TN 1 (03-07)
HI 01194.075 IRMAA Reconsideration Reversal (Notice Type 600)
We send a reconsideration reversal letter when IRMAA changes as a result of our reconsidered determination. This letter will be generated when a beneficiary who has a qualifying circumstance for a new initial determination insists on filing a reconsideration of our initial determination. Reconsideration reversal notices contain appeal rights.
Example: We send an initial determination notice to Mr. Thomas which tells him that he will have to pay IRMAA in 2007, based on MAGI information from his tax return from 2005. Mr. Thomas had MAGI in 2005 that was over the threshold amount, due to his partial work stoppage. He contacts the field office, and requests a reconsideration. He is eligible for a new initial determination, because he has had a qualifying major life-changing event; however, he insists on filing a reconsideration. We process a “Reversal” determination following the procedures in HI 01140.005, and the system issues a reconsideration reversal notice.
B. Sample – IRMAA Reconsideration Reversal, Title II Beneficiary
Social Security Administration
Medicare Part B Premium
Claim Number: xxx-xx-xxxxA
On March 1, 2007, we told you that we had decided that you would have to pay an income-related premium amount of $30.90 a month for 2007. On March 17, 2007 you asked us to take another look at our decision about your income-related premium amount. Someone who did not make the first decision reviewed your case, including any new facts we received. After reviewing all the information carefully, we agree that we did not figure the income-related amount of your Medicare Part B premium correctly. In this letter, we will explain the information we used, and tell you what you should do if you disagree with our decision.
Your 2007 monthly Medicare Part B premium should have been: $102.90
This change will be effective January, 2007.
You will get another letter explaining how this will affect your Social Security benefits.
How We Decided Your Income-Related Premium Amount
To decide if your income is high enough that you must pay an income-related adjustment, the Internal Revenue Service (IRS) gave us information about your modified adjusted gross income (MAGI) from your income tax return for 2005. MAGI is the sum of your adjusted gross income plus certain amounts of income that are not taxable. For most people, MAGI is the sum of adjusted gross income and tax-exempt interest income on IRS form 1040.
IRS told us that you filed your Federal income tax with a filing status of Single and adjusted gross income of $85,780.00.
You reported new information about your income. You said that your MAGI was $68,300.00 in 2006 and that your tax filing status was Single. We used the following table to decide your income-related adjustment:
If your filing status was:
And your MAGI was:
Then your income-related monthly adjustment amount is:
Single, Head of household or Qualifying widow(er)
$ 80,000.01 - $ 100,000.00
$ 100,000.01 - $ 150,000.00
$ 150,000.01 - $ 200,000.00
More than $ 200,000.00
Married, filing jointly
$ 160,000.01 - $ 200,000.00
$ 200,000.01 - $ 300,000.00
$ 300,000.01 - $ 400,000.00
More than $400,000.
Married, filing separately (if you lived apart throughout the year, see below)
$ 80,000.01 - $ 120,000.00
More than $ 120,000.00
If You Have Other Information About Your Income
The law permits us to use other information about your MAGI under certain circumstances. If any of the situations in the list below apply or if they occur later this year, you should contact us and explain that you have new information about your Medicare Part B income-related premium. You can call us at 1-800-772-1213 (TTY 1-800-325-0778 for the hearing-impaired) or visit any Social Security office to discuss the following situations:
You should contact us as soon as you know about any of the situations listed above. We will be able to tell you what kind of evidence you need to give us about the situation and your change in MAGI.
If you believe that the information IRS gave us is incorrect, contact the IRS to get IRS's copy of 2005 tax return. You can call us if you have any questions.
If You Disagree With This Decision
If you disagree with this decision, you have the right to request a hearing. A person who has not seen your case before will look at it. That person is an Administrative Law Judge (ALJ) from the Department of Health and Human Services of the U.S. Government. The ALJ will review your case again and look at any new facts you have before deciding your case.
If you do appeal our decision, you will have to pay an income-related premium amount until the ALJ makes a decision on your appeal. If the ALJ changes our decision about your income-related premium amount, we will make retroactive corrections to any incorrect income-related premium amounts.
You have 60 days to ask for a hearing.
The 60 days start the day after you receive this letter. We assume that you got this letter 5 days after the date on it unless you show us that you did not get it within the 5-day period.
You must have good reason for waiting more than 60 days to ask for a hearing.
You have to ask for a hearing in writing. We will ask you to sign a form HA-501-U5, called "Request for Hearing by Administrative Law Judge" and an authorization for us to release information about 2005 tax return to the Department of Health and Human Services, form 8821. You can find these forms online at www.socialsecurity.gov, at an SSA field office or by calling us at 1-800-772-1213 to request the forms. If you are deaf or hard of hearing, you can call our TTY number, 1-800-325-0778. If you download these forms, you should complete and sign them and mail them to: Social Security Administration, Southeastern Program Service Center, P.O. Box 12247, Birmingham, AL 35202.
The ALJ will mail you a letter at least 20 days before the hearing to tell you the date, time and place. The letter will explain the law in your case and tell you what has to be decided. Since the ALJ will review all the facts in your case, it is important that you give us any new facts as soon as you can.
The hearing is your chance to tell the ALJ why you disagree with the decision in your case. You can give the ALJ new evidence and bring people to testify for you.
If You Want Help With Your Hearing
You can have a friend, lawyer, or someone else help you. Your local Social Security office has a list of groups that can help you.
If You Have Any Questions
If you have questions about your Medicare coverage, call 1-800-MEDICARE (1-800-633-4273, TTY 1-877-486-2048).
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 also write or visit any Social Security office. The office that serves your area is located at:
Address of field office
If you 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.