Form SSA-44, Medicare Income-Related Monthly Adjustment Amount, Life-Changing Event
Medicare premium surcharges (IRMAA) are set from a tax return two years old. If your income has since dropped because of retirement or another life event, Form SSA-44 asks SSA to use the newer, lower figure.
This is the genuine SSA PDF, unmodified. Source: SSA official page.
What is SSA-44?
Form SSA-44 reports a life-changing event that reduced your income, so the income-related monthly adjustment amounts added to Medicare Part B and Part D premiums can be recalculated from your more recent income instead of the two-year-old tax return SSA normally uses.
Qualifying events are listed on the form: work stoppage or reduction, marriage, divorce or annulment, death of a spouse, loss of income-producing property, loss of pension income, and an employer settlement payment.
Who files SSA-44?
- New retirees whose Medicare premiums were set from peak working-year income
- Beneficiaries who married, divorced, or lost a spouse
- Anyone whose qualifying event cut the income SSA used for IRMAA
How to fill out SSA-44
- Check the life-changing event in Step 1 and enter its date.
- Report your reduced modified adjusted gross income for the affected year in Step 2.
- Estimate next year’s income in Step 3 if it will drop further.
- Download, sign, and take or mail it to your local Social Security office with evidence: retirement letter, death certificate, or divorce decree.
Quick fill SSA-44 on this page
Prefer to see the form itself while you type? Open SSA-44 in the editor to fill it on the actual pages, add a signature, and download.
Frequently asked questions
Does selling investments count as a life-changing event?
No. A one-time capital gain, Roth conversion, or IRA withdrawal is not on the qualifying list, even though it raised your IRMAA.
How far back can relief go?
SSA generally adjusts the current premium year for the event and income you document; appeal promptly rather than letting surcharged months pile up.