Fill Out Form SSA-44, Medicare Income-Related Monthly Adjustment Amount - Life-Changing Event

Stop struggling with complex IRMAA appeal forms. Upload your SSA‑44 PDF, answer straightforward questions about your life‑changing event, income changes, and tax year, and Simplicity AI fills every required field accurately. Review, sign, and export a clean SSA‑44, ready for submission to Social Security.

AI converts the SSA-44 into an interactive form. No flipping between the 7-page instruction booklet and the PDF, trying to figure out which sections apply to your situation.

Select your life-changing event (retirement, death of spouse, marriage, divorce, work reduction, work stoppage, loss of income-producing property) and AI shows only the fields relevant to that event, skipping everything else.

Need to report reduced income for both you and your spouse? AI separates individual and joint income sections and prompts users to enter the correct modified adjusted gross income estimate for the year the event occurred.

Form INFORMATIONS

Section 1 — Your Information:

Your full legal name (as on Medicare card and Social Security records), 9-digit SSN, and Medicare Claim Number (HICN or 11-character MBI). Include current mailing address and daytime phone so Social Security can send the determination letter and contact you. A name or SSN mismatch can delay processing.

Section 2 — Life-Changing Event Selection:

Select at least one qualifying event that caused your income to decrease: Marriage (combined income changed); Divorce or Annulment (individual income now lower—divorce decree required); Death of Spouse (death certificate and income-loss documentation); Work Stoppage (full retirement or job loss—employer letter or final pay stub); Work Reduction (reduced hours—employer letter or pay stubs); Loss of Income-Producing Property (disaster, involuntary sale, business closure—insurance or sale docs); Loss of Pension Income (pension administrator letter); Employer Settlement Payment (one-time back pay, severance, or settlement—payment records). Each event has specific documentation requirements.

Section 3 — Modified Adjusted Gross Income (MAGI) Estimate:

Tax year of the event; your estimated AGI and tax-exempt interest (e.g., municipal bonds—Social Security adds this to MAGI); your spouse's estimated AGI and tax-exempt interest if filing jointly; combined MAGI. Social Security compares this to IRMAA brackets to reduce or eliminate the surcharge. Be realistic; they may verify against IRS data.

Section 4 — Supporting Documentation:

Proof of the life-changing event (retirement letter, death certificate, divorce decree, pension administrator letter, etc.) and proof of income reduction (recent tax return, benefits statement, employer statement). The form won't be processed without the right evidence for your selected event. Simplicity AI generates a checklist based on your event.

Section 5 — Remarks:

Optional but recommended. Explain unusual circumstances, timing, or context—e.g., "Retired from [employer] on March 15, 2024. 2022 return reflected full-year salary of $145,000. 2025 income will consist of Social Security and a small pension totaling approximately $52,000." Clear remarks strengthen your case and reduce follow-up requests.

Section 6 — Signature and Date:

Sign under penalty of perjury. If an authorized representative completes the form, they sign with authority noted. Date of signature. IRMAA adjustments typically apply from the month Social Security processes the request, so prompt submission matters. Representative name, address, phone, and relationship if applicable (Form SSA-1696 may be required).

WHAT IS FORM SSA-44?

What Is Form SSA-44 and Who Needs to Fill It Out?

Form SSA-44, officially called "Medicare Income-Related Monthly Adjustment Amount - Life-Changing Event," is how you ask Social Security to reconsider your Medicare premium surcharge after a qualifying change in your financial situation. It isn't filed with the IRS. Instead, Social Security uses it to review your current income against the tax return from two years ago that triggered the higher premium and determine whether your Part B and Part D surcharges should be reduced or eliminated.

If any of the following describe you, you may need to file: Medicare beneficiaries who recently retired or stopped working and whose tax returns still reflect a full year of salary; surviving spouses whose household income dropped after losing a partner's earnings, pension, or benefits; recently divorced individuals whose joint return reflected combined income now split between two households; workers who significantly reduced hours; retirees who lost pension income; property owners who lost income-producing assets; or individuals who received a one-time employer settlement that inflated the return Social Security used.

The form covers personal identification, event selection, income estimates for both spouses, and supporting documentation. MAGI calculations, qualifying event distinctions, and documentation checklists often trip people up. Simplicity AI guides you through each section and ensures the right documents are attached.

How to Fill Out Your SSA-44 Online in 6 Simple Steps

Upload your blank Form SSA-44 PDF to the AI tool. The AI scans the form layout and converts it into a guided interactive questionnaire.

Enter your personal and Medicare information. This identifies you as the beneficiary requesting reconsideration of IRMAA.

Select your life-changing event and enter the date it occurred. Upload supporting documents that prove the event.

Enter your previous income and your expected reduced income. Upload tax returns or financial records so AI can extract the correct figures.

Review all entries carefully to ensure your event details, income amounts, and documents match your records. Even small inconsistencies can delay approval.

Export your completed SSA-44 as a clean PDF. Sign it, attach your supporting documents, and submit it to the Social Security Administration.

Super Fast

Complete your SSA-44 in minutes instead of hours. AI extracts income and event details from your uploaded documents and automatically fills out complex sections.

AI-Powered

The AI understands the SSA-44 structure, from life-changing event selection to income recalculation, and maps your answers to the correct fields.

Secure

Your SSA-44 contains Social Security numbers, income data, and personal documents. Files are encrypted, handled privately, and never shared. Your data remains under your control.

FAQs

Frequently Asked Questions About Form SSA-44

What is Form SSA-44, and why do I need to fill it out?

Form SSA-44 is the Social Security Administration form you use to request a reduction in your Medicare Part B and Part D premium surcharges (IRMAA) after experiencing a qualifying life-changing event. Social Security bases your premium on your tax return from two years ago. If your income has decreased due to retirement, death of a spouse, divorce, work reduction, or another qualifying event, the SSA-44 is the only way to request that Social Security use your current income.

How do I fill out Form SSA-44 online for free?

You can fill out Form SSA-44 online for free using Simplicity AI. Our platform converts the PDF into a guided questionnaire that walks you through each section, from selecting your life-changing event to estimating your Modified Adjusted Gross Income. Upload your SSA-44 PDF and follow the prompts to complete your form in minutes.

What qualifies as a life-changing event for IRMAA purposes?

Social Security accepts these specific events: marriage, divorce or annulment, death of a spouse, work stoppage (full retirement or job loss), work reduction (reduced hours or part-time transition), loss of income-producing property, loss of pension income, and receipt of an employer settlement payment. Your event must have caused a significant change in your income compared to the tax return Social Security used.

How long does it take Social Security to process an SSA-44?

Processing times vary, but Social Security typically reviews SSA-44 requests within a few weeks of receiving the form and all required supporting documentation. If documentation is incomplete or unclear, they may request additional evidence. Premium adjustments are generally applied from the month your request is processed, not retroactively, so submitting sooner means fewer months at the higher premium.

Can I file SSA-44 if my spouse died and my income dropped?

Yes. The death of a spouse is one of the most common life-changing events reported on Form SSA-44. If your household income decreased because you lost your spouse's earnings, pension, Social Security benefits, or other income, you can request that Social Security recalculate your IRMAA using your current individual income. You'll need to submit a death certificate and documentation showing the income you lost.

Do I need to file a separate SSA-44 for Part B and Part D?

No. A single SSA-44 covers both your Medicare Part B and Part D IRMAA surcharges. When Social Security processes your request and determines your updated income bracket, the adjustment applies to both premiums.

What supporting documents do I need to submit with my SSA-44?

The required documentation depends on your life-changing event. Retirement or work stoppage requires an employer letter, final pay stub, or retirement benefits statement. Divorce requires a decree or annulment order. Death of a spouse requires a death certificate. Loss of pension requires a letter from the pension administrator. Loss of income-producing property requires insurance claims, sale documents, or business dissolution records. Simplicity AI generates a customized checklist based on the event you select.

Is my data safe when filling out Form SSA-44 on Simplicity AI?

Yes. Your SSA-44 contains sensitive information, including your Social Security number, Medicare claim number, income details, and documentation of personal life events. Simplicity AI encrypts all documents, handles your data privately, and never shares it with third parties. Your data stays yours.

Common Mistakes in Completing Form SSA-44

Selecting the Wrong Life-Changing Event

Each qualifying event has different documentation requirements. Choosing "Work Stoppage" when you actually reduced hours ("Work Reduction") or "Loss of Pension Income" when your pension was reduced but not eliminated can result in denial or delay. Simplicity AI explains each event type in plain English before you commit.

Submitting Without Supporting Documentation

Social Security doesn't take your word for it. Every life-changing event requires specific evidence: retirement letter, death certificate, divorce decree, pension administrator letter, etc. Submitting without the required documentation results in Social Security returning the form. Simplicity AI generates a checklist of documents for your selected event so nothing is missed.

Using the Wrong Tax Year for Income Estimates

The MAGI estimate must reflect the year you're asking Social Security to use, not necessarily the year the event occurred. If you retired in October 2024 and want Social Security to use your reduced 2025 income, your estimate should reflect projected 2025 earnings. Entering 2024 income that still includes nine months of full salary defeats the purpose. Simplicity AI prompts for the correct tax year.

Forgetting Tax-Exempt Interest Income

Social Security adds tax-exempt interest (e.g., municipal bonds) back into your MAGI for IRMAA. If you hold muni bonds and leave that field blank, Social Security will catch the discrepancy and your surcharge could be reinstated. Simplicity AI prompts for tax-exempt interest separately to prevent oversight.

Only Reporting Your Income on a Joint Return

If you file jointly, Social Security uses combined household MAGI. Reporting only your income and leaving your spouse's fields blank results in an artificially low number that Social Security will reject. Simplicity AI separates individual and spousal income fields and automatically calculates the combined total.

Waiting Too Long to Submit

IRMAA adjustments are applied from the month Social Security processes your request, not retroactively. If you retired in January and don't submit until August, you've paid seven months of the higher premium you won't get back. Simplicity AI helps you complete and export the form the same day.

Leaving the Remarks Section Blank

The remarks section is optional but a missed opportunity. A clear, specific explanation (e.g., retirement date, prior salary, projected income) gives the reviewer context and reduces follow-up requests. Simplicity AI prompts you with targeted questions to help you write an effective explanation.

Not Filing Because You Think IRMAA Is Permanent

IRMAA is recalculated every year and can be challenged whenever a qualifying life-changing event occurs. If your circumstances have changed, you have the right to request a new determination. The SSA-44 is specifically designed for this purpose.

POPULAR FORMS

PRODUCT

Features How it works Pricing FAQs Download iOS App Download Android App

COMPANY

Terms & Conditions Privacy Policy