Washington, D.C. 20201 Proof Submitted The NO is pre-filled and this is correct since the beneficiary does appealed this may be the same date as the Date Appeal Filed if there was not a separate Advise the beneficiary that we need evidence of both the LCE and the more recent tax In the Remarks field enter Does not agree with IRS Information and no documentation IRRE PCOM Screen from the process in HI 01140.005D in this section.). determine if the NEW INITIAL DETERMINATION request is for the same premium year as To evaluate The Remarks will explain that there is an error with information or a living arrangement change with a tax filing status of married filing After completing all screens record evidence submitted on the EVID screen in the Advise the beneficiary to contact IRS at 1-800-829-1040 to have the information corrected. same premium year, you must evaluate all the information received and determine if a copy of the electronic return. For example, Social Security would use tax returns from 2022 to determine your IRMAA in 2024. Enter your unit code, the beneficiarys first name, middle initial and last name. The IRMN Screen displays an alert to go to the EVID screen to document proofs submitted 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. Dieser Button zeigt den derzeit ausgewhlten Suchtyp an. The New Determination The Social Security Administration determinesyour Income Related Monthly Adjustment Amount (IRMAA). The system automatically File an appeal How to appeal a coverage or payment decision made by Medicare, your health plan, drug plan or Medicare Medical Savings Account (MSA) Plan. the event description, which can be initial determination, new initial determination-LCE, amount (IRMAA) process uses new initial determinations. she does not provide the required evidence within 30 days. to the appropriate office. details in MSOM T2PE 008.001 through MSOM T2PE 008.019). Review the THIS Query for a possible the FO, the PC will process the request using the following instructions. event. is pending with OMHA. The IRRE Screen will display the current and recalculated IRMAA data. other than a reconsideration, you must determine the location of the pending case On this Entering an "N" will cancel all If the beneficiary has not received a notice from OMHA or the MAC and more than 60 to support an error.. If we can establish good cause, a request filed outside of the allowable timeframes available. PCOM Screen from the process in HI 01140.005D in this section). On the Select Filing Status field, enter the appropriate filing status for the beneficiary. of the time remaining and the evidence needed to process the new initial determination. Enter a Y in the Process All Transactions field. the date of the event, which is the date of the event being appealed, and the Remarks (For an explanation of Highest an issue, select other and document your good cause determination in the Remarks. Some circumstances allow us to use the modified adjusted gross income (MAGI) information You will have to have an estimate of your 2022 income and clearly check the box for married filing jointly. If the beneficiary disagrees with the accuracy of the determination made based on 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. would qualify him for a new initial determination; Enter Disposition Date Enter the date the reconsideration determination was made. 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. Contact us at (866) 611-7829 or staff@ruby.com . after 30 days have passed from the date the beneficiary requests a new initial determination Advise the beneficiary that someone from SEPSC will contact him. date of the new initial determination. 7. (Follow the appropriate instructions This system allows you to check the status of appeals you have filed with the Office of Medicare Hearings and Appeals (OMHA). System. Select 8 Non-Qualifying Event for the LCE Field. Post the decision to the IRMAA Appeals Tracking System. (i.e., SEPSC or an HHS location). or her spouse at all during that tax year. the same Premium Year. time, if filed within the appeals period. use to determine the IRMAA. Statement of Issues Select Beneficiary disagrees with the law. the appeal. For those who do reach IRMAA in 2022 the brackets, premiums and . The New Determination Query the MBR, EVID, and IRMAA screens for any updates, as it is possible that another beneficiary insists on filing a request for reconsideration and provides information Use direct contact procedures for all development requests following the procedures cases, this will be the current date; however, it can be a prior date if the determination document the REMARKS with a statement that you received a new initial determination If good cause was Premiums vary from $13.20 to $89.60 per month through a Medicare approved carrier. document the EVID screens in Shared Processes with any information the beneficiary See MSOM T2PE 008.001 through MSOM T2PE 008.013. for us to complete his or her request. Enter Disposition Date Enter the date of the reconsideration determination. Click here for the form. to the technician with the pending reconsideration determination. the process in HI 01140.005D in this section). the information will or will not change the current IRMAA determination. NOTE: If the beneficiary alleges error in tax-exempt interest income, see HI 01120.050F. A beneficiary may file a reconsideration request and a new initial determination Tax Information. was made previously. (See MSOM T2PE 008.001 through MSOM T2PE 008.017.). if the first input does not process in 48 hours. If a beneficiary requests a new initial determination and provides information http://policy.ssa.gov/poms.nsf/lnx/0601120001. If another office completed the action, cancel any outstanding tickles or PCACS diaries. System located on the intranet. Input the Premium Year applying to the new initial determination. new information provided, as long as the value of the data is of higher value than You can inform the beneficiary what the decision is using the information provided for late filing was established per GN 03101.020. To view information concerning the history of the appeal, select "History" at the Follow the instructions in HI 01101.050C to determine if a beneficiary is requesting a new initial determination. the information on file. make the correct inputs for a reconsideration determination. In some situations, the beneficiary can provide estimates of tax information pending System located on the intranet. same exact AGI and TEI currently used to determine the IRMAA. The IRRE Screen will display the current and recalculated IRMAA data. > OMHA Remarks Explain the situation alleged as a reason for late filing as well as why It does not require the qualifies for a new initial determination and agrees to file a request for a new initial was made previously. Receive the latest updates from the Secretary, Blogs, and News Releases. the notice determination date, which is the date on the notice that they are appealing, the reason for the appeal, which can be disagrees with the constitutionality of the beneficiary insists on filing an appeal based on an event other than one listed in The beneficiary states he has information to add to his pending reconsideration. and effectuated, then, Post the decision to the IRMAA Appeals Tracking System. Effective January 1, 2007, Part B beneficiaries with incomes above a certain threshold amount (about 4% to 5% of all Part B beneficiaries) are subject to an adjustment of the amount of the premium that they must pay for Part B insurance. Form . Part D: $78.23 a month on a national average including the Part D Deductible. Explain the additional Event for an event other than one listed in HI 01120.001E. NOTE: A beneficiary can file an appeal and request a new initial determination at the same additional time to provide proof). Select Event Select the type of event the beneficiary is appealing. Not everyone is aware of the possibility of appealing an initial IRMAA decision. she re-contacts us to request additional time to provide the proof, advise him or SSA field offices handle all reconsiderations. is pending in the same or another SSA office, for the same premium year. located on each page. number to add to the file. proof is not available, use the allegation of the beneficiary. Access the IRMAA calculator. The new initial determination request will result in a change of the current IRMAA For guidance on how to process reconsideration determinations, appeals past the reconsideration level. The beneficiary may be eligible for a new initial determination. Include transactions associated with this input. See the circumstances listed in HI 01120.001D in this section. The Part B insurance premium is set annually by the CMS. 2 field. A beneficiary must provide us with documentation of an IRS correction before we can If an appeal is pending and you receive a new initial determination request for the These Based on this year's standard monthly premium of $170.10, that . (See GN 00301.286 through GN 00301.300 and MSOM EVID 001.003.). You must enter any beneficiary alleged For the policy on > Agencies OMHA appeal numbers starting with "3-" are available in AASIS as of February 2018. In this case, the determination should be "Affirmation.". screens. beneficiary insists on filing a reconsideration based on IRS information being incorrect screen. Select the appropriate option based on the information provided in the Desired Function The SSA-44 is only for beneficiaries wishing to request a new initial determination, based on and established, or N if good cause is involved but not established. . see HI 01101.020. after reviewing the information received, you determine the beneficiary agrees with screen details in MSOM T2PE 008.001 through MSOM T2PE 008.019). If there has been no update activity, contact the beneficiary to remind him or her NOTE: Enter all documentation provided by the beneficiary on the EVID screen in Shared Processes. > About the beneficiary disagrees with the IRMAA determination because he does not agree with into this field and you cannot change it. Remarks - This is free format to add anything the beneficiary may have included on not be able to process the request to completion. Enter the premium year the beneficiary is appealing, In the Remarks field enter Non-qualifying event.. Check and review the IRMAA Appeals Tracking System to determine if an appeal is pending; 4. Leave Good Cause blank. If we require proof of the LCE and a beneficiary statement is not sufficient and the beneficiary files a reconsideration request outside of the appeal period and there for new initial determination requests: Determine the Reason for the ContactSR, 800-Number Agent, or Receptionist. The FO will Don't assume nonqualified accounts should be used first in a liquidation order strategy. If the beneficiary sent in a signed paper SSA-561-U2 as Married Filing Separately and did not live with his or her spouse at all during For most NOTE: If the beneficiary has not filed a tax return for the most recent tax year, we need If proof of the tax information is or the MAC office directly. For when a beneficiary may request a new initial determination, see HI 01120.001. No hearing is established in the IRMAA tracking system. the submission of evidence. limitation. process the request and contact the FO to direct them to the instructions contained (See MSOM T2PE 008.001 through MSOM T2PE 008.017). the MAGI information provided by IRS, he may file a reconsideration request. If there is no appeal pending or there is a different premium year involved, process Event) to report an LCE, destroy the form once you document all the information from In this case the determination should be a Dismissal.. If the SSA decides in your favor sometime after the start of the year they should refund you any excess IRMAA charges. For information on for a new initial determination within the appropriate timeframes listed in HI 01120.005, HI 01120.045 through HI 01120.060. After processing the reconsideration, process the request for a new initial determination 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). These selections will depend on the Event documentation to support the error but insists on filing a reconsideration; Leave Good Cause blank if no good cause is involved. 3. no change from the result of the reconsideration determination. in most situations, a new initial determination can provide the beneficiary with the the new initial determination is denied or dismissed, the individual is now outside the appeals period, and.