The following list contains the sequencing of captions and paragraphs for IRMAA Predetermination
Notices for Non-T2 beneficiaries. An “R” indicates a required paragraph, while an
“O” indicates an optional paragraph.
-
•
Introductory (no caption)
MIR001 R
MIR014 O
MIR009 R
MIR015 R
-
•
MIRCO4 – How We Decided Your Income-Related Premium Amount
MIR080 O
MIR081 O
MIR084 O
MIR030 O
MIR019 R
MIR020 R
MIR097 O
-
•
MIRCO3 – If You Have Other Information About Your Income
MIR021 O
MIR027 O
MIR022 R
MIR026 O
MIR023 O
MIR024 R
MIR088 R
MIR025 O
-
•
REFC01 – If You Have Any Questions
REF093 O
REF103 O
REF104 O
REF106 O