verified premium year, the year that the IRMAA change is effective, and advises that another notice will be sent explaining how the past-due income-related premiums will be paid (if sent to a T2 beneficiary). For T2 beneficiaries, the other notice is a T2R notice.
4. Annual verification determination notice
This notice is sent to those who contact SSA within 20 days from the date of the Annual Verification Predetermination notice, with proof of an IRS correction, an amended tax return, or documentation of an obvious IRS transcription error in tax-exempt interest income which SSA accepts and processes. It includes appeal rights and states that there will be another notice about the impact on benefits if sent to a T2 beneficiary. For T2 beneficiaries, the other notice is a T2R notice.
5. Annual verification reconsideration notices
Beneficiaries may request a reconsideration of Annual Verification actions. These notices are sent to those who request SSA to reconsider its decision after receipt of an Annual Verification Predetermination notice, Overage notice, Correction notice or Determination notice.