This notice informs the beneficiary that SSA plans to collect an arrearage of IRMAA
as a result of MAGI information received from IRS during the verification data exchange.
This notice will explain:
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That a higher IRMAA will apply for the premium year verified,
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What MAGI information was received from IRS,
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What the IRMAA will be for Medicare Part B and Medicare prescription drug coverage
as applicable for the premium year verified,,
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What the total Medicare Part B premium will be for Title II beneficiaries,
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When SSA plans to make the IRMAA change effective,
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How SSA made the determination, and
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What the beneficiary can do if the tax information provided by IRS is wrong or the
beneficiary filed an amended tax return or has an IRS letter of correction for the
verified year.
This notice does not contain appeal rights but will invite beneficiaries to contact
SSA within 10 days if the information is incorrect before SSA makes a change to the
verified premium year.
After 20 days (5 days mailing time, 10 days for the beneficiary to contact SSA and
5 more days of mailing time), SSA sends an IRMAA Annual Verification Correction notice
with appeal rights.
NOTE: A beneficiary who disagrees with the information in a predetermination notice may
request a new initial determination under certain circumstances. See HI 01120.001 for more information on new initial determinations. If the beneficiary insists on
filing an appeal based on a predetermination notice, we must accept his or her appeal
request. Follow the appeals instructions in HI
01140.001D and HI 01140.005C through HI 01140.005E.