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SSA 44 Medicare Income Related Monthly Adjustment Amount  Form

SSA 44 Medicare Income Related Monthly Adjustment Amount Form

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1-800-772-1213 (TTY 1-800-325-0778). Name Social Security Number You may use this form if you received a notice that your monthly Medicare Part B (medical insurance) or prescription drug coverage premiums include an income-related monthly adjustment amount (IRMAA) and you experienced a life-changing event that may reduce your IRMAA. To decide your IRMAA, we asked the Internal Revenue Service (IRS) about your adjusted gross income plus certain tax-exempt income which we call "modified adjusted...
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