The following list contains the sequencing of captions and paragraphs for Income-Related Monthly Adjustment Amount (IRMAA) Annual Verification Predetermination Notices for T2 beneficiaries. An “R” indicates a required paragraph, while an “O” indicates an optional paragraph.

• •

  Introductory (no caption)

  MIR092 R

  MIR094 R

  MIR095 R

• •

  INFC01 – The Information We Have

  MIR107 R

  MIR002 R

  MIR065 R

  MIR006 O

  MIR007 R

  MIR017 O

  MIR120 R

• •

  MIRC04 – How We Decided Your Income-Related Premium Amount

  MIR102 O

  Or MIR103 O

  Or MIR115 & MIR116 O

  MIR108 O

  Or MIR109 O

  MIR019 R

  MIR020 R

  NOTE: If MIR115 generates, MIR116 is required.

• •

  MESC01 – What You Can Do

  MIR110 R

• •

  REFC01 – If You Have Any Questions

  REF103 O

  REF104 O

  REF106 O

The following list contains the sequencing of captions and paragraphs for IRMAA Annual Verification Predetermination Notices for Non-T2 beneficiaries. An “R” indicates a required paragraph, while an “O” indicates an optional paragraph.

• •

  Introductory (no caption)

  MIR092 R

  MIR094 R

  MIR095 R

• •

  INFC01 – The Information We Have

  MIR107 R

  MIR121 R

• •

  MIRC04 – How We Decided Your Income-Related Premium Amount

  MIR102 O

  Or MIR103 O

  Or MIR115 & MIR116 O

  MIR108 O

  Or MIR109 O

  MIR019 R

  MIR020 R

  NOTE: If MIR115 generates, MIR116 is required.

• •

  MESC01 – What You Can Do

  MIR110 R

• •

  REFC01 – If You Have Any Questions

  REF093 (RRB) O

  REF103 O

  REF104 O

  REF106 O