Where do I get Form SSA-44?

From the Social Security Administration. Download the current version from SSA.gov, because the form is updated from time to time. IRMAA Hub is independent of the SSA and does not provide or file the form.

Where do I send the completed SSA-44?

To Social Security. You can mail the signed form and your documents to your local Social Security office or bring them in person. Confirm the current submission options and address at SSA.gov or by calling Social Security.

What documents do I attach?

Proof of the life-changing event, such as a retirement letter, death certificate, or marriage or divorce certificate, plus evidence of your lower income, such as a recent pay stub or a signed estimate. Send copies and keep your originals.

Can I file Form SSA-44 online?

It is generally submitted by mail or in person rather than through an online form. Check SSA.gov for the current options, since Social Security updates its processes periodically.

How to Fill Out Form SSA-44 (Step by Step)

Before you start: what to have ready

Filling out the form goes quickly if you gather a few things first:

Your name and Social Security number as they appear on your Medicare card.
Which of the eight qualifying events applies and the date it happened. If you are not sure you qualify, check the life-changing events first.
Your estimated MAGI for the affected year. The guide to MAGI and the calculator help you work it out.
Documents that prove both the event and your lower income.

Your information at the top

The form opens with identifying details. Enter your name and Social Security number exactly as they appear on your Medicare card, so Social Security can match the request to your record without delay.

Step 1: your life-changing event

Here you check the single event that applies to you and write in the date it happened. Only the eight recognized events qualify, such as work stoppage (retirement), the death of a spouse, marriage, or divorce. Pick the one that actually reduced your income and use its real date, because Social Security matches the date against the year you are claiming.

If none of the listed events fits your situation, SSA-44 is not the right form. A simple drop in investment income, for example, does not qualify. In that case you would request a formal reconsideration instead. See the eight events and what does not qualify.

Step 2: your reduced income

This is the heart of the form. You give the tax year affected by the event and your estimated income for it: your expected adjusted gross income plus any tax-exempt interest, which together are your MAGI. You also indicate the filing status you expect to use for that year.

Take care with this estimate, because it is the figure that sets your bracket. Build it the same way you would any MAGI estimate: start from your expected AGI, add tax-exempt interest, and leave out income that has stopped. Running the number through the calculator shows which tier your estimate lands in before you write it down.

Step 3: a second year, only if income drops again

If you expect your income to fall even further the following year, the form lets you provide an estimate for that more recent year too. This step is optional. Use it only when a second, lower year genuinely applies, for example when an event partway through one year means the next full year will be lower still. If that does not apply to you, leave it blank.

Step 4: documentation

Finally you list and attach your supporting evidence. Social Security wants to see proof of two things: that the event happened, and that your income is lower. Typical documents include:

For the event: a retirement or termination letter, a death certificate, or a marriage or divorce certificate.
For the income: a recent pay stub, a benefit statement, or a signed statement of your estimate when no document exists yet.

Send copies, not originals, and keep your originals for your records.

Sign, then submit to Social Security

Sign and date the form. Then submit the signed form and your documents to Social Security, by mail to your local office or in person. Because Social Security updates the form and its submission options periodically, download the current SSA-44 and confirm where to send it at SSA.gov. Processing times vary by office, and a complete form with clear documents is the best way to avoid delays.

For the bigger picture of who can appeal and the overall process, read how to appeal IRMAA.

Common questions

Where do I get Form SSA-44?: From the Social Security Administration. Download the current version from SSA.gov, because the form is updated from time to time. IRMAA Hub is independent of the SSA and does not provide or file the form.
Where do I send the completed SSA-44?: To Social Security. You can mail the signed form and your documents to your local Social Security office or bring them in person. Confirm the current submission options and address at SSA.gov or by calling Social Security.
What documents do I attach?: Proof of the life-changing event, such as a retirement letter, death certificate, or marriage or divorce certificate, plus evidence of your lower income, such as a recent pay stub or a signed estimate. Send copies and keep your originals.
Can I file Form SSA-44 online?: It is generally submitted by mail or in person rather than through an online form. Check SSA.gov for the current options, since Social Security updates its processes periodically.
What income figure do I enter on the form?: Your estimated MAGI for the year the event affects, which is your expected adjusted gross income plus any tax-exempt interest. Estimate it as accurately as you can, because that number decides your bracket.

Source: U.S. Social Security Administration, Form SSA-44 and publication 05-10536, "Medicare Premiums: Rules for Higher-Income Beneficiaries." Always confirm the current form and instructions at SSA.gov. Informational only, not financial or tax advice. Last verified June 2026.