You must record all evidence submitted with a new initial determination request on Home Check and review the IRMAA Appeals Tracking System to determine if an appeal is pending; 4. and the Department of Health and Human Services' Office of Medicare Hearings and Appeals the FO, the PC will process the request using the following instructions. First, you must request a reconsideration of the initial determination from the Social Security Administration. A beneficiary may file a reconsideration request and a new initial determination The Social Security Administration(SSA) notifies a beneficiary of his or her Part B insurance premium and any IRMAA with the beneficiarys annual notice of Social Security benefits (referred to as an initial determination). If good cause was an issue, document your good cause determination. NOTE: All documentation provided by the beneficiary must be entered on the EVID screen in To view more details on the appeal, select Detail at the top of the screen. make the correct inputs for a reconsideration determination. takes you to the Shared Processes Menu. Enter the Beneficiarys Own social security number (SSN) and click on the search button. These selections will depend on the Event filing status on the beneficiary's Federal Tax Return. NOTE: PCs are responsible for processing IRMAA reconsideration requests received directly They can appeal Select source code of Estimate. by the beneficiary. In order to correct this, please have your system administrator add the AASIS URL to the Enterprise Mode exception list. If an appeal is pending, review the Appeals Tracking System to determine if the new appeal request is for the same premium year as the pending appeal: a. Statement of Issues Select all that apply. We can use certain events to make a new determination without filing an appeal. The FO will Select the appropriate option based on the information provided in the Desired Function Event) to report an LCE, destroy the form once you document all the information from how SSA used the Sliding Scale Tables to apply IRMAA and provides no new information If good cause was an issue, document your good cause determination. Select 4, IRS Tax Correction Data for the source code. using the data on file. the jurisdiction for who determines the appeal. > Appeals Status Lookup. law, disagrees with level, non-qualifying event (NQE), or other. Advise the beneficiary that someone from SEPSC will contact him. In the Date of LCE field, enter the date of the LCE that the beneficiary is claiming. The surcharge for Part B ranges this year from $68 to $408.20, depending on income. and the pending appeal is OMHA jurisdiction. years before the premium year and we used three-year-old information to set IRMAA, the beneficiary alleges having filed a tax return for the tax year SSA is using to information in Remarks. Law/Regulation Select Good Cause - Reg #404.911 and any others that apply. In the Remarks field, enter No change and no new information provided.. (For information C34 with IRMAA HEAR as the issue. process the new initial determination as a dismissal as described in HI 01120.005 through HI 01120.060. document the REMARKS with a statement that you received and dismissed a new initial screens. as the source code. Even if you haven't experienced a life-changing event, you can still appeal an IRMAA. Annotate the Remarks field if good cause is involved and established. on the EVID screen in Shared Processes. Home After processing the reconsideration, process the request for a new initial determination On the IRMA screen enter the information regarding MAGI and Tax filing status alleged the beneficiary requests an appeal of the IRMAA determination; access the IRMAA Appeals Tracking System: Enter the Beneficiarys own SSN (BOAN - do not enter the claim number), click on Search. the beneficiary disagrees with the IRMAA determination because he does not agree with The Social Security Administration (SSA) determines if you owe an IRMAA based on the income you reported on your IRS tax return two years prior, meaning two years before the year when you pay the IRMAA. 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. If good cause was IRMAA's intended payer system was designed to only include the most affluent enrollees of Medicare Part B and Medicare Part D. If you find that you are having a lot of trouble paying for IRMAA . A new initial determination is a new decision we make that does not require reopening screen. Leave Good Cause blank. A popular pre-retirement accumulation strategy is to defer . PDFs are available for 30 days and can be saved or printed. the MAGI information, use the IRMAA calculator in MSOM T2PE 008.013. Enter Y in the Appeal Involved field. Follow the instructions in HI 01101.050C to determine if a beneficiary is requesting a new initial determination. record the evidence submitted on the EVID screen in Shared Processes. to the appropriate office. same premium year, you must evaluate all the information received and determine if NOTE: If an appeal is pending with the Department of Health and Human Services (DHHS), However, The beneficiary files a reconsideration request outside of the appeal period and there Always advise the beneficiary of the options to file: A predetermination notice (see HI 01101.035D) is not a notice of determination and does not contain appeal rights. a statement from the beneficiary estimating the MAGI. insists on appeal. This system allows you to check the status of appeals you have filed with the Office of Medicare Hearings and Appeals (OMHA). The beneficiary may be eligible for a new initial determination. new information provided, as long as the value of the data is of higher value than Washington, D.C. 20201 After processing the new initial determination, process an Affirmation decision The New Determination Results field will provide the appeal determination based on the information entered. Shared Processes (See GN 00301.286 through GN 00301.300 and MSOM EVID 001.003). IRMAA stands for Income Related Monthly Adjustment Amount. Include a beneficiary requests a new initial determination, but does not have evidence readily Social Security uses federal income tax return information from the Internal Revenue Service (IRS) about your modified adjusted gross income (MAGI) to make Income-Related Monthly Adjustment Amount (IRMAA) determinations. Screens. immediately process the new initial determination as described in HI 01120.005 through HI 01120.060. document the REMARKS with a statement that you received and processed a new initial give a reason for the dismissal. adjusted gross income (MAGI). new initial determination-tax information or new initial determination-non qualifying Advise the beneficiary that he or she must provide a copy of IRS Form 1040, or attest So for 2023, the SSA looks at your 2021 tax returns to see if you must pay an IRMAA. The IRRE Screen will display the current and recalculated IRMAA data. In most cases this will be the current date; however it can be a prior date if the If the premium year is the same, see HI 01120.001I, in this section, for processing instructions. is pending in the same or another SSA office, for the same premium year. MAGI correctly or did not apply the proper level of the Sliding Scale Tables to determine a letter from IRS acknowledging receipt of the amended tax return. If proof of the tax information is late filing of the appeal, see GN 03101.020, if a beneficiary is outside of the appeals period. Definitions: Case Number - The number assigned by the Medicare Appeal System (MAS) to the Level 2, or Level 3 appeal. the same Premium Year. Otherwise, select the notice and include the closeout paragraph with the request for evidence. Enter the Beneficiarys Own SSN and click on the search button. http://policy.ssa.gov/poms.nsf/lnx/0601140005. request. make a new initial determination. NOTE: If the beneficiary has not filed a tax return for the most recent tax year, we need details in MSOM T2PE 008.001 through MSOM T2PE 008.019). year, advise the beneficiary that he or she must provide the signed two-year-old tax the beneficiary alleges there is corrected IRS information for the tax year that we if annotated. If the beneficiary still has questions about the reconsideration, set up an appointment OMHA handles appeals of the Medicare programs determination of a beneficiarys Income Related Monthly Adjustment Amount (IRMAA), which determines a Medicare beneficiarys total monthly Part B insurance premium. return or similar proof (such as a transcript), and submit the proof from IRS in order Welcome to AASIS. (this is the disposition that is generated on the IRRE PCOM Screen from the process We make IRMAA determinations based on information the IRS provides electronically. the new initial determination is denied or dismissed, the individual is now outside the appeals period, and. On this screen, the fields are: the filing date, which is the date the reconsideration was filed. appealing based on a life changing event, amended, corrected or more recent tax return as a LCE and does not support the use of a More Recent Tax Year. No hearing is established in the IRMAA tracking system. Open the 'Electronic case documents are ready for download' message. Return. Click on the Select Option next to the pending appeal established per instructions If a beneficiary has questions concerning a pending appeal or about appealing a decision Below are the situations which may qualify a beneficiary for a new Part B determination: There are 7 qualifying life-changing events: Events that result in the loss of dividend income or affect a beneficiary's expenses, but do not affect the beneficiary's modified adjusted gross income are not considered qualifying life-changing events. In the Remarks field enter, Information provided qualifies for new initial determination, In this case the determination should be a Dismissal.. information in Remarks. NOTE: The system will automatically release all notices. Documentation is essential for an appeal. A request for a new initial determination applies only to the beneficiary requesting follow instruction on married, filing separately when the beneficiary did not live If your IRMAA appeal is granted, you will be asked to supply a copy of the required tax return next year, to confirm the estimated income you filled out. would qualify him for a new initial determination; Enter Disposition Date Enter the date the reconsideration determination was made. the notice determination date, which is the date on the notice which they are appealing. or revising a prior initial determination during a specified period. a change in the IRMAA), so an appeal is not necessary. Effectuate the decision using the IRMAA PCOM screens as explained in HI 01140.005D in this section. same exact AGI and TEI currently used to determine the IRMAA. For acceptable Results field provides the new initial determination based on the information entered. for the event reported. The system automatically if this is a systems error. payee name for beneficiary's name. In 2023, it can more than triple Part B premiums to as much as $560.50 a month or $6,732 for the year. 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. how SSA computed their MAGI and/or how SSA used the Sliding Scale Tables to apply a new initial determination but insists on filing a reconsideration; Select the appropriate option based on the information provided for the Desired Function evidence of a life-changing event (LCE) and more recent or accurate tax information. Sign-up for our free Medicare Part D Newsletter, Use the Online Calculators, FAQs or contact us through our Helpdesk -- Powered by Q1GROUP LLC other than a reconsideration, you must determine the location of the pending case us. MAGI or tax filing information related to the request. Calling SS and Mcare support numbers just resulted in "you'll have to wait" messages. You'll get this notice if you have Medicare Part B and/or Part D and Social Security determines that any Income Related Monthly Adjustment Amounts (IRMAA) apply to you. for new initial determination requests: Determine the Reason for the ContactSR, 800-Number Agent, or Receptionist. This can add up to $816 more a year for Part B in addition to the standard . beneficiary insists on filing a request for reconsideration and provides information a paper SSA-561-U2 submitted. U.S. Department of Health & Human Services Click here for the form. Inform the beneficiary that you will dismiss the new initial determination if he or after reviewing the information received you determine the beneficiary qualifies for Input the request on the IRMAA PCOM screens where a determination will be processed and effectuated, then 3. ), If you receive the correct computation; re-input the information on the IRMAA screens. SSA field offices handle all reconsiderations. If you select 1, use the highest probative value, the system will process the determination Once you effectuate the determination 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. and you have not received the necessary evidence. 008.019). an issue, document your good cause determination. If a beneficiary insists on filing an appeal based on a predetermination Inform the beneficiary if the reconsideration is still pending or if there is a decision. with his or her spouse all year in HI 01120.060. > Agencies ), the new initial determination request results in a change of the current IRMAA determination Entering an "N" will cancel all Disposition Select Affirmation (this is the disposition that is generated on the If you receive the same incorrect computation; contact your Regional Office Coordinator (See GN 00301.286 through GN 00301.300 and MSOM EVID 001.003.). imposed. on the IRMAA PCOM screens, you must post the determination on the IRMAA Appeals Tracking System. the name and SSN of the beneficiary. It does not require the 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 limitation. The information provided confirms the information provided by IRS is correct but the the MAGI information provided by IRS, he may file a reconsideration request. below that apply to the request for reconsideration.). Then click continue. Medicare Part D - also known as "prescription drug coverage.". Statement of Issues Select Beneficiary disagrees with the law. the beneficiary insists on filing a reconsideration based on information received If the beneficiary does not provide new information, input the same exact AGI and On the IRMAA Appeals Determination (IRAP) Screen. In some situations, the beneficiary can provide estimates of tax information pending 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. It is a notice Enter a Y in the Process All Transactions field. In effect, IRMAA reduces the subsidy that high-income beneficiaries receive from Medicare. given out are available in Systems of Records Notice 60-0321 (Medicare Database File). Results field will provide the appeal determination based on the information entered. For evidence requirements for individuals If the beneficiary disagrees with the accuracy of the determination made based on being appealed and reason for the appeal. specific reason for the appeal such as Disagrees With Law for a beneficiary who does (For instructions NOTE: If the PC receives a request directly from the beneficiary, or erroneously from cases, this will be the current date. The new appeals process was established in the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 (BIPA) and modified by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA). A new initial determination is a new decision made by SSA. in HI 01140.005C in this section. Disposition Select either Fully Favorable Reversal or Partially Favorable Reversal 6 Strategies for Avoiding IRMAA Issues. Disposition Select Dismissal (this is the disposition that is generated on the IRRE 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. See MSOM T2PE 008.001 through MSOM T2PE 008.013. In the Remarks field, describe the NQE that the beneficiary is claiming (sale of property). 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 Once you record all information in the IRMAA system, and you properly document the Select Level of Appeal - Select Reconsideration. information that is more accurate to make his or her IRMAA determination(s), he or Statement of Fact Enter the IRMAA Level and other information currently being used Remarks Remarks are mandatory. any updated activity, as it is possible that another office received the required For instructions on developing good cause, see GN 03101.020. related to the IRMAA, containing information documented on the IRMAA screens and in Law/Regulation Select all that apply. Enter a "Y" in the Process All Transactions field. Beneficiary Report Date Enter the date the beneficiary reported the event being On the Select Type field, select the appropriate tax source, based on the information a letter from IRS about the correction. NOTE: If a beneficiary has a representative payee, the beneficiary or the representative establish his or her IRMAA, as Married Filing Separately and did not live with his the beneficiary alleges a life changing event (LCE) that affects MAGI, the qualifying 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. Receive the latest updates from the Secretary, Blogs, and News Releases. If an appeal is pending and you receive a new initial determination request for the Enter a Y in the Process All Transactions field. on the "General" and "Disposition" screen. a case from the FO, the PC determines if a manual action is required due to a processing Pressing transactions associated with this input. determine if the NEW INITIAL DETERMINATION request is for the same premium year as http://policy.ssa.gov/poms.nsf/lnx/0601120001. On the IRMAA Menu (IRSU), select Function 3 Calculator. In 2021, the income thresholds were more than $88,000 for an. it. > Filing An Appeal Tracking System. Finding of Fact Select Other and any additional selections that apply. after reviewing the information received, you determine SSA did not compute the beneficiary's top of the screen. In REMARKS, enter IRMAA HEARING FILING ALLEGED, SYSTEM NIF.. Fax: Fax comments to (410) 966-2830. The New Determination Advise the beneficiary to recontact us after he or she receives is using to determine the IRMAA, the beneficiary claims to have a copy of a tax return from two years before the premium The IRMAA is then added to the standard premium amount to calculate the beneficiarys total monthly Part B insurance premium. appealed this may be the same date as the Date Appeal Filed if there was not a separate If we require proof of the LCE and a beneficiary statement is not sufficient and the (i.e., SEPSC or an HHS location). Some examples of appeal requests are the: beneficiary disagrees with the IRMAA determination because he or she does not agree System. see HI 01101.020. Query the MBR, EVID, and IRMAA screens for any updates, as it is possible that another same results as an appeal (i.e. Although not described as a tax, it can behave as a tax-like cost for retired Medicare recipients, increasing . the beneficiary alleges there is an amended tax return for the tax year that we use the process in HI 01140.005D in this section). Beneath the following equation is specific information on each component of your premium. time, if filed within the appeals period. Send an MDW documenting WSU as the unit in the UNIT field. The SSA-44 is only for beneficiaries wishing to request a new initial determination, based on NOTE: If a processing limitation exists, the PC must process a manual action. http://policy.ssa.gov/poms.nsf/lnx/0601140020. (Follow the appropriate instructions Enter the determination dates (usually the current date) in the Date of Appeal Determination When Processes. need to appeal the prior determination. The reconsideration request received is outside of the appeal period and no good cause If a beneficiary requests a new initial determination and provides information The beneficiary insists on filing a reconsideration based on IRS information being Select Tax Return do not process the new initial determination request. have not received the necessary evidence or the evidence submitted is insufficient. Request SEPSC to provide the beneficiary with status. 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 The Social Security Administration (SSA) uses your income tax information from 2. annotate that you are sending the new initial determination request to SEPSC. A Hearing before a Department of Health and Human Services (DHHS) Administrative Law Judge (ALJ) in the Office of Medicare Hearings and Appeals (OMHA) see GN 03101.150 ; 3. do not take a request for an appeal unless the beneficiary insists (For information See HI 01120.001E. Advise the beneficiary that we need evidence of both the LCE and the more recent tax > Agencies SSA cannot discourage an individual from filing an appeal. Remarks Remarks are mandatory. When a field office or PC receives a request for a new initial To view information concerning the beneficiarys attorney or representative, select Non-beneficiary requests for hearing are entered into the OMHA case tracking system on average within one week after receipt. on appeals, see HI 01140.001). There's also an IRMAA surcharge for 8% of Medicare beneficiaries who have Part D plans . a copy of the electronic return. referring field office or processing center posts the disposition.