Example of a situation when this notice would be sent: Mr. Jones files a claim for
Medicare benefits at age 65. He knows that we will be requesting IRS information,
and he believes it will show that he has MAGI above the threshold. He reports his
partial work stoppage and reduction of his MAGI to a below-threshold amount. We hold
his information for use after the IRS data exchange; however, the IRS does not return
any MAGI information about Mr. Jones. We dismiss his request for a new initial determination
and he will not pay IRMAA.
Part B Premium
Date: November 24, 2006
Claim Number: xxx-xx-xxxxA
This is about your request for a new initial determination about your Medicare Part B income-related premium amount for 2008. You provided us information about your income to use in considering your request for a new initial determination.
About Your Request for a New Decision
We cannot make a new initial determination in your case because the Internal Revenue
Service did not report to us that your modified adjusted gross income in your most recent filed income tax return was higher than the income-related premium threshold
for a Medicare Part B income-related premium. Because of the IRS information we received,
we will not charge you an income-related adjustment to your Medicare Part B premium.
Since we can not determine whether the information you provided shows a lower income
than the amount in the IRS records, we must dismiss your request.
If You Have Any Questions
If you have questions about your Medicare coverage, call 1-800-MEDICARE (1-800-633-4273,
If you have questions about your Medicare Part B premium, please visit www.medicare.gov
on the Internet. For general information, you can visit our website at www.socialsecurity.gov.
You also can call us at 1-800-772-1213 and speak to a representative from 7 a.m. to
7 p.m. on business days. If you have a touch-tone phone, recorded information and
services are available 24 hours a day. We can answer most questions over the phone.
If you are deaf or hard of hearing, you can call our TTY number, 1-800-325-0778).
You can call your local Social Security office at 1-555-332-0545. You can also write
or visit any Social Security office. The office that serves your area is located at:
2315 Second Avenue North
Dodge, IA 50501-9918
If you do call or visit an office, please have this letter with you. It will help
us to answer your questions. Also, if you plan to visit an office, you may call ahead to make an appointment.
This will help us serve you more quickly when you arrive at the office.