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HI 01120: New Initial Determinations Using Beneficiary Information

Effective Dates: 10/15/2012 - Present

TN 3 (02-09)

A. Policy

B. What Evidence is Needed to Support the Change

C. How to Process the Request

A. Policy

The threshold and ranges applicable to the IRS tax filing status of “Married, Filing Jointly” are twice those of Single. The marriage of a beneficiary could cause a beneficiary's tax filing status and MAGI to change. (See HI 01101.020C. for the tables used to determine the IRMAA thresholds.) When a beneficiary marries, it is possible for the effect on the MAGI to be delayed. Reports of marriage only apply to the reporting spouse. Do not extend the use of the more recent tax year to the new spouse. If the non-reporting spouse is also affected by the LCE, it is each individual's responsibility to contact SSA.

B. What Evidence is Needed to Support the Change

If a beneficiary alleges marriage, SSA will need proof of the marriage and tax information for the tax year to be used.

If no valid proof of marriage is shown on SSA records (MBR, EVID, etc.), follow GN 00305.005 through GN 00305.115 to determine marital status and necessary evidence.

A beneficiary may submit the following tax information:

  • An estimate of MAGI and tax filing status for the tax year they are requesting SSA to use (current year or PY-1), or

  • A signed copy of the PY-1 tax return (or a filed amended tax return with an IRS letter of receipt for PY-1) if the PY-1 tax return shows a significant reduction in MAGI.

    NOTE: If the beneficiary provides an estimate of MAGI, process the request using the estimate. Request the beneficiary to supply a signed copy of the tax return once it has been filed with the IRS. Once the filed tax return is received follow the procedures listed in HI 01120.065. If a beneficiary alleges electronic filing, ask the beneficiary to print and sign a copy of the electronic return. If a beneficiary is updating a MAGI estimate, follow the procedures listed in HI 01120.065.

C. How to Process the Request

If

Then

The beneficiary has evidence of marriage and alleges a change in MAGI and/or tax filing status.

  • Evaluate the proof of marriage.

  • Obtain MAGI and tax filing status information from the beneficiary for the tax year to be used.

NOTE: Two separate premium year inputs are necessary with all LCEs.

  • Access the IRMAA screens (See MSOM T2PE 008.001 through MSOM T2PE 008.019)

  • On the IRMN screen

    • Enter the Beneficiary's Own SSN.

    • In the “Select the Desired Option” field select “1” Establish

    • Input the premium year that the new initial determination request is for.

    • In the “Select the Desired Function” field select “1” Life Changing Event

    • Input the Tax Year the beneficiary requests we use to determine the IRMAA.

    • Press Enter

  • The PYTY screen appears when there is data on file for the tax year requested and it is displayed under the Highest Probative Value Data Field. (For an explanation of Highest Probative see MSOM T2PE 008.019.)

    • If you select “1” Use the Highest Probative Data, the system will process the determination using that data on file. The date will be propagated to the IRMA screen.

    • If you select “2” New Tax Data, the system will process the determination using the new information provided as long as the value of the data is of higher value than the information on file. See MSOM T2PE 008.019

    • Press Enter.

  • On the IRLC screen

    • In the “Select Life Changing Event” Field select “2” Marriage/Remarriage.

    • In the “Date of Life Changing Event” field enter the date of marriage (Month and Year)

    • Show Proof as “1” Proven

    • Press Enter
 

  • On the IRMA screen

    • Input the beneficiary's alleged adjusted gross income and tax exempt interest for the tax year the beneficiary is requesting to use. NOTE: If selection “1” Use Highest Probative Data on the PYTY was selected, the information will be propagated and cannot be changed.

    • On the “Select Type” field select the appropriate tax source based on the information provided by the beneficiary. See MSOM T2PE 008.005.

    • On the “Select Filing Status” field enter the appropriate filing status for the beneficiary.

    • Show Proof as “1” Proven

    • Press Enter.

The IRRE Screen will display the current and recalculated IRMAA data. The “New Determination Results” field will provide the determination based on the information entered.

  • The IRMN Screen will display an alert to go to the EVID screen to document proofs submitted for the event reported. Pressing any “PF” key or the “Enter” key from the IRMN screen, will take you to the Shared Processes Menu.

  • Record the evidence provided on the EVID screen in Shared Processes (See GN 00301.286 through GN 00301.300 and MSOM EVID 001.003).

The beneficiary alleges marriage with a change in MAGI and/or tax filing status but does not have proof of the marriage.
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HI 01101: Medicare Income-Related Monthly Adjustment Amount
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HI 011: Medicare Income-Related Monthly Adjustment Amount
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HI 01130: Annual Verification
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