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Adjustment Amount (IRMAA). Submit this completed form and required documentation to: NYS Department of Civil Service Employee Benefits Division Attn: IRMAA Accounting Alfred E. Smith State Office Building Albany, NY 12239 ENROLLEE INFORMATION Name: Last, First, MI Social Security Number (Last) (First) (MI) Enrollee Mailing Address Address Daytime Telephone Number (with area code) Apt.# City State Zip Code check here if this is a change of address DEPENDENT INFORMATION If you are a.

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If your income has seen a significant decrease in the past two years, you can file an appeal. To dispute your IRMAA payments, complete Form SSA-44 with information about your life-changing event and income reduction. Is there a refund after a successful IRMAA appeal? Yes, the IRS will refund any excess amounts.

How do I know if I am eligible for Part B reimbursement? You must be a retired member or qualified survivor who is receiving a pension and is eligible for a health subsidy, and enrolled in both Medicare Parts A and B.

To be reimbursed for IRMAA, you must complete the IRMAA Reimbursement Request application and submit it to the Employee Benefits Division along with proofs of payment of your Medicare Part B premium.

Medicare Part A is free for most people. For Part B, you pay a premium. Basic Option members who have Medicare Part A and Part B can get up to $800 with a Medicare Reimbursement Account. All you have to do is provide proof that you pay Medicare Part B premiums.

For 2022, the IRMAA thresholds started at $91,000 for a single person and $182,000 for a married couple. For 2023, the IRMAA thresholds increased significantly, to $97,000 for a single person and $194,000 for a married couple.

Call 1-800-MEDICARE (1-800-633-4227) if you think you may be owed a refund on a Medicare premium. Some Medicare Advantage (Medicare Part C) plans reimburse members for the Medicare Part B premium as one of the benefits of the plan. These plans are sometimes called Medicare buy back plans.

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 that you start paying IRMAA. The income that counts is the adjusted gross income you reported plus other forms of tax-exempt income.

To dispute your IRMAA payments, complete Form SSA-44 with information about your life-changing event and income reduction. Is there a refund after a successful IRMAA appeal? Yes, the IRS will refund any excess amounts.

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© Copyright 1997-2025
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3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232