This version of the form is not currently in use and is provided for reference only. Download this version of Form SSA-44 for the current year.
This is a legal form that was released by the U.S. Social Security Administration on December 1, 2022 and used country-wide. As of today, no separate filing guidelines for the form are provided by the issuing department.
Q: What is Form SSA-44?
A: Form SSA-44 is a form used to apply for a Medicare Income-Related Monthly Adjustment Amount (IRMAA) based on a life-changing event.
Q: What is the Medicare Income-Related Monthly Adjustment Amount (IRMAA)?
A: The Medicare Income-Related Monthly Adjustment Amount (IRMAA) is an additional amount that some people have to pay for their Medicare Part B and Part D premiums, based on their income.
Q: What is a life-changing event?
A: A life-changing event is a specific event that may have caused a change in your income that could affect your IRMAA. Examples include marriage, divorce, death of a spouse, or reduction in work hours.
Q: Why would I need to fill out Form SSA-44?
A: You would need to fill out Form SSA-44 if you have experienced a life-changing event and want to request a reduction in your Medicare IRMAA.
Q: When should I submit Form SSA-44?
A: You should submit Form SSA-44 as soon as possible after your life-changing event and no later than 6 months after the end of the year in which the event occurred.
Q: What happens after I submit Form SSA-44?
A: After you submit Form SSA-44, the Social Security Administration will review your application and determine if you qualify for a reduction in your Medicare IRMAA.
Q: Can I appeal if my request for a reduction is denied?
A: Yes, if your request for a reduction in your Medicare IRMAA is denied, you have the right to appeal the decision.
Form Details:
Download a fillable version of Form SSA-44 by clicking the link below or browse more documents and templates provided by the U.S. Social Security Administration.