How to Complete Form SSA-44 (Life-Changing Event)
Form SSA-44 is used to request a reduction in your Medicare IRMAA surcharge if you experienced a life-changing event that reduced your income.
Download Form SSA-44
What Is Form SSA-44?
Form SSA-44 is the "Medicare Income-Related Monthly Adjustment Amount — Life-Changing Event" form. It allows you to request that Social Security use a more recent year's income to calculate your IRMAA surcharge, rather than the standard two-year look-back period, if you experienced a qualifying life-changing event that significantly reduced your income.
Qualifying Life-Changing Events
- Marriage
- Divorce or annulment
- Death of your spouse
- Work stoppage (retirement)
- Work reduction (reduced hours or salary)
- Loss of income-producing property (due to a disaster or other event beyond your control)
- Loss of pension income
- Employer settlement payment
How to Complete SSA-44
Section 1 – Your Information
- Full name
- Social Security Number
- Date of birth
- Medicare Beneficiary Identifier (MBI)
- Contact phone number
Section 2 – Life-Changing Event
- Select the type of life-changing event from the list
- Date the event occurred
- Brief description of the event
Section 3 – Income Information
- Your estimated Modified Adjusted Gross Income (MAGI) for the tax year you want SSA to use
- The tax year you are requesting SSA to use (must be more recent than the look-back year)
Section 4 – Supporting Documentation
- Attach proof of the life-changing event (e.g., death certificate, divorce decree, letter from employer confirming retirement)
- Attach tax return or other income documentation for the year you want used
Section 5 – Signature
- Sign and date the form
- Your signature certifies the information is accurate and complete
Consult a Tax Professional
IRMAA calculations involve your Modified Adjusted Gross Income (MAGI), which can be complex. Consult a tax professional or financial advisor to accurately estimate your MAGI before completing this form.
Where to Submit
Submit Form SSA-44 to your local Social Security Administration office:
- Mail to your local Social Security office
- Bring in person to a Social Security office
- Call SSA at 1-800-772-1213 for assistance