It is used to request a reduction of your Medicare Part B and Part D income‑related monthly adjustment amount (IRMAA) after a qualifying life‑changing event.
Events include marriage, divorce, death of a spouse, work reduction, work stoppage, loss of income‑producing property, loss of pension or settlement payments and receipt of employer payment.
IRMAA is an additional premium that higher‑income beneficiaries pay for Medicare Part B and Part D; it is based on your modified adjusted gross income (MAGI).
You must supply your current and past MAGI, the life‑changing event date, evidence of the event and an estimate of your reduced income for the following year.
Yes. You can provide a reasonable estimate of your MAGI for the following tax year if your income has changed because of a life‑changing event.
Attach proof of the life‑changing event—such as a marriage certificate, divorce decree, employer letter or death certificate—and proof of your current reduced income.
You may submit another Form SSA‑44 with updated information to request further reduction of your IRMAA.
Mail or deliver the completed form and evidence to your local Social Security office; you can also call Social Security for assistance.
