them. a beneficiary submits an SSA-561-U2 (Request for Reconsideration) and disagrees with If a beneficiary has questions concerning a pending appeal or about appealing a decision You must enter any beneficiary alleged transactions associated with this input. located on each page. to file a tax return for that tax year. the new initial determination is denied or dismissed, the individual is now outside the appeals period, and. The beneficiary states he has information to add to his pending reconsideration. OMHA appeal numbers starting with "3-" are available in AASIS as of February 2018. This should be the date of the Initial Notice to Impose IRMAA or the IRMAA; NOTE: This only applies if the reviewed information is the same information SSA used to It is important to remember that IRMAAs apply for only one year. on the EVID screen in Shared Processes. HI 01140.001D in this section, Appeals processing procedures for service representatives (SR) and 800 number agents (N8NN) HI 01140.005 The Reconsideration Process for Income-Related Monthly Adjustment Amount (IRMAA) B. Effective January 1, 2007, Part B beneficiaries with incomes above a certain threshold amount (about 4% to 5% of all Part B beneficiaries) are subject to an adjustment of the amount of the premium that they must pay for Part B insurance. request at the same time. We can use certain events to make a new determination without filing an appeal. The level of the Income-Related Monthly Adjustment Amount (IRMAA) appeal determines Disposition Select either Fully Favorable Reversal or Partially Favorable Reversal 1. Tracking System. An IRMAA appeal is a petition that you can file with Social Security to reduce your Part B premium if you feel there is a compelling reason why you should NOT pay this higher premium. If the beneficiary is unable to submit the documents immediately, or if he or she > Medicare Part B Premium Appeals. record the evidence submitted on the EVID screen in Shared Processes. does not have a letter, he or she can get a transcript of the amended tax return from Pressing Once all information has been input in the IRMAA Appeals Tracking System and the IRMAA PCOM screens, destroy the paper SSA-561-U2, Request for Reconsideration. Input the Premium Year applying to the new initial determination. same premium year, you must evaluate all the information received and determine if she can request a new initial determination. C34 with IRMAA HEAR as the issue. Non-beneficiary requests for hearing are entered into the OMHA case tracking system on average within one week after receipt. If you meet the criteria (more on that below), you can file an appeal with Medicare to get your premiums lowered. Click here for the form. In order to appeal IRMAA you will need to fill out form SSA-44 titled "Medicare Income-Related Monthly Adjustment Amount - Life Changing Event". the beneficiary insists on filing a reconsideration based on information received Annotate the Remarks field if good cause is involved and established. the submission of evidence. that could affect a spouse or ex-spouse, we do not extend its findings to the non-reporting Enter Y in the Appeal Involved field. qualifies for a new initial determination and agrees to file a request for a new initial Check the MBR to verify this is the correct representative payee transactions associated with this. If unable to contact the beneficiary by phone, send the DPS IRMAA Request For Information Query the MBR, EVID, and IRMAA screens for any updates, as it is possible that another filing of the appeal select Yes. In the Remarks field, document any information related to the LCE or leave blank. new initial determination-tax information, or new initial determination-non qualifying Good Cause - If good cause is involved and the beneficiary has good cause for late If the beneficiary still has questions about the reconsideration, set up an appointment Remarks Remarks are mandatory. Recording an IRMAA reconsideration request is a three-step process: 1. Beneath the following equation is specific information on each component of your premium. After completing all the required screens, record the evidence submitted on the Otherwise, select the process the request and contact the FO to direct them to the instructions contained IRMAA. follow instructions on using corrected IRS tax data in HI 01120.050. the request. being appealed and reason for the appeal. using the same information. Law/Regulation Select all that apply. new initial determination-tax information or new initial determination-non qualifying process uses new initial determinations. ); 2. Shared Processes (See GN 00301.286 through GN 00301.300 and MSOM EVID 001.003). The Social Security Administration (SSA) uses your income tax information from 2. On this screen, the fields are: the filing date, which is the date the reconsideration was filed. an issue, select other and document your good cause determination in the Remarks. the beneficiary alleges there is a copy of a tax return from two years before the NOTE: If the PC receives a request directly from the beneficiary, or erroneously from It is important to note that your appeal will not appear in the AASIS system until it has been entered into OMHAs case tracking system and uploaded to AASIS. > Appeals Status Lookup. Even if you haven't experienced a life-changing event, you can still appeal an IRMAA. evidence of a life-changing event (LCE) and more recent or accurate tax information. that would qualify him or her for a new initial determination. Select the appropriate option based on the information provided in the Desired Function tax exempt interest income (TEI), and. You can inform the beneficiary what the decision is using the information provided 2. to the Attestation Statement. > Filing An Appeal Results field will provide the appeal determination based on the information entered. you received a new initial determination request and mailed it on mm/dd/yy. There's also an IRMAA surcharge for 8% of Medicare beneficiaries who have Part D plans . EVID screen in the Shared Processes (See GN 00301.286 through GN 00301.300 and MSOM EVID 001.003). separately, see HI 01120.001 through HI 01120.060. and jurisdiction in order to provide accurate information. NOTE: If you select 1, Use Highest Probative Data on the PYTY, the tax data propagates NOTE: If the beneficiary alleges error in tax-exempt interest income, see HI 01120.050F. The AdQIC subsequently has 10 days to update the appeals tracking system and to decide whether the case requires further review by the Medicare Appeal Council (referred to interchangeably as the Departmental Appeals Board, or DAB) or is sent to the Medicare administrative contractor (MAC) for payment. follow instructions on using amended income tax returns in HI 01120.045. Contact us at (866) 611-7829 or staff@ruby.com . attach a route slip to the evidence stating New Initial Determination Request, Recon The IRRE Screen will display the current and recalculated IRMAA data. Access the intranet IRMAA Appeals 6 Strategies for Avoiding IRMAA Issues. We make IRMAA determinations based on information the IRS provides electronically. or (202) 565-0100. Check and review the IRMAA Appeals Tracking System to determine if an appeal is pending; If an appeal is pending, review the information in the Appeals Tracking System to was made previously. All requests for a new initial determination require that the beneficiary provide If good cause was an issue, document your good cause determination. The IRRE Screen will display the current and recalculated IRMAA data. The IRMAA Appeals Tracking System shows the case is located in HHS and the beneficiary the event description, which can be initial determination, new initial determination-LCE, Some circumstances allow us to use the modified adjusted gross income (MAGI) information (See MSOM T2PE 008.001 through MSOM T2PE 008.017.). Enter the determination date (l usually the current date) in Date of Appeal Determination. a statement from the beneficiary estimating the MAGI. When should I get it? Select 2 Tax information in theDesired Function field. event, the SSA-44, Medicare Income-Related Monthly Adjustment Amount Life Changing Event is available As explained in HI 01101.010, a beneficiary's Income-Related Monthly Adjustment Amount (IRMAA) is determined based (For an explanation of Highest Select Other In the Remarks explain the MAGI allegations and filing status alleged NOTE: If a beneficiary alleges electronic filing, ask the beneficiary to print and sign 7. Explain the additional required and proof is not available, show proof as PENDING.. the case to the FO. 008.019). NOTE: A beneficiary can file an appeal and request a new initial determination at the same cases, this will be the current date; however it can be a prior date if the determination The new initial determination request will result in a change of the current IRMAA The reason for your appeal must be one of the following: Marriage. If an appeal is pending and you receive a new initial determination request for the proof is not available, use the allegation of the beneficiary. C. Referrals to the Office of Medicare Hearings and Appeals (OMHA) or the Medicare Appeals Council (MAC) Inform the beneficiary if the reconsideration is still pending or if there is a decision. send an e-mail to the mailbox of the office with the pending appeal and advise that The New Determination Processes. Enter the premium year the beneficiary is appealing. Law/Regulation Select LCE Reg #418.1201 and Calculations of IRMAA Reg #418.1120. the beneficiary insists on filing a reconsideration and provides information that status that results in the use of a lower threshold table, the beneficiary can qualify For 2020, the base premium is $144.60 per month. Check and review the IRMAA Appeals Tracking System to determine if an appeal is pending; 4. If you do not receive proof within the additional The FO will Menu. In the Remarks field enter, Information provided qualifies for new initial determination, The reconsideration request received is outside of the appeal period and no good cause In Date of Appeal Determination enter the date the determination is made (this will The income-related monthly adjustment amount (IRMAA) applies to people enrolled in Medicare who have incomes above a certain amount.