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  • SSA-44 - The United States Social Security Administration
    INSTRUCTIONS FOR COMPLETING FORM SSA-44 STEP 2 Supply information about the more recent year's modified adjusted gross income (MAGI) Note that this year must reflect a reduction in your income due to the life-changing event(s) you listed in Step 1
  • Request to lower an Income-Related Monthly Adjustment Amount (IRMAA) | SSA
    Other ways to complete this task Fax or mail your request Fill out the Medicare Income-Related Monthly Adjustment Amount – Life-Changing Event (SSA-44) (PDF) form Fax or mail your completed form and evidence to a Social Security office
  • Social Security Forms | SSA
    About Forms All forms are free If you cannot find the form you need or require assistance completing the form, please go to the Contact Us link Submitting Forms and Supporting Documents You can electronically complete, upload, and submit select forms to Social Security using the Upload Documents feature You can also fax or mail any paper form to your local office, unless otherwise
  • Submit forms and upload documents | SSA
    Gather your documents, including any Social Security forms you filled out Then, find your local Social Security office and submit them by fax, by mail, or using your office’s drop box
  • Benefits Planner: Retirement | Medicare Premiums | SSA
    If your income has gone down, you may also use Form SSA-44 to request a reduction in your income-related monthly adjustment amount Monthly Medicare Premiums for 2026 If You Disagree with Our Decision If you disagree with the decision we made about your income-related monthly adjustment amounts, you have the right to appeal
  • SSA - POMS: HI 01120. 005 - Life Changing Events - 06 18 2013
    NOTE: Beneficiaries may use the optional Form SSA-44 (Medicare Income-Related Monthly Adjustment Amount – Life-Changing Event) to report a life-changing event with a significant reduction in income If you receive an SSA-44 without a second tax year estimate, contact the beneficiary to request a second year estimate
  • More Medicare Information | SSA
    Social Security Medicare Resources Request for a replacement Medicare card - Replace your lost or damaged Medicare card Apply for Medicare Medicare Publications Medicare Income-Related Monthly Adjustment Amount – Life-Changing Event, (Form SSA-44) Apply for Medicare Part D Extra Help program Other Medicare Resources Medicare gov - The official U S Government site for Medicare information
  • Check application or appeal status | SSA
    Many factors affect how long our review takes, including the type of application or appeal you submitted See where you're at in the process and when we expect to have a decision for you
  • Medicare Income-Related Monthly Adjustment Amount - SSA
    Medicare Income-Related Monthly Adjustment Amount - Table of Contents
  • Solicite disminuir del ajuste mensuale acorde a su ingreso (IRMAA) | SSA
    Llene el formulario de Medicare Income-Related Monthly Adjustment Amount – Life-Changing Event (SSA-44) (PDF) (en inglés) Envíe su formulario lleno y la evidencia por fax o por correo a una oficina del Seguro Social





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