The SSA SSA-44 form is a crucial document used by individuals seeking a reduction in their Medicare premiums due to a significant change in their income. This form helps ensure that those who qualify can receive the financial assistance they need. Understanding how to properly complete and submit this form can make a significant difference in managing healthcare costs.
The SSA SSA-44 form is a critical document for individuals seeking to adjust their Social Security benefits based on changes in their financial circumstances. This form, officially titled the "Request for Reconsideration of the Reduction of Monthly Social Security Benefits," serves as a means for beneficiaries to request a review of their benefit amounts when they believe an error has been made or when their income has changed significantly. Understanding the nuances of this form can empower individuals to navigate the often complex world of Social Security benefits. From the information required to complete the form to the deadlines for submission, each aspect plays a vital role in ensuring that beneficiaries receive the correct amount of support. Additionally, the SSA SSA-44 form can help individuals advocate for their rights and secure the benefits they deserve, making it an essential tool for anyone affected by changes in their financial situation. Whether you're facing unexpected medical expenses or changes in employment, knowing how to effectively utilize the SSA SSA-44 form can make a substantial difference in your financial well-being.
When filling out the SSA SSA-44 form, it's important to follow certain guidelines to ensure accuracy and efficiency. Here are five things you should and shouldn't do:
Taking these steps can help ensure that your form is processed smoothly and efficiently.
The SSA SSA-44 form is an important document for individuals seeking to adjust their Social Security benefits. Here are key takeaways regarding its use:
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Form SSA-44 (11-2019)
Page 1 of 8
Discontinue Prior Editions
Social Security Administration
OMB No. 0960-0784
Medicare Income-Related Monthly Adjustment Amount -
Life-Changing Event
If you had a major life-changing event and your income has gone down, you may use this form to request a reduction in your income-related monthly adjustment amount. See page 5 for detailed information and line-by-line instructions. If you prefer to schedule an interview with your local Social Security office, call 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 gross income" or MAGI from the Federal income tax return you filed for tax year 2018. If that was not available, we asked for your tax return information for 2017. We took this information and used the table below to decide your income-related monthly adjustment amount.
The table below shows the income-related monthly adjustment amounts for Medicare premiums based on your tax filing status and income. If your MAGI was lower than $87,000.01 (or lower than $174,000.01 if you filed your taxes with the filing status of married, filing jointly) in your most recent filed tax return, you do not have to pay any income-related monthly adjustment amount. If you do not have to pay an income-related monthly adjustment amount, you should not fill out this form even if you experienced a life-changing event.
Your Part B
Your prescription
drug coverage
If you filed your taxes as:
And your MAGI was:
monthly
adjustment is:
-Single,
$ 87,000.01 - $109,000.00
$ 57.80
$ 12.20
-Head of household,
-Qualifying widow(er) with dependent
$109,000.01 - $136,000.00
$144.60
$ 31.50
child, or
$136,000.01 - $163,000.00
$231.40
$ 50.70
$163,000.01 - $500,000.00
$318.10
$ 70.00
-Married filing separately (and you did
More than $500,000.00
$347.00
$ 76.40
not live with your spouse in tax year)*
$174,000.01 - $218,000.00
$218,000.01 - $272,000.00
-Married, filing jointly
$272,000.01 - $326,000.00
$326,000.01 - $750,000.00
More than $750,000.00
-Married, filing separately (and you
$87,000.00 - $413,000.00
lived with your spouse during part of
More than $413,000.00
that tax year)*
*Let us know if your tax filing status for the tax year was Married, filing separately, but you lived apart from your spouse at all times during that tax year.
Page 2 of 8
STEP 1: Type of Life-Changing Event
Check ONE life-changing event and fill in the date that the event occurred (mm/dd/yyyy). If you had more than one life-changing event, please call Social Security at 1-800-772-1213 (TTY 1-800-325-0778).
Marriage
Work Reduction
Divorce/Annulment
Loss of Income-Producing Property
Death of Your Spouse
Loss of Pension Income
Work Stoppage
Employer Settlement Payment
Date of life-changing event:
mm/dd/yyyy
STEP 2: Reduction in Income
Fill in the tax year in which your income was reduced by the life-changing event (see instructions on page 6), the amount of your adjusted gross income (AGI, as used on line 7 of IRS form 1040) and tax-exempt interest income (as used on line 2a of IRS form 1040), and your tax filing status.
Tax Year
2 0 __ __
Adjusted Gross Income
$ __ __ __ __ __ __ . __ __
Tax-Exempt Interest
Tax Filing Status for this Tax Year (choose ONE ):
Single
Head of Household
Married, Filing Jointly
Married, Filing Separately
Qualifying Widow(er) with Dependent Child
STEP 3: Modified Adjusted Gross Income
Will your modified adjusted gross income be lower next year than the year in Step 2?
No - Skip to STEP 4
Yes - Complete the blocks below for next year
Estimated Adjusted Gross Income
Estimated Tax-Exempt Interest
$ __ __ __ __ __ __. __ __
Expected Tax Filing Status for this Tax Year (choose
ONE ):
Page 3 of 8
STEP 4: Documentation
Provide evidence of your modified adjusted gross income (MAGI) and your life-changing event. You can either:
1.Attach the required evidence and we will mail your original documents or certified copies back to you;
OR
2.Show your original documents or certified copies of evidence of your life-changing event and modified adjusted gross income to an SSA employee.
Note: You must sign in Step 5 and attach all required evidence. Make sure that you provide your current address and a phone number so that we can contact you if we have any questions about your request.
STEP 5: Signature
PLEASE READ THE FOLLOWING INFORMATION CAREFULLY BEFORE SIGNING THIS FORM.
I understand that the Social Security Administration (SSA) will check my statements with records from the Internal Revenue Service to make sure the determination is correct.
I declare under penalty of perjury that I have examined the information on this form and it is true and correct to the best of my knowledge.
I understand that signing this form does not constitute a request for SSA to use more recent tax year information unless it is accompanied by:
•Evidence that I have had the life-changing event indicated on this form;
•A copy of my Federal tax return; or
•Other evidence of the more recent tax year's modified adjusted gross income.
Signature
Phone Number
Mailing Address
Apartment Number
City
State
ZIP Code
Page 4 of 8
THE PRIVACY ACT
We are required by sections 1839(i) and 1860D-13 of the Social Security Act to ask you to give us the information on this form. This information is needed to determine if you qualify for a reduction in your monthly Medicare Part B and/or prescription drug coverage income-related monthly adjustment amount (IRMAA). In order for us to determine if you qualify, we need to evaluate information that you provide to us about your modified adjusted gross income. Although the responses are voluntary, if you do not provide the requested information we will not be able to consider a reduction in your IRMAA.
We rarely use the information you supply for any purpose other than for determining a potential reduction in IRMAA. However, the law sometimes requires us to give out the facts on this form without your consent. We may release this information to another Federal, State, or local government agency to assist us in determining your eligibility for a reduction in your IRMAA, if Federal law requires that we do so, or to do the research and audits needed to administer or improve our efforts for the Medicare program.
We may also use the information you provide in computer matching programs. Matching programs compare our records with records kept by other Federal, state or local government agencies. We will also compare the information you give us to your tax return records maintained by the IRS. The law allows us to do this even if you do not agree to it. Information from these matching programs can be used to establish or verify a person’s eligibility for Federally funded or administered benefit programs and for repayment of payments or delinquent debts under these programs.
Explanations about these and other reasons why information you provide us may be used or given out are available in Systems of Records Notice 60-0321 (Medicare Database File). 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.
Paperwork Reduction Act Statement - This information collection meets the requirements of 44 U.S.C. § 3507, as amended by section 2 of the Paperwork Reduction Act of 1995. You do not need to answer these questions unless we display a valid Office of Management and Budget control number. We estimate that it will take about 45 minutes to read the instructions, gather the facts, and answer the questions. SEND OR BRING THE COMPLETED FORM TO
YOUR LOCAL SOCIAL SECURITY OFFICE. The office is listed under U. S. Government agencies in your telephone directory or you may call Social Security at 1-800-772-1213 (TTY 1-800-325-0778). You may send comments on our time estimate above to: SSA, 6401 Security Blvd, Baltimore, MD 21235-6401. Send only comments relating to our time estimate to this address, not the completed form.
Page 5 of 8
INSTRUCTIONS FOR COMPLETING FORM SSA-44
Medicare Income-Related Monthly Adjustment Amount
Life-Changing Event--Request for Use of More Recent Tax Year Information
You do not have to complete this form in order to ask that we use your information about your modified adjusted gross income for a more recent tax year. If you prefer, you may call
1-800-772-1213 and speak to a representative from 7 a.m. until 7 p.m. on business days to request an appointment at one of our field offices. If you are hearing-impaired, you may call our TTY number, 1-800-325-0778.
Identifying Information
Print your full name and your own Social Security Number as they appear on your Social Security card. Your Social Security Number may be different from the number on your Medicare card.
STEP 1
You should choose only one life-changing event on the list. If you experienced more than one life-changing event, please call your local Social Security office at 1-800-772-1213 (TTY
1-800-325-0778). Fill in the date that the life-changing event occurred. The life-changing event date must be in the same year or an earlier year than the tax year you ask us to use to decide your income-related premium adjustment. For example, if we used your 2016 tax information to determine your income-related monthly adjustment amount for 2018, you can request that we use your 2017 tax information instead if you experienced a reduction in your income in 2017 due to a life-changing event that occurred in 2017 or an earlier year.
Use this category if...
You entered into a legal marriage.
Your legal marriage ended, and you will not file a joint return
with your spouse for the year.
Your spouse died.
Work Stoppage or Reduction
You or your spouse stopped working or reduced the hours
that you work.
You or your spouse experienced a loss of income-producing
property that was not at your direction (e.g., not due to the
Loss of Income-Producing
sale or transfer of the property). This includes loss of real
property in a Presidentially or Gubernatorially-declared
Property
disaster area, destruction of livestock or crops due to natural
disaster or disease, or loss of property due to arson, or loss
of investment property due to fraud or theft.
You or your spouse experienced a scheduled cessation,
termination, or reorganization of an employer's pension plan.
You or your spouse receive a settlement from an employer
or former employer because of the employer's bankruptcy or
reorganization.
Page 6 of 8
STEP 2
Supply information about the more recent year's modified adjusted gross income (MAGI). Note that this year must reflect a reduction in your income due to the life-changing event you listed in Step 1. A change in your tax filing status due to the life-changing event might also reduce your income-related monthly adjustment amount. Your MAGI is your adjusted gross income as used on line 7 of IRS form 1040 plus your tax-exempt interest income as used on line 2a of IRS form 1040. We used your MAGI and your tax filing status to determine your income-related monthly adjustment amount.
•Fill in both empty spaces in the box that says “20_ _". The year you choose must be more recent than the year of the tax return information we used. The letter that we sent you tells you what tax year we used.
•
Choose this year (the "premium year") - if your modified adjusted gross income is lower this year than last year. For example, if you request that we adjust your income-related premium for 2020, use your estimate of your 2019 MAGI if:
1.Your income was not reduced until 2020; or
2.Your income was reduced in 2019, but will be lower in 2020.
Choose last year (the year before the "premium year," which is the year for which you want us to adjust your IRMAA) - if your MAGI is not lower this year than last year. For example, if you request that we adjust your 2020 income-related monthly adjustment amounts and your income was reduced in 2018 by a life-changing event AND will be no lower in 2020, use your tax information for 2019.
Exception: If we used IRS information about your MAGI 3 years before the premium year, you may ask us to use information from 2 years before the premium year. For example, if we used your income tax return for 2017 to decide your 2020 IRMAA, you can ask us to use your 2018 information.
• If you have any questions about what year you should use, you should call SSA.
•Fill in your actual or estimated adjusted gross income for the year you wrote in the “tax year” box. Adjusted gross income is the amount on line 7 of IRS form 1040. If you are providing an estimate, your estimate should be what you expect to enter on your tax return for that year.
Tax-exempt Interest Income
•Fill in your actual or estimated tax-exempt interest income for the tax year you wrote in the “tax year” box. Tax-exempt interest income is the amount reported on line 2a of IRS form 1040. If you are providing an estimate, your estimate should be what you expect to enter on your tax return for that year.
Filing Status
•Check the box in front of your actual or expected tax filing status for the year you wrote in the “tax year” box.
Page 7 of 8
STEP 3
Complete this step only if you expect that your MAGI for next year will be even lower and will reduce your IRMAA below what you told us in Step 2 using the table on page 1. We will record this information and use it next year to determine your Medicare income-related monthly adjustment amounts. If you do not complete Step 3, we will use the information from Step 2 next year to determine your income-related monthly adjustment amounts, unless one of the conditions described in “Important Facts” on page 8 occurs.
•Fill in both empty spaces in the box that says “20 _ _ ” with the year following the year you wrote in Step 2. For example, if you wrote "2020" in Step 2, then write "2021" in Step 3.
•Fill in your estimated adjusted gross income for the year you wrote in the “tax year” box. Adjusted gross income is the amount you expect to enter on line 7 of IRS form 1040 when you file your tax return for that year.
•Fill in your estimated tax-exempt interest income for the tax year you wrote in the “tax year” box. Tax-exempt interest income is the amount you expect to report on line 2a of IRS form 1040.
•Check the box in front of your expected tax filing status for the year you wrote in the “tax year” box.
STEP 4
Provide your required evidence of your MAGI and your life-changing event.
Modified Adjusted Gross Income Evidence
If you have filed your Federal income tax return for the year you wrote in Step 2, then you must provide us with your signed copy of your tax return or a transcript from IRS. If you provided an estimate in Step 2, you must show us a signed copy of your tax return when you file your Federal income tax return for that year.
Life-Changing Event Evidence
We must see original documents or certified copies of evidence that the life-changing event occurred. Required evidence is described on the next page. In some cases, we may be able to accept another type of evidence if you do not have a preferred document listed on the next page. Ask a Social Security representative to explain what documents can be accepted.
Page 8 of 8
Evidence
An original marriage certificate; or a certified copy of a public record of
marriage.
A certified copy of the decree of divorce or annulment.
A certified copy of a death certificate, certified copy of the public record of
death, or a certified copy of a coroner’s certificate.
An original signed statement from your employer; copies of pay stubs;
Work Stoppage or
original or certified documents that show a transfer of your business.
Note: In the absence of such proof, we will accept your signed statement,
Reduction
under penalty of perjury, on this form, that you partially or fully stopped
working or accepted a job with reduced compensation.
An original copy of an insurance company adjuster’s statement of loss or a
Loss of Income-
letter from a State or Federal government about the uncompensated loss. If
the loss was due to investment fraud (theft), we also require proof of
Producing Property
conviction for the theft, such as a court document citing theft or fraud
relating to you or your spouse's loss.
Loss of Pension
A letter or statement from your pension fund administrator that explains the
Income
reduction or termination of your benefits.
Employer Settlement
A letter from the employer stating the settlement terms of the bankruptcy
Payment
court and how it affects you or your spouse.
STEP 5
Read the information above the signature line, and sign the form. Fill in your phone number and current mailing address. It is very important that we have this information so that we can contact you if we have any questions about your request.
Important Facts
•When we use your estimated MAGI information to make a decision about your income-related monthly adjustment amount, we will later check with the IRS to verify your report.
•If you provide an estimate of your MAGI rather than a copy of your Federal tax return, we will ask you to provide a copy of your tax return when you file your taxes.
•If your estimate of your MAGI changes, or you amend your tax return for that reason, you will need to contact us to update our records. If you do not contact us, we may have to make corrections later including retroactive assessments or refunds.
•We will use your estimate provided in Step 2 to make a decision about the amount of your income-related monthly adjustment amounts the following year until:
•IRS sends us your tax return information for the year used in Step 2; or
•You provide a signed copy of your filed Federal income tax return or amended Federal income tax return with a different amount; or
•You provide an updated estimate.
•If we used information from IRS about a tax year when your filing status was Married filing separately, but you lived apart from your spouse at all times during that year, you should contact us at 1-800-772-1213 (TTY 1-800-325-0778) to explain that you lived apart from your spouse. Do not use this form to report this change.
The SSA SSA-44 form is an important document related to Social Security benefits, yet several misconceptions surround it. Understanding these misconceptions can help individuals navigate the process more effectively.
This is incorrect. The SSA-44 form can also be used by individuals who are applying for benefits or have had a change in their financial situation.
Filling out the SSA-44 does not guarantee an increase. It is a request for reconsideration of benefits based on new information, and approval depends on the review process.
While it may seem daunting, the form is straightforward. Clear instructions accompany it, making it manageable for most individuals to complete.
There are deadlines for submitting the SSA-44 form. Delays may affect the eligibility for increased benefits, so timely submission is crucial.
While legal assistance can be beneficial, many people successfully complete the SSA-44 form on their own. Resources are available to guide individuals through the process.
SSA-1099: This form is used to report Social Security benefits received during the year. Like the SSA-44, it is essential for understanding income and determining eligibility for assistance programs.
SSA-16: This application form is for Social Security Disability Insurance benefits. It shares similarities with the SSA-44 in that both forms assess eligibility based on income and medical conditions.
SSA-827: This authorization form allows the SSA to obtain medical records. It relates to the SSA-44 as both are involved in the evaluation of an individual's claim for benefits.
SSA-3368: This form is used for adult disability reports. It is similar to the SSA-44 as both require detailed information about the claimant's circumstances to assess eligibility.
SSA-3373: This form collects information about daily activities and limitations. Like the SSA-44, it helps the SSA evaluate how a disability affects an individual's ability to work.