Form SSA-44: Appeal Your IRMAA Surcharge

Medicare bases your 2026 surcharge on your 2024tax return. If your income has since dropped because of retirement or another life-changing event, Form SSA-44 asks Social Security to use this year's estimate instead. The worksheet below tells you whether to file and what it is worth, then walks you through the form line by line.

8
Qualifying events
$0
Cost to file
Up to $6,936
Saved / person / yr
1 form
2 pages + evidence
Worksheet A-1 · Should you file SSA-44
1. What changed for you?
2. How do you file your taxes?
$
Example

The income Social Security is using now. It is printed on your IRMAA letter.

$

Your MAGI estimate for this year, after the event. On the form it is entered as two lines that add up to it: adjusted gross income plus tax-exempt interest.

Example · Determination · SSA-44 · 2026
File SSA-44. It could be worth $2,885 a year.

Work Stoppage is a qualifying event. With 2026 income of $85,000 instead of $160,000, you move from tier 2 to the standard premium. If both spouses are on Medicare, each files their own form.

Paying now
$443.30/mo
After appeal
$202.90/mo
Saved / yr
$2,885

Walk through the form with these numbers ↓

Premium figures from the 2026 sliding scale (SSA / CMS). Events per SSA POMS HI 01120.005.Your income never leaves this page.

The form, line by line

SSA-44 is five short steps. The walkthrough follows your worksheet answers, so the amounts you see here are the amounts you will write on the form.

Step 1Your life-changing event and its date

Check one box only. Based on your answer, check Work Stoppage, and write the date the event happened: your last day of work, the date of death, the date of the decree. If more than one event applies, pick the one with the biggest income effect.

Step 2This year's estimated income

Write the tax year 2026, then your estimate split across two lines: adjusted gross income on the first, tax-exempt interest on the second. Together the two lines must add up to the $85,000 you entered above (if you have no tax-exempt interest, your AGI is the whole amount). Then mark your expected filing status. You sign under penalty of perjury that the estimate is made in good faith; Social Security checks it against your actual return later.

Step 3Next year's estimate (only if it will be lower again)

Skip this step unless you expect 2027 income to drop below your 2026 estimate: for example, a partial year of wages this year and none next year. If so, write the 2027estimate here so the reduction can carry into next year's premium too.

Step 4Evidence

Attach proof of the event. Your checklist below is built for work stoppage. Bring originals or certified copies if you visit an office; send copies by mail and keep your originals.

Step 5Sign and file

Sign, date, phone number. File at your local Social Security office, or mail the form with copies of your evidence. SSA-44 is generally filed on paper rather than online; check SSA.gov for the current options. Keep a copy of everything you send.

Evidence checklist · work stoppage
Employer letter or signed personal statementStating your last day of work
Retirement or severance paperworkIf the stoppage was retirement
Copy of your IRMAA letterThe determination you are correcting
Copy of the completed SSA-44Keep one for your records

Your income stays in your browser. Premium figures come from official SSA and CMS sources for 2026.

What SSA-44 actually does

Social Security calls it a new initial determination: you report one of the eight recognized life-changing events and give a good-faith estimate of this year's MAGI, and your premium is recalculated from that estimate instead of the two-year-old return. You attest to the estimate under penalty of perjury, and Social Security checks it against your actual return once it is filed.

The form is the fast path, not the only one. For the wider process, who qualifies, and what happens after you file, read how to appeal IRMAA. If you are unsure whether your situation counts as a life-changing event, the guide to the eight events covers the edge cases. And to build the income estimate the form asks for, use the MAGI calculator.

Get the official Form SSA-44

Form SSA-44 is published and processed by the Social Security Administration. IRMAA Hub is independent, is not affiliated with the SSA, and does not file the form for you. Always download the current form from the official source.

Get Form SSA-44 at SSA.gov

Common questions

Is there a deadline to file Form SSA-44?
File as soon as the event happens, so the correction applies to the current premium year. There is no fee. If you are instead disputing the determination itself rather than reporting a life event, that reconsideration request has a 60-day window from when you receive your IRMAA letter.
My income dropped, but nothing on the list happened. Can I still file?
No. A lower-income year by itself, such as a one-time capital gain rolling off or a smaller Roth conversion, is not a life-changing event, so SSA-44 does not apply. The surcharge corrects itself when the two-year lookback reaches your lower-income return. If the income Social Security used is simply wrong or outdated, ask for a new determination with the corrected return instead.
Where do I get the form, and where does it go?
Download the current Form SSA-44 from SSA.gov. File it at your local Social Security office or mail it in with copies of your evidence. It is generally a paper filing rather than an online one; check SSA.gov for the current submission options, since Social Security updates its processes periodically.
What if Social Security says no?
You can request reconsideration within 60 days of receiving the decision, and after that a hearing before an administrative law judge. The denial letter lists the exact route and deadlines.
Does one form fix both Part B and Part D?
Yes. Both the Part B and Part D income adjustments come from the same income determination, so a successful request corrects both at once.
How long does a decision take?
Times vary by office, and the decision arrives by mail. A complete form with clear documents is the best way to avoid delays.

Sources: SSA POMS HI 01120.005 (life-changing events) and HI 01140.001 (appeals); Form SSA-44; SSA and CMS premium figures for 2026. Always confirm the current form and instructions at SSA.gov. Informational only, not financial or tax advice. Last verified August 2026.