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

• •

  Introductory (no caption)

  MIR093 R

  MIR094 R

• •

  Caption MIRC02 – Another Letter

  MIR012 O

• •

  Caption INFC01 – The Information We Have

  MIR107 R

  MIR002 R

  MIR065 R

  MIR016 O

  MIR006 O

  MIR007 R

  MIR017 o

  MIR008 R

• •

  Caption MIRCO4 – How We Decided Your Income-Related Premium Amount

  MIR102 O

  Or MIR103 O

  MIR106 O

  MIR105 O

  MIR108 O

  Or MIR109 O

  MIR019 O

  MIR020 O

  MIR114 O

• •

  Caption ALSC19 – If You Disagree With This Decision

  ALS162 R

• •

  Caption REPC01 – If You Want Help With Your Appeal

  REP031 R

• •

  Caption 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 Overage Notices for Non-T2 beneficiaries. An “R” indicates a required paragraph, while an “O” indicates an optional paragraph.

• •

  Introductory (no caption)

  MIR093 R

  MIR094 R

• •

  COPC01 – Other Information

  MIR122 (OPM) O

  MIR124 (RRB) O

• •

  INFC01 – The Information We Have

  MIR107 R

  MIR018 R

• •

  MIRC04 – How We Decided Your Income-Related Premium Amount

  MIR102 O

  Or MIR103 O

  MIR106 O

  MIR105 O

  MIR108 O

  Or MIR109 O

  MIR019 O

  MIR020 O

  MIR114 O

• •

  ALSC19 – If You Disagree With This Decision

  ALS162 R

• •

  REPC01 – If You Want Help With Your Appeal

  REP031 R

• •

  REFC01 – If You Have Any Questions

  REF093 (RRB) O

  REF103 O

  REF104 O

  REF106 O