Title 20, Part 418 — Medicare Subsidies

What is this subpart about?

Purpose and administration.

Definitions.

What is the income-related monthly adjustment amount?

What is the threshold?

What is the effective date of our initial determination about your income-related monthly adjustment amount?

What are the modified adjusted gross income ranges?

How do we determine your income-related monthly adjustment amount?

How will the income-related monthly adjustment amount affect your total Medicare Part B premium?

[Reserved]

What modified adjusted gross income information will we use to determine your income-related monthly adjustment amount?

What will happen if the modified adjusted gross income information from IRS is different from the modified adjusted gross income information we used to determine your income-related monthly adjustment amount?

How do we determine your income-related monthly adjustment amount if IRS does not provide information about your modified adjusted gross income?

When will we use your amended tax return filed with IRS?

When will we determine your income-related monthly adjustment amount based on the modified adjusted gross income information that you provide for a more recent tax year?

What is a major life-changing event?

What is not a major life-changing event?

What is a significant reduction in your income?

What is not a significant reduction in your income?

Which more recent tax year will we use?

What is the effective date of an income-related monthly adjustment amount initial determination that is based on a more recent tax year?

When will we stop using your more recent tax year's modified adjusted gross income to determine your income-related monthly adjustment amount?

Should you notify us if the information you gave us about your modified adjusted gross income for the more recent tax year changes?

What will happen if you notify us that your modified adjusted gross income for the more recent tax year changes?

What evidence will you need to support your request that we use a more recent tax year?

What kind of major life-changing event evidence will you need to support your request for us to use a more recent tax year?

What major life-changing event evidence will we not accept?

What kind of significant modified adjusted gross income reduction evidence will you need to support your request?

What modified adjusted gross income evidence will we not accept?

What is an initial determination regarding your income-related monthly adjustment amount?

What is not an initial determination regarding your income-related monthly adjustment amount?

When may you request that we make a new initial determination?

How will we notify you and what information will we provide about our initial determination?

What is the effect of an initial determination?

How will a Medicare prescription drug coverage income-related monthly adjustment amount determination for the effective year affect your Medicare Part B?

When may you request a reconsideration?

Can you request a reconsideration when you believe that the IRS information we used is incorrect?

What should you do if our initial determination is based on modified adjusted gross income information you believe to be incorrect?

What are the rules for our administrative review process?

Is reopening of an initial or reconsidered determination made by us ever appropriate?

What are the rules for review of a reconsidered determination or an administrative law judge decision?

What are the rules for reopening a decision by an administrative law judge of the Office of Medicare Hearings and Appeals (OMHA) or by the Medicare Appeals Council (MAC)?

What is this subpart about?

Purpose and administration.

Definitions.

What is the income-related monthly adjustment amount?

What is the threshold?

What is the effective date of our initial determination about your income-related monthly adjustment amount?

Paying your income-related monthly adjustment amount.

What are the modified adjusted gross income ranges?

How do we determine your income-related monthly adjustment amount?

How will the income-related monthly adjustment amount affect your total Medicare prescription drug coverage premium?

What modified adjusted gross income information will we use to determine your income-related monthly adjustment amount?

What will happen if the modified adjusted gross income information from the IRS is different from the modified adjusted gross income information we used to determine your income-related monthly adjustment amount?

How do we determine your income-related monthly adjustment amount if the IRS does not provide information about your modified adjusted gross income?

When will we use your amended tax return filed with the IRS?

When will we determine your income-related monthly adjustment amount based on the modified adjusted gross income information that you provide for a more recent tax year?

What is a major life-changing event?

What is not a major life-changing event?

What is a significant reduction in your income?

What is not a significant reduction in your income?

Which more recent tax year will we use?

What is the effective date of an income-related monthly adjustment amount initial determination based on a more recent tax year?

When will we stop using your more recent tax year's modified adjusted gross income to determine your income-related monthly adjustment amount?

Should you notify us if the information you gave us about your modified adjusted gross income for the more recent tax year changes?

What will happen if you notify us that your modified adjusted gross income for the more recent tax year changes?

What evidence will you need to support your request that we use a more recent tax year?

What kind of evidence of a major life-changing event will you need to support your request for us to use a more recent tax year?

What major life-changing event evidence will we not accept?

What kind of evidence of a significant modified adjusted gross income reduction will you need to support your request?

What modified adjusted gross income evidence will we not accept?

What is an initial determination regarding your income-related monthly adjustment amount?

What is not an initial determination regarding your income-related monthly adjustment amount?

When may you request that we make a new initial determination?

How will we notify you and what information will we provide about our initial determination?

What is the effect of an initial determination?

How will a Medicare Part B income-related monthly adjustment amount determination for the effective year affect your Medicare prescription drug coverage?

When may you request a reconsideration?

Can you request a reconsideration when you believe that the IRS information we used is incorrect?

Can you request a reconsideration when you believe that the CMS information we used is incorrect?

What should you do if we base our initial determination on modified adjusted gross income information you believe to be incorrect?

What are the rules for our administrative review process?

Is reopening of an initial or reconsidered determination made by us ever appropriate?

What are the rules for review of a reconsidered determination or an ALJ decision?

What are the rules for reopening a decision by an ALJ of the Office of Medicare Hearings and Appeals (OMHA) or by the Medicare Appeals Council (MAC)?

What is this subpart about?

Purpose and administration of the program.

Definitions.

How do you become eligible for a subsidy?

Who does not need to file an application for a subsidy?

What happens when you apply for a subsidy?

What events will make you ineligible for a subsidy?

What happens if your circumstances change after we determine you are eligible for a subsidy?

When is a change in your subsidy effective?

What are redeterminations?

Must you file an application to become eligible for a subsidy?

What makes an application a claim for a subsidy?

What is a prescribed application for a subsidy?

Who may file your application for a subsidy?

When is your application considered filed?

How long will your application remain in effect?

When will we use your subsidy inquiry as your filing date?

What is income?

What is not income?

Whose income do we count?

What is earned income?

How do we count your earned income?

What earned income do we not count?

What is unearned income?

What types of unearned income do we count?

How do we count your unearned income?

What types of unearned income do we not count?

What are resources?

What types of resources do we count?

Whose resources do we count?

How do we determine countable resources?

How are funds held in financial institution accounts counted?

What resources do we exclude from counting?

What could cause us to increase or reduce your subsidy or terminate your subsidy eligibility?

How would an increase, reduction or termination affect you?

When would an increase, reduction or termination start?

How could you qualify for a subsidy again?

When do you have the right to administrative review?

What is an initial determination?

Is there administrative or judicial review for administrative actions that are not initial determinations?

Will we mail you a notice of the initial determination?

What is the effect of an initial determination?

What is the process for administrative review?

How do you request administrative review?

Can anyone request administrative review on your behalf?

How do we determine if you had good cause for missing the deadline to request administrative review?

Can you request that the decision-maker be disqualified?

How do we make our decision upon review?

How will we notify you of our decision after our review?

Can your request for a hearing or case review be dismissed?

How will you be notified of the dismissal?

How does our decision affect you?

What is the process for correcting Agency clerical errors?

What happens if your case is remanded by a Federal court?