Fill Out SSA Form SSA-44 Online
Medicare Income-Related Monthly Adjustment Amount - Life-Changing Event
Social Security Administration
Requests a reduction of the Medicare income-related premium surcharge (IRMAA) after a life-changing event such as retirement.
Reviewed July 2026
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Form SSA-44, Medicare Income-Related Monthly Adjustment Amount - Life-Changing Event, is the Social Security Administration form you file when your income has dropped because of a major life event and you want your Medicare premium surcharge recalculated. Medicare Part B and Part D surcharges, known as IRMAA, are normally based on your tax return from two years earlier, which can overstate what you actually earn today.
You can complete Form SSA-44 in the Universal PDF editor, entering your event details and income estimates directly into the form fields. Download the finished PDF, print and sign it, and submit it to Social Security with your evidence.
What is Form SSA-44 used for
The form asks the SSA to use a more recent, lower income figure when setting your income-related monthly adjustment amount for Medicare Part B and Part D. It applies only when the income drop resulted from a qualifying life-changing event, not from ordinary year-to-year fluctuations in earnings or investments.
- Marriage
- Divorce or annulment
- Death of a spouse
- Work stoppage, such as retirement
- Work reduction, such as moving to part-time hours
- Loss of income-producing property beyond your control
- Loss or reduction of certain pension income
- Receipt of a settlement payment from a current or former employer
Who files Form SSA-44
Medicare beneficiaries who received an IRMAA determination notice and have experienced one of the qualifying events file this form. Retirement is the most common trigger: someone who stopped working recently is often assessed a surcharge based on their final full working years, even though their current income is much lower.
If you are married and both spouses pay IRMAA, each spouse files their own SSA-44 even when the life-changing event, such as one spouse retiring, is the same.
How to fill out Form SSA-44
The form walks through five steps. Be ready to estimate your modified adjusted gross income, which is your adjusted gross income plus tax-exempt interest.
- Step 1: check the life-changing event that applies and enter the date it happened
- Step 2: estimate your modified adjusted gross income for the year the event reduced your income, and your tax filing status
- Step 3: estimate next year's income if you expect it to be lower still
- Step 4: list the evidence you are attaching, such as a signed tax return, a letter from your employer confirming retirement, or a death certificate
- Step 5: sign and date the form; unsigned forms are returned
How to submit it
Take the signed form and your original documentation to a local Social Security office, or mail everything to your local office. You can also call the SSA to discuss an IRMAA appeal before filing. If the SSA agrees, it adjusts your premium and refunds or credits any overcharged amounts for the affected months.
If your dispute is about an error in the tax data itself rather than a life-changing event, contact the SSA about correcting the record instead of, or in addition to, filing SSA-44.
Frequently asked questions
The form lists eight events: marriage, divorce or annulment, death of a spouse, work stoppage, work reduction, loss of income-producing property, loss of pension income, and an employer settlement payment. A one-time spike in investment income does not qualify.
Yes. Retirement is the most common event reported on SSA-44. You will typically attach evidence such as an employer letter or documentation showing your last day of work.
Proof of the event and proof of the income change. Common examples are a signed copy of your most recent federal tax return, an employer statement, a marriage or death certificate, or pension plan correspondence.
Each beneficiary files their own form. If both of you pay IRMAA and are affected by the same event, submit two separate forms, each signed by the person it covers.
The SSA reviews your estimate and evidence and issues a new determination. If your surcharge is lowered, the change applies to the year you requested and any overpaid premium amounts are refunded or credited.
Yes. You can request reconsideration of an IRMAA determination. The denial notice explains the appeal steps and deadlines that apply to your case.
Related forms
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