Social Security Administration
Important Information
Date: November XX, 2018
BNC#:
BENEFICIARY NAME
ADDRESS
CITY ST ZIP CODE
We review Social Security benefits each year to make sure they keep up with the cost
of living. The law does not permit an increase in benefits when there is no increase
in the cost of living. The government measures changes in the cost of living through
the Department of Labor’s Consumer Price Index (CPI). There was no increase in the
cost of living during the past year based on the CPI. As a result, your benefit will
stay the same in 20xx.
The Social Security Act requires some people to pay a higher premium for their Medicare
Part B (Medical Insurance) and Part D (Prescription Drug Plan) based on their income.
We will increase your premiums because of your income. The information in this letter
about your premium is for one year only.
If you currently do not have Medicare Part B or Part D and enroll in 20xx, those premiums
will also be increased based on your income.
How Much Social Security Will I Get?
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Your 20xx monthly benefit amount before deductions is : $XXX.xx
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Your 20xx monthly deduction for the Medicare Part B premium is: -$XXX.xx
- $XXX.xx for the standard Medicare premium, plus
- $XXX.xx for the income-related monthly adjustment amount
(IRMAA) based on your 2017 income tax return
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Your 20xx deduction for the Medicare Part D plan is: - $XX.xx
(We will notify you if the amount changes in 20xx.)
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Your 20xx deduction for Medicare Part D IRMAA based on your 2017 income tax return
is: - $XX.xx
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Your benefit amount after deductions that will be deposited into your bank account
or sent in your check on January 3, 2018 is: $999.99
Your Medicare Premiums
If you are enrolled in Medicare Part B, your monthly Part B premium for 20xx includes
any surcharges for late enrollment or reenrollment, plus an IRMAA. Your monthly Part
B premiums, including the IRMAA, will be deducted from your Social Security benefits.
If you have Medicare Part D, your IRMAA for Part D coverage will be deducted from
your Social Security benefits no matter how you normally pay your Part D plan premium.
The law requires you to pay this amount in addition to your Part D plan premium. If
the Part D IRMAA is more than the benefit payment, we will not be able to deduct it.
If this happens, you will get a separate bill from the Medicare and you must pay this
amount to keep your Part D coverage.
Each year to decide if you must pay IRMAAs, we use your Federal income tax information
for the most recent tax year that is available. However, we do not use any information
that is more than three years old. We ask the Internal Revenue Service (IRS) for your
tax filing status, your adjusted gross income, and your tax-exempt interest income.
We then add your adjusted gross income together with your tax-exempt interest income
to get an amount that we call modified adjusted gross income (MAGI). We compare your
MAGI with the income thresholds set by Medicare law.
MAGI may include one-time only income, such as capital gains, the sale of property,
withdrawals from an Individual Retirement Account (IRA) or conversion from a traditional
IRA to a Roth IRA. One-time income will affect your Medicare premium for only one
year.
How We Figured Your IRMAAs
The IRS told us that for tax year 2017 you filed your taxes as married, filing jointly.
You had an adjusted gross income of $999,999.99 plus $999.99 in tax-exempt interest
income. We added these amounts together to get your MAGI of $999,999.99.
We used the following table to decide IRMAAs for the Medicare Part B and Part D premiums:
| |
|
Part B |
Part D |
| If you filed |
With MAGI of: |
IRMAA |
IRMAA |
| as: |
|
is: |
is: |
| Single, Head of |
$85,000.01 - $107,000.00 |
$53.50 |
$13.00 |
| household or |
$107,000.01 - $133,500.00 |
$133.90 |
$33.60 |
| Qualifying Widow(er) |
$133,500.01 - $160,000.00 |
$214.30 |
$54.20 |
| |
$160,000.01 - $499,999.99 |
$294.60 |
$74.80 |
| |
More than $499,999.99 |
$321.60 |
$83.10 |
| Married, filing |
$170,000.01 - $214,000.00 |
$53.50 |
$13.00 |
| jointly |
$214,000.01 - $267,000.00 |
$133.90 |
$33.60 |
| |
$267,000.01 - $320,000.00 |
$214.30 |
$54.20 |
| |
$320,000.01 - $749,999.99 |
$294.60 |
$74.80 |
| |
More than $749,999.99 |
$321.60 |
$83.10 |
| Married, filing |
$85,000.01 - $414,999.99 |
$294.60 |
$74.80 |
|
separately
(if you lived apart throughout 2017, see below about Some Special Situations)
|
More than $414,999.99 |
$321.60 |
$83.10 |
These IRMAAs are effective for 20xx only. Next year when we receive updated information
from the IRS, we will make a new decision about any IRMAA owed.
Some Special Situations That May Apply To You
If your tax filing status was married, filing separately, and you lived apart from
your spouse throughout the tax year we used, please call us about your living arrangement.
It could lower your IRMAAs. We will set up an appointment to discuss that information.
You will need to bring a copy of the most recent income tax return you filed with
IRS to the appointment.
If Your Income Has Gone Down
In some situations, we can make a new decision about your IRMAAs. Contact us to request
a new decision if your MAGI has gone down at least one range in the table above or
has gone below the lowest amounts in the table since the 2017 tax year, AND the decrease
in MAGI was caused by any of the following life-changing events:
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You divorced, or your marriage was annulled;
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You became a widow or widower;
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You or your spouse stopped working or reduced work hours;
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You or your spouse lost income from income-producing property due to a disaster or
other event beyond your control;
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You or your spouse experienced a scheduled cessation, termination, or reorganization
of an employer's pension plan; or
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You or your spouse received a settlement from an employer or former employer because
of the employer's closure, bankruptcy, or reorganization.
We will use the new lower MAGI to see if we can make a new decision about your IRMAAs.
We cannot make a new decision if your income has changed for a reason other than those
listed above, such as receiving one-time income from capital gains.
You will need to submit proof of the event listed above that caused your income to
go down (such as a death certificate, a letter from your pension fund administrator,
or a letter from your employer about your retirement). If you filed an amended or
corrected tax return for the year you want changed, you will also need to submit a
copy of the tax return with proof the IRS has received it.
If your MAGI has gone down at any time during January through September, you will
need to tell us before the end of that year so we can correct your IRMAAs in that
year. However, if the event that makes your MAGI go down did not occur until October
1 or later in the year, we can correct your IRMAAs for that year if you tell us before
the end of March of the following year.
If The Information We Used Is Incorrect
We based the IRMAAs on information we received from the IRS. If you have proof that
the information we received from the IRS was not correct, please contact us to ask
for a new decision about your income-related Medicare premiums. If you filed an amended
tax return for that year, you will need to show us a copy of your amended Federal
income tax return. You also will need to show us a letter or transcript from the IRS
acknowledging receipt of your amended return. If the IRS corrected their records of
your tax information for the year we used, you will need to show us the letter you
received from the IRS. If you do not have all this information, the IRS can help you
get it.
If we have included an IRMAA for your Part D coverage, and you do not have Medicare
Part D coverage, please contact the Centers for Medicare & Medicaid Services (CMS)
at 1-800-MEDICARE (1-800-633-4227; TTY1-877-486-2048). CMS is the only agency that
can correct the information about your Part D.
If You Disagree With Our Decision
If you disagree with our decision about your IRMAAs, you have the right to:
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Request a new decision if your income has gone down due to any of the life-changing
events listed above; or
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Request a new decision using more recent tax information if you have amended or corrected
tax information for 2017, or if we used tax information for 2016.
If you qualify for a new decision on your IRMAAs, we will make a new decision using
your tax information. If we make a new decision, you will be able to file an appeal
on the new decision.
If You Want To Appeal This Decision
If you disagree with this decision about your IRMAAs, you have the right to appeal.
We will review the decision we made to verify it is correct. A person who did not
make the first decision will decide your case.
If you do appeal, we may start withholding your increased premiums before we make
our decision on your appeal. If we change our decision about your IRMAAs, we will
correct the amounts and refund any incorrectly withheld premiums.
We based the IRMAAs of your Medicare Part B and Part D premiums on information we
received from the IRS. If you request an appeal because you believe that the IRS information
is incorrect, we will give you information on how you can contact the IRS to obtain
evidence to support your request for a new decision. If you request an appeal because
we included amounts for your Part D premium and you do not have Medicare Part D coverage,
you need to contact the Centers for Medicare & Medicaid Services (CMS) at 1-800-MEDICARE
(1-800-633-4227; TTY 1-877-486-2048). CMS is the only agency that can correct the
information about your Part D coverage.
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You have 60 days to ask for an appeal.
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The 60 days start the day after you get this letter. We will assume you received this
letter 5 days after the date of the letter, unless you show us that you did not get
it within the 5-day period.
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You must have good reason for waiting more than 60 days to ask for an appeal.
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You may contact one of our offices to file your appeal. You may also visit www.ssa.gov/non-medical/appeal to appeal online, or you can call 1-800-772-1213 for help.
If You Want Help With Your Appeal
You may choose to have a representative help you. We will work with this person just
as we would work with you. If you decide to have a representative, you should find
one quickly so that person can start preparing your case.
Many representatives charge a fee only if you receive benefits. Others may represent
you for free. Usually, your representative may not charge a fee unless we approve
it. Your local Social Security office can give you a list of groups that can help
you find a representative.
If you get a representative, you or that person must notify us in writing. You may
use our Form SSA-1696 "Appointment of Representative." Any local Social Security office
can give you this form.
Other Important Social Security Information
What If I Work In 20xx?
If you are at full retirement age (now age 66) or older for all of 20xx, you may keep
all of your benefits no matter how much you earn.
If you are younger than full retirement age at any time in 20xx, there is a limit
to how much you can earn before we reduce your benefits. Continuing to work could
result in withholding some of your benefits. However, we would adjust your benefit
amount once you reach full retirement age to account for the months of withheld benefits.
Also, we use your 35 highest years of earnings to calculate your benefits. If you
continue to work and these earnings are higher than one of the years we used to compute
your benefit, your benefit amount may increase. Tell us right away if you expect to
earn more than the limit, so we can pay you correctly.
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The 20xx earnings limit for people under age 66 all year is $XX,XXX. We deduct $1
from your benefits in 20xx for each $2 you earn over $XX,XXX.
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The 20xx earnings limit for people turning age 66 is $XX,XXX. We deduct $1 from your
benefits in 20xx for each $3 you earn over $XX,XXX until the month you turn age 66.
What If I Worked In 2018?
If you were under full retirement age in 2018 and worked, we paid your benefits based
on your estimate of how much you would make. We will adjust your benefits as necessary
when your employer reports your earnings on your W-2 form. If the earnings on your
2018 W-2 form(s) include money you earned in another year, please contact us before
April 15, 2019, to let us know.
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The 2018 earnings limit for people under age 66 all year was $17,040.
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The 2018 earnings limit for people who turned age 66 in 2018 was $45,360.
To Access “my Social Security” Online Services
Go to www.socialsecurity.gov/myaccount to create a my Social Security online account to check your benefits and make sure your contact information is up
to date. If you have Medicare, it is important that you keep your address up to date
with us. You can change your address or telephone number, start or change direct deposit
of your benefits, get a replacement Medicare card, and get a benefit verification
letter online.
Rules For Certain Family Members
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Tell us if you marry or remarry if you get benefits as a widow, widower, parent, or
child.
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Tell us if a child who gets benefits no longer lives with you.
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Tell us if a stepchild gets benefits from your work, and you and the stepchild’s parent
divorce.
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Tell us if you divorce or your spouse dies if you get benefits as a spouse.
Life Changes May Affect Eligibility For Federal Benefits
It's not unusual for people’s circumstances to change after they apply for or start
receiving benefits. These changes may increase your Federal benefits. For example,
if your spouse or ex-spouse dies, you may qualify for a higher Social Security benefit.
Visit www.ssa.gov/potentialentitlement to find out more. You also can use the Benefit Eligibility Screening Tool at www.ssabest.benefits.gov/ to find out about benefits from Social Security.
Suspect Social Security Fraud?
If you suspect Social Security fraud, please visit https://oig.ssa.gov/report or call the Inspector General’s Fraud Hotline at 1-800-269-0271 (TTY 1-866-501-2101).
Help Prevent Identity Theft
Be aware of scams through the mail, Internet, telephone, or in person. You should
be careful when someone asks for personal information, especially your Social Security
number. Please visit www.usa.gov/identity-theft to find out more.
Other Help For Seniors
Call the Eldercare Locator service of the U.S. Administration on Aging at 1-800-677-1116
or visit their website at www.eldercare.acl.gov to learn about a wide variety of services that may be helpful to you.
If You Have Questions
If you have any questions about this letter, please:
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Visit our website at www.socialsecurity.gov to find general information about Social Security.
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Call us toll-free at 1-800-772-1213. We can answer most questions over the phone.
If you are deaf or hard of hearing, our toll-free TTY number is 1-800-325-0778.
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Write or visit any Social Security office. The office that serves your area is located
at:
123 MAIN ST
SEATTLE, WA 97210
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If you are outside the United States, please contact your Federal Benefits Unit. Visit
www.ssa.gov/foreign/foreign.htm for a list of Federal Benefits Units.
Please have your full Social Security claim number available when you call or visit
and include it on any letter you may send to us.
For questions about Medicare coverage, please visit www.medicare.gov or call
1-800-MEDICARE (1-800-633-4227; TTY 1-877-486-2048).
Social Security Administration