Get Life Changing Event. Form Request A Reduction In Claimants Medicare Part B Income Premium

This guide provides clear, step-by-step instructions on how to fill out the Life Changing Event form to request a reduction in your Medicare Part B income premium. By following these steps, users can effectively submit their form online and potentially lower their premiums based on recent life changes.

Follow the steps to successfully fill out your form.

1. Press the ‘Get Form’ button to retrieve the Life Changing Event form. This will allow you to access the form and proceed with filling it out.
2. Complete the identifying information section by entering your Social Security number and full name as they appear on your Social Security card.
3. In step 1 of the form, select one life-changing event from the provided list, such as marriage or work reduction, and fill in the date it occurred in the specified format (mm/dd/yyyy).
4. For step 2, indicate the tax year during which your income was affected by the life-changing event. Provide the adjusted gross income and tax-exempt interest income for that year, and specify your tax filing status.
5. If you anticipate your modified adjusted gross income will be lower next year, address this in step 3. Fill in the tax year and provide expected adjusted gross income and tax-exempt interest information for that year.
6. Step 4 requires you to provide documentation that supports your claim of a life-changing event and evidence of your modified adjusted gross income. You may either attach documents or present them to a Social Security representative.
7. Finally, complete step 5 by signing the form, providing your current phone number, and entering your mailing address, ensuring the SSA can contact you if necessary.

Begin completing your Life Changing Event form online today for potential premium reductions.