Get NY IRMAA Medicare Part B Reimbursement Claim Submission Form 2015-2024

To request a new initial determination, submit a Medicare IRMAA Life-Changing Event form or schedule an appointment with Social Security. You will need to provide documentation of either your correct income or of the life-changing event that caused your income to decrease.

If you submit the required documentation for Medicare Part B IRMAA reimbursement, your reimbursement will be deposited directly into your bank account. IRMAA Medicare Part B Reimbursement Application (for 2021, 2020 & 2019) - Reimbursement for 2021 was issued during the 3rd week of October 2022.

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.

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.

What document do I need to submit to receive my correct Part B reimbursement amount? You must submit a copy of your Social Security benefits verification statement (your “New Benefit Amount”) or a copy of a 2023 Centers for Medicare and Medicaid Services (CMS) billing statement.

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.

Or, mail to: NYC Health Benefits Program, ATTN: IRMAA 22 Cortlandt Street, 12th Floor New York, NY 10007 If you need a replacement copy of your IRMAA notice, you can obtain one from your local Social Security office, which can be located on the following website: https://.ssa.gov/onlineservices.

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.