200 Independence Avenue, S.W. or her spouse at all during that tax year. Date of Determination Enter the date of the determination. the beneficiary provides, rather than the information we receive from IRS to make NOTE: Complete all other screens as if you are processing a request for a new initial determination. If you select 1, use the highest probative value, the system will process the determination Input the same exact AGI and TEI currently used to determine the IRMAA. The Southeastern Program Service Center (SEPSC) A beneficiary will be notified by SSA near the end of the current year if he or she has to pay an IRMAA for the upcoming year. Check your claim status with your secure Medicare account, your Medicare Summary Notice (MSN), your Explanation of Benefits (EOB), Medicare's Blue Button, or contact your plan. On the Select Filing Status field, enter the appropriate filing status for the beneficiary. transactions associated with this input. A new initial determination is a new decision we make that does not require reopening Input the Tax Year the beneficiary requests we use to determine the IRMAA. Finding of Fact Select all that apply. IRMAA. a beneficiary requests a new initial determination, but does not have evidence readily > Filing An Appeal is located on the notice from OMHA or the MAC confirming receipt of the appeal request. Occasionally, the PC may receive a request from a beneficiary directly or from the You can inform the beneficiary what the decision is using the information provided SSA field offices handle all reconsiderations. that would qualify him or her for a new initial determination. IRMAA stands for Income Related Monthly Adjustment Amount. Law/Regulation Select Good Cause - Reg #404.911 and any others that apply. is no good cause for late filing. Results field will provide the appeal determination based on the information entered. The Part B insurance premium is set annually by the CMS. If an appeal is pending, review the information in the Appeals Tracking System to determine if the NEW INITIAL DETERMINATION request is for the same premium year as the appeal. These their Initial Determination, an LCE, More Recent Tax Information or Non-Qualifying Process the dismissal on the IRMAA Results (IRRE) screen. Proof Submitted Answer Yes if the beneficiary provided any additional documentation. year or alleges he or she was not required to file a tax return for the tax year two IRMAA but disagrees with the constitutionality of imposing IRMAA; Access the IRMAA screens (See MSOM T2PE 008.001 through MSOM T2PE 008.017). filing information related to the request. Prepare another 15-day tickle or PCACS diary (or 90 days if the beneficiary requests of a notice. For married couples filing joint. PCOM Screen from the process in HI 01140.005D in this section). Disposition Select either Fully Favorable Reversal or Partially Favorable Reversal imposition of IRMAA. Tracking System. When a field office or PC receives a request for a new initial Some examples of appeal requests are the: beneficiary disagrees with the IRMAA determination because he or she does not agree NOTE: If a processing limitation exists, the PC must process a manual action. Appealing Your Part B Premium As a beneficiary, you have the right to appeal if you believe that an Income Related Monthly Adjustment Amount (IRMAA) is incorrect for one of the qualifying reasons. If the FO has not taken action and it appears the transfer was in error, If the PYTY screen appears, there is data on file for the tax year requested and it on completing evidence screens, see GN 00301.286 through GN 00301.300 and MSOM EVID 001.003. Recording an IRMAA reconsideration request is a three-step process: Initiate the appeal by annotating the IRMAA Appeals Tracking System, then, Input the request on the IRMAA PCOM screens where a determination will be processed See HI 01120.001E. Law/Regulation Select Corrected IRS Tax Information Reg #418.1335. Note: The data also propagates to the IRMA screen. is requesting status or providing new information; such as change of address or phone This system allows you to check the status of appeals you have filed with the Office of Medicare Hearings and Appeals (OMHA). Appeal records and data in AASIS are generally updated weekly, with appeals that were entered into the OMHA case tracking system during the prior week. event. The FO will For example, Social Security would use tax returns from 2022 to determine your IRMAA in 2024. and effectuated, then, Post the decision to the IRMAA Appeals Tracking System. screen. determination and the pending appeal is MAC jurisdiction. If a beneficiary has questions concerning a pending appeal or about appealing a decision time. Remarks Explain that the system is not computing the correct level of IRMAA for Documentation is essential for an appeal. has a centralized unit that controls all appeals past the reconsideration level. It is the responsibility of the affected beneficiary to contact A beneficiary has questions concerning a pending reconsideration, Access the IRMAA Appeals In this case, the determination should be "Affirmation.". Click the YES radio button to enter a new appeal and then click continue. establish his or her IRMAA, as Married Filing Separately and did not live with his to support an error.. The "New Determination See HI 01120.001I to determine what evidence must be submitted and what process to follow. payee name for beneficiary's name. in most situations, a new initial determination can provide the beneficiary with the Re-input the same information currently used in the IRMAA determination to determine the beneficiary insists on filing a reconsideration based on information received (For instructions Post the decision to the IRMAA Appeals Tracking System. (See GN 00301.286 through GN 00301.300 and MSOM EVID 001.003.). using an amended tax return, see HI 01120.045A.1. after reviewing the information received, you determine SSA did not compute the beneficiary's follow instruction on married, filing separately when the beneficiary did not live (Request for Reconsideration), answer YES to the attestation question. Check and review the IRMAA Appeals Tracking System to determine if an appeal is pending; 4. make the correct inputs for a reconsideration determination. is pending in the same or another SSA office, for the same premium year. All requests for a new initial determination require that the beneficiary provide Advise the beneficiary to contact the OMHA central docketing unit at (855) 556-8475 NOTE: If the beneficiary alleges error in tax-exempt interest income, see HI 01120.050F. If there has been no update activity, contact the beneficiary to remind him or her she can request a new initial determination. Select Estimate for source code, if the tax year is a more recent tax year than Statement of Issues Select Beneficiary disagrees with the law. 008.019). married, filing separately when the beneficiary did not live with his or her spouse In REMARKS, enter IRMAA HEARING FILING ALLEGED, SYSTEM NIF.. and has no proof of the error, or. EVID screens, you may destroy all SSA-795s (Statement of Claimant or other person), MAGI or tax filing information related to the request. If we can establish good cause, a request filed outside of the allowable timeframes NOTE: A beneficiary can file an appeal and request a new initial determination at the same Select the appropriate option based on the information provided in the Desired Function If the MAC appeal is unsuccessful, your final recourse will be to appeal to the Federal District Court within 60 days of the council's denial. is using to determine the IRMAA, the beneficiary claims to have a copy of a tax return from two years before the premium to the Attestation Statement. Welcome to AASIS. would qualify him for a new initial determination; Enter Disposition Date Enter the date the reconsideration determination was made. Enter the premium year the beneficiary is appealing. a new initial determination on the beneficiary's behalf. into this field and you cannot change it. need to appeal the prior determination. them. from beneficiaries and requests transferred from the FO to the PC. is reporting. Washington, D.C. 20201 return or similar proof (such as a transcript), and submit the proof from IRS in order Click on the 'Your electronic case documents (PDF)' link to view the PDF. If the beneficiary These selections will depend on the Event being If another office completed the action, cancel any outstanding tickles or PCACS diaries. The IRRE Screen will display the current and recalculated IRMAA data. SSA-44 Follow the instructions in HI 01101.050C to determine if a beneficiary is requesting a new initial determination. If the premium year is the same, see HI 01140.011B in this section. all requests received. 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. The Department of Health and Human Services (HHS) has jurisdiction over all IRMAA OMHA appeal numbers starting with "3-" are available in AASIS as of February 2018. Select 2 Tax information in theDesired Function field. a beneficiary requests a new initial determination based on a qualifying event and Providing detailed information on the Medicare Part D program for every state, including selected Medicare Part D plan features and costs organized by State. online at, Internet: http://www.ssa.gov/online/ssa-44.pdf. Date Appeal Filed Enter the date the beneficiary filed the request for reconsideration. the EVID screen of Shared Processes (Selection Number 4 on the SSA Main Menu). send the new initial determination request to: The new initial determination request will not change the current IRMAA determination Enter the date of the determination (usually the current date) in the Date of Appeal a paper SSA-561-U2 submitted. NOTE: If a beneficiary alleges electronic filing, ask the beneficiary to print and sign Advise the beneficiary that we need evidence of both the LCE and the more recent tax adjustment amount (IRMAA) and you experienced a life-changing event that may reduce your IRMAA. process the request and contact the FO to direct them to the instructions contained Toll Free Call Center: 1-877-696-6775, Content created by Office of Medicare Hearings and Appeals (OMHA), U.S. Department of Health & Human Services, Office of Medicare Hearings and Appeals (OMHA), Medicare Beneficiary and Enrollee Appeals and Assistance, Whistleblower Protections and Non-Disclosure Agreements, Centers for Medicaid and Medicare Services (CMS). appeal. Because an IRMAA is based on the income . For evidence requirements for individuals It took 4 months for my appeal to be granted. the submission of evidence. field office because a processing limitation occurred. All reconsideration requests are processed by someone other than the person who made and the pending appeal is OMHA jurisdiction. For an overview of the appeals process for If the beneficiary still has questions about the reconsideration, set up an appointment After processing the reconsideration, process the request for a new initial determination Premiums vary from $13.20 to $89.60 per month through a Medicare approved carrier. All documentation provided by the beneficiary must be entered into the Shared Evidence Form . (eLAS) PE Appointment System using Event Type 9 "Medicare Issue" and select Event > About If the beneficiary sent in a signed paper SSA-561-U2 If a beneficiary has a representative payee, the beneficiary or the payee can request is no good cause for late filing. Disposition Select Affirmation (this is the disposition that is generated on the The IRRE Screen will display the current and recalculated IRMAA data. ); 2. a copy of the electronic return. This notice includes information about Social Security's determination and appeal rights. with his or her spouse all year in HI 01120.060. or Processing Center (see note in GN 03102.175B.2. Results" field will provide the appeal determination based on the information entered. If you've been notified that your premiums for either Medicare part B or prescription drug coverage include an IRMAA, then you can fill out and submit this form if you experience a life-changing event that reduces your income. Pending Same PY. notice and include the closeout paragraph with the request for evidence. The Notice, additional information about this form, and any other information regarding our systems and programs, are available on-line at www.socialsecurity.gov or at your local Social Security office. usually be the current date). the request as explained in HI 01120.005 through HI 01120.060. http://policy.ssa.gov/poms.nsf/lnx/0601120001. Request SEPSC to provide the beneficiary with status. so it can be posted to the IRMAA Appeals Tracking System as instructed in HI 01140.005E in this section. The information provided confirms the information provided by IRS is correct but the is based on the status of Married Filing Separately, but he or she did not live For information on If the beneficiary wants SSA to use a more recent year's tax return information or (this is the disposition that is generated on the IRRE PCOM Screen from the process A beneficiary may file a reconsideration request and a new initial determination If we require proof of the LCE and a beneficiary statement is not sufficient and the The definitions of the status indicators are: Query results will not display or print correctly for organizations using Internet Explorer 11 in "Enterprise Mode". If you want to appeal your IRMAA, you should visit the Social Security website and complete the Request for Reconsideration form. See HI 01120.001E. Attorney/Rep at the top of the screen. not be able to process the request to completion. is acceptable. Congress held down this cost in a spending bill passed earlier this year.The annual Part B deductible is increasing to $203, up from $198 in 2020.Many Medicare beneficiaries are unaware that higher income levels can trigger possibly lofty surcharges added The beneficiary files a reconsideration request outside of the appeal period and there **Income Related Monthly Adjustment Amount (IRMAA), Set by the Centers for Medicaid and Medicare Services (CMS). To get an appeal form, you can go into a nearby Social Security office, call 800-772-1213, or check the Social Security website. that could affect a spouse or ex-spouse, we do not extend its findings to the non-reporting the beneficiary insists on filing an appeal based on an event other than one listed The following chart provides references on circumstances allowing new initial determinations: Use of two-year-old tax return when we use IRS information from three years prior referring field office or processing center posts the disposition. The SSA-44 is only for beneficiaries wishing to request a new initial determination, based on Here's the bracket and how much you can expect to pay for Medicare Part B depending on your income from 2 years ago. system is applying the wrong IRMAA level or computing the MAGI incorrectly. NOTE: If a beneficiary has a representative payee, the beneficiary or the representative the event description, which can be initial determination, new initial determination-LCE, the request. The beneficiary may be eligible for a new initial determination. follow instructions in GN 00301.286 through GN 00301.300 and MSOM EVID 001.003. the evidence submitted is for proof of work reduction, the evidence submitted is for proof of work stoppage, the evidence submitted is for proof of loss of income-producing property, the evidence submitted is for proof of loss of employer pension income, the evidence submitted is for proof of an employer settlement payment, the beneficiary claims to have an amended tax return for the tax year that SSA is attach a route slip to the evidence stating New Initial Determination Request, Recon has questions about his or her IRMAA reconsideration. information that is more accurate to make his or her IRMAA determination(s), he or the new initial determination is denied or dismissed, the individual is now outside the appeals period, and. Initial IRMAA Determination What is it? Screens. on the: beneficiary's MAGI, which is the total of the Adjusted Gross Income (AGI) and certain beneficiary insists on filing an appeal and provides no new or additional information determination was made previously. in this section. IRMAA. new initial determination-tax information, or new initial determination-non qualifying Medicare Part D - also known as "prescription drug coverage.". you receive a new initial determination request, with supporting evidence and a reconsideration Initial IRMAA determination. Good Cause - If good cause is involved and the beneficiary has good cause for late In order to correct this, please have your system administrator add the AASIS URL to the Enterprise Mode exception list. The extra charge for Part B starts at $68 per month for those in the lowest income-adjustment bracket. beneficiary insists on filing a reconsideration based on IRS information being incorrect In the Remarks field, enter Disagrees with the constitutionality of the law.. the date of the event, which is the date of the event being appealed, and the Remarks Enter the determination into the IRMAA Appeals Tracking System.