Follow the chart below to determine how to complete the required reconsideration field. The New Determination attach a route slip to the evidence stating New Initial Determination Request, Recon to the Attestation Statement. the name and SSN of the beneficiary. A beneficiary may file a reconsideration request and a new initial determination Advise the beneficiary that we need evidence of both the LCE and the more recent tax Send a Modernized Development Worksheet (MDW) documenting Workload Support Unit WSU In order for us to make a new initial determination of IRMAA, the beneficiary: must request, either verbally or in writing, that we use other tax information. Once completed contact your local Social Security office for an appointment at (800) 772-1213. Select 8 Non-Qualifying Event for the LCE Field. sends the dismissal notice. The IRRE Screen will display the current and recalculated IRMAA data. NOTE: Enter all documentation provided by the beneficiary on the EVID screen in Shared Processes. Date of the Event Enter the date of the event being appealed. The Remarks will explain the MAGI allegations and On this screen, the fields are: the filing date, which is the date the reconsideration was filed. If the beneficiary Associate with IRMAA reconsideration filed mm/dd/yy and forward Enter the determination dates (usually the current date) in the Date of Appeal Determination If a beneficiary has questions concerning a pending appeal or about appealing a decision the process in HI 01140.005D in this section). If there is no appeal pending or there is a different premium year involved, process Select Tax Return was made previously. (See MSOM T2PE 008.013.). To view the final disposition of the appeal, select Disposition at the top of the See MSOM T2PE 008.005. system is applying the wrong IRMAA level or computing the MAGI incorrectly. make the correct inputs for a reconsideration determination. OMHA appeal numbers starting with "3-" are available in AASIS as of February 2018. the beneficiary provides the requested proof. Select the appropriate option based on the information provided in the Desired Function Disposition Select either Fully Favorable Reversal or Partially Favorable Reversal no change from the result of the reconsideration determination. All reconsideration requests are processed by someone other than the person who made IRMAA; NOTE: This only applies if the reviewed information is the same information SSA used to Enter the determination into the IRMAA Appeals Tracking System. for the reconsideration as described in HI 01140.005C in this section. a beneficiary requests a new initial determination, but does not have evidence readily System located on the intranet. NOTE: The system will automatically release all notices. The 2023 Medicare IRMAA surcharge kicks in when modified adjusted gross income exceeds $91,000 for single taxpayers or $182,000 for married couples filing jointly. field. law, disagrees with level, non-qualifying event (NQE), or other. IRE Appeal Priority - The priority determined by the IRE which determines appeal processing timeframes (Expedited, Pre-Service, Retrospective). Other If you need to provide more information select Other. the beneficiary alleges there is corrected IRS information for the tax year that we > Agencies The AdQIC subsequently has 10 days to update the appeals tracking system and to decide whether the case requires further review by the Medicare Appeal Council (referred to interchangeably as the Departmental Appeals Board, or DAB) or is sent to the Medicare administrative contractor (MAC) for payment. do not process the new initial determination request. The IRMAA is based on information from the individuals income tax return obtained from the Internal Revenue Service (IRS) and calculated according to a mathematical formula established by law. after 15 days have passed from the date the beneficiary requested a new initial determination For example, Social Security would use tax returns from 2022 to determine your IRMAA in 2024. amended, corrected or more recent tax return information or a living arrangement change SSA cannot discourage an individual from filing an appeal. IRMAA but disagrees with the constitutionality of imposing IRMAA; Access the IRMAA screens (See MSOM T2PE 008.001 through MSOM T2PE 008.017). For an overview of the appeals process for How to Appeal Your IRMAA | IRMAA Series Part 3/3 6,017 views Apr 16, 2021 138 Dislike Share Save Boomer Benefits - Medicare Expert 49.5K subscribers Danielle K. Roberts and Benjamin Brandt wrap. and the pending appeal is OMHA jurisdiction. beneficiary files a reconsideration request outside of the appeal period and there imposition of IRMAA. Appeal records and data in AASIS are generally updated weekly, with appeals that were entered into the OMHA case tracking system during the prior week. State that the new information resulted in a change of the the event description, which can be initial determination, new initial determination-LCE, the beneficiary alleges a life changing event (LCE) that affects MAGI, the qualifying For instructions on developing good cause, see GN 03101.020. the office that currently has the appeal pending for the same premium year. However, the beneficiary does not have documentation showing the error and effectuated, then, Post the decision to the IRMAA Appeals Tracking System. the system calculating the correct IRMAA level. payee name for beneficiary's name. Access the IRMAA calculator. To view more details on the appeal, select Detail at the top of the screen. determination information on the IRMAA PCOM screens. SSA office received the required evidence and completed the IRMAA action. and makes a request for a new initial determination using the same information as Explain the additional A beneficiary will be notified by SSA near the end of the current year if he or she has to pay an IRMAA for the upcoming year. The beneficiary insists on filing a reconsideration based on IRS information being Entering an N will cancel all is based on the status of Married Filing Separately, but he or she did not live NOTE: PCs send the AURORA exhibit notice E4008. SSA field offices handle all reconsiderations. Use direct contact procedures for all development requests following the procedures Input the request on the IRMAA PCOM screens where a determination will be processed and effectuated, then 3. It is important to note that your appeal will not appear in the AASIS system until it has been entered into OMHAs case tracking system and uploaded to AASIS. To view information concerning the beneficiarys attorney or representative, select Here's the bracket and how much you can expect to pay for Medicare Part B depending on your income from 2 years ago. NOTE: All evidence received with an appeal must be input into the Shared Processes EVID screens. Request an appeal in writing by completing a request for reconsideration form. in HI 01140.005C in this section. she re-contacts us to request additional time to provide the proof, advise him or establish his or her IRMAA, as Married Filing Separately and did not live with his beneficiary. to file a tax return for that tax year. You must enter any beneficiary alleged MAGI or Tax good cause for late filing was not granted. takes you to the Shared Processes Menu. Tracking System. information in Remarks. The New Determination event, the SSA-44, Medicare Income-Related Monthly Adjustment Amount Life Changing Event is available current date). filing status on the beneficiary's Federal Tax Return. If the beneficiary disagrees with the accuracy of the determination made based on To get an appeal form, you can go into a nearby Social Security office, call 800-772-1213, or check the Social Security website. spouse or ex-spouse. If good cause was related to the IRMAA, containing information documented on the IRMAA screens and in the beneficiary alleges there is a copy of a tax return from two years before the to determine the IRMAA. Reason For Appeal - Select the reason the beneficiary is filing the appeal. Sign-up for our free Medicare Part D Newsletter, Use the Online Calculators, FAQs or contact us through our Helpdesk -- Powered by Q1GROUP LLC A request for a new initial determination applies only to the beneficiary requesting a beneficiary requests a new initial determination based on a qualifying event and The Social Security Administration determinesyour Income Related Monthly Adjustment Amount (IRMAA). top of the screen. determination and the pending appeal is MAC jurisdiction. We like to say, "You date your Part D," as you can change this every year during the annual enrollment period (Oct.15- Dec.7). First, you must request a reconsideration of the initial determination from the Social Security Administration. After completing all screens record evidence submitted on the EVID screen in the Process the dismissal on the IRMAA Results (IRRE) screen. NOTE: If a beneficiary alleges electronic filing, ask the beneficiary to print and sign Beneficiary requests for hearing submitted to the Beneficiary Mail Stop are entered into the OMHA case tracking system (docketed) upon receipt. Pending Same PY. Remarks Explain that the system is not computing the correct level of IRMAA for Always advise the beneficiary of the options to file: A predetermination notice (see HI 01101.035D) is not a notice of determination and does not contain appeal rights. If the FO has not taken action and it appears the transfer was in error, after reviewing the information received, you determine the beneficiary agrees with 90 days, process as a dismissal. Medicare has neither reviewed nor endorsed this information. 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. if the appeal is pending in the same office, provide the new and material evidence