or More than $174,000 for a married filing joint federal tax return? The Medicare income-related monthly adjustment amount, or IRMAA, is a surcharge on Medicare premiums for Medicare Part B (medical insurance) and Part D prescription drug plans. 0000020776 00000 n In 2021, the standard Medicare Part B premium is $148.50 per month. Medicare Part B IRMAA Surcharge Reimbursement form for: 2019, 2020, 2021. If you already submitted your Medicare Part A & B card to the Health Benefits Program, this payment is automatic and you will receive it annually. 6#(f` d)2(3x0\F+Y@. On September 27, 2022, the Centers for Medicare & Medicaid Services (CMS) released the 2023 premiums, deductibles, and coinsurance amounts for the Medicare Part A and Part B programs, and the 2023 Medicare Part D income-related monthly adjustment amounts. 0 If you dont have EFT or direct deposit, you will receive a check in the mailin June. What is IRMAA?A: The Income Related Monthly Adjustment Amount (IRMAA) is an additional amount that you pay for your monthly Medicare premiums if you have higher annual earnings.Q. %PDF-1.3 % If you received less than a $144.60 Medicare Part B 7500 Security Boulevard, Baltimore, MD 21244. Find a Medicare Supplement Insurance (Medigap) policy. This IRMAA is a surcharge you must pay in addition to the standard premium. The Employee Benefits Division (EBD) will notify you if your application is incomplete.Q. %PDF-1.6 % If your modified adjusted gross income, as reported on your IRS tax return from 2 years ago, is above a certain amount, you'll pay the standard premium amount and an Income Related . Please resubmit your documents as follows: 1) Forms/documents can submitted electronically using the following link: https://nycemployeebenefits.leapfile.net. For most retirees, the refund is issued automatically by the Health Benefits Program. Medicare prescription drug coverage helps pay for your prescription drugs. Retirees and/or eligible dependents currently receiving Medicare reimbursement will automatically be updated to receive this amount each month. subsidy and are enrolled in both Medicare Parts A and B. %%EOF 7500 Security Boulevard, Baltimore, MD 21244, Find a Medicare Supplement Insurance (Medigap) policy. Find out what to do with Medicare information you get in the mail. How do I know if I was required to pay IRMAA for Medicare Part B in 2020?A: If your income in 2018 was less than or equal to $87,000 as an individual, or less than or equal to $174,000 as a married couple, you did not pay IRMAA and the enclosed information does not apply to you. Each year the Centers for Medicare and Medicaid Services (CMS) announces the Medicare Part B premium. "wH`6?&aZ f`b0nd= "v/$[`r| "fH`35" /,$'n^kx2xtCrDr FL` GI2^ nv Reimbursement for the standard premium payments is generally sent out in August of . 8 34 receive a retroactive reimbursement for up to twelve (12) pension What you may not know is that if you are subject to the Income-Related Monthly Medicare Adjustment Amount (the IRMAA) because your annual total adjusted . For more information about Medicare and health benefits programs, contact us at 1-800-MEDICARE (). Can I be reimbursed for Medicare Part D (drug coverage) IRMAA payments? For detailed instructions on how to submit your form/document securely through LeapFile and to view a short video, click here. 311 0 obj <> endobj You may also access proof of your 2021 To update your Part B reimbursement for the 2021 calendar year, According to CMS, most Medicare beneficiaries will pay the standard Medicare Part B premium amount. IRMAA 2021 annual reimbursements were issued in October 2022. Since there is no longer a difference in reimbursement rates and they were made correctly . <<4D5786F2A3DC724AAE643C4E70D5659D>]/Prev 91856>> roll months from the date your submission is received. 2021 Medicare Part B Reimbursement - The reimbursement for the standard Medicare Part B was $1,782.00. The standard monthly premium for Medicare Part B enrollees will be $148.50 for 2021, an increase of $3.90 from $144.60 in 2020. . If your Medicare Part B reimbursement amount was less than what you paid in Medicare Part B premiums, excluding penalties, you may be eligible for a Medicare Part B Differential reimbursement. 0000015995 00000 n Click on the link at the bottom of this post for the form needed to apply for a refund. increase to $148.50 for 2021. However, NYS Dept. IRMAA 2019 reimbursements were issued during October and November 2020. IRMAA refers to Income-Related Monthly Adjustment Amount added to your Medicare Part B and Part D premiums. If you have additional questions about your Medicare Part B Maximum allowable for Medicare . What Is IRMAA? October 2021 Medicare Part D Income-Related Monthly Adjustment Amounts (IRMAAs) On January 1, 2011, as part of the Patient Protection and Affordable Care Act and the Health . %PDF-1.6 % The reimbursement amount is based on the standard Medicare Part B premiums. December 1, 2021 NJREA 2 minutes to read. The location of your local office can be found in your telephone directory or on the SSA website at www.ssa.gov/onlineservices.Q. 0000028831 00000 n By using this site you agree to our use of cookies as described in our, Something went wrong! If you are enrolling in Medicare Part B through IRMA and you are eligible to receive Part B Part A through your job, then you may qualify for additional Medicare financial assistance. Other costs: Medigap usually helps pay your portion of the costs (like deductibles and coinsurance) for services that Part A and Part B cover in Original Medicare. As you may know, CalPERS automatically reimburses the basic Medicare Part B monthly premium (which will be $170.10 for 2022) for its retirees who are in Medicare. What is it? startxref Where can I find an update on processing of IRMAA reimbursement requests?A: To find the current processing date of IRMAA applications, please contact the EBD Call Center at 518-457-5754 or 1-800-833-4344 and press 4, then 2. 0000009899 00000 n or Qualified Survivors who are eligible for an LAFPP health IRMAA payments go directly to Medicare . Since 2020, the Income-Related Monthly Adjustment Amount (IRMAA) income brackets are inflation adjusted. 16, 2021, 9:30 p.m. . %%EOF The Social Security Administration (SSA) uses your income tax information from 2 . 2021 Standard Base Medicare Part B Premium Rate. *Applications requesting reimbursement of 2017 amounts must be received by 4/15/2021 2020 Medicare Part B premium including IRMAA $202.40 $289.20 $376.00 $462.70 $491.60 REQUIRED DOCUMENTATION Please enclose all required documentation for each person for which you are applying. 330 0 obj <> endobj 2021 Annual . reimbursement on yourpension check in 2020, LAFPP will Here are the Part B IRMAA premiums for 2023 (for each income range, based on 2021 tax returns, the applicable premium is shown on the right; for incomes that are subject to IRMAA, the premium shown includes the IRMAA . 236 0 obj <> endobj Managing employee benefits for any size company is hard enough, make it easier with our Benefits Administration platform. You'll get this notice if you have Medicare Part B and/or Part D and Social Security determines that any Income Related Monthly Adjustment Amounts (IRMAA) apply to you. 2021 Medicare Part B premium including IRMAA . notify you by email or mail with instructions on how to update Admissions Criteria for Post 16 (Sixth Form) Abbeyfield School Sixth . You will immediately receive notification stating "Success! in Parts A and B is eligible for Medicare Part B premium Medicare-eligible retirees and their Medicare-eligible dependents were reimbursed annually for the standard Medicare Part B amount of $148.50 per month ($148.50 x 12 months = $1,782), excluding any penalties and late enrollment fees, and subject to be pro-rated. Health Plan Premium. Copyright 2016 MTA TMBA. If you are currently receiving your pension check through Electronic Fund Transfer (EFT) or direct deposit, your reimbursement will be deposited directly into your bank account. The City of New York Health Benefits Program reimburses Medicareeligible retirees and their Medicare- eligible dependents for any - Medicare Part B incomerelated monthly adjustment amount (IRMAA) premiums (excluding any penalties or surcharges) paid during - the calendar year. The standard premium for Medicare Part B is $164.90 in 2023. IRMAA 2020 reimbursements were issued in October 2021. Please identify yourself as a City of New York retiree or dependent of a retiree. 2021 *2020 2019 2018 *Applications requesting reimbursement of 2018 amounts must be received by 4/15/20 22. irmaa 2021 form City of New York Health Benefits Program IRMA Medicare Part B Reimbursement Claim Instructions A new federal law requires that some beneficiaries pay a 2012 tax forms The products you should use to complete Form 1099-MISC are the 2012 General Instructions for Certain Information Returns and the 2012 Instructions for We appreciate your cooperation in assisting us in our efforts to administer this program. If you received a Medicare Part B reimbursement of $144.60 on Get email updates. This will only delay processing. 41 0 obj <>stream 0000069415 00000 n If you did not pay more than the standard amount, then you are not eligible for IRMAA. We know this is true because the Medicare Board of Trustees has stated that the standard premium for part B is 25% or 1/4th of the Average expenditure. Medicare-eligible retirees and their Medicare-eligible dependents will be reimbursed annually for the standard Medicare Part B amount of $170.10 per month ($170.10 x 12 months = $2,041.20), excluding any penalties and late enrollment fees, and subject to be pro-rated. hb``c``N``e`gd@ A_D&h@fpz; 2[\ d`lgPdgc4`bTf4`cgbb5u(S6u ^>of|hpC/@Lq*]liF5@Zm,H06|mwfqv,@d)l7 3 . The additional amount added to your premiums is called the income-related monthly adjustment amount (IRMAA). Medicare Part B requires a monthly premium that is automatically deducted each month from your Social Security check and usually changes (goes up) each January 1st. 2020 Medicare Part B Reimbursement - The reimbursement for the standard Medicare Part B was $1,735.20. REQUIRED DOCUMENTATION Please enclose all required documentation for each person for which you are applying. If you paid more than the standard monthly reimbursement rate for Medicare Part B, as an Income Related Monthly Adjustment Amount (IRMAA), you may be eligible for additional reimbursement. January 2023 - You will receive your Social Security Benefit Statement, SSA 1099 (2022) form. A copy of your 2021 Social Security Form SSA-1099, or A copy of your 2021 Form RRB-1099 (if in the Railroad Retirement system) If you did not receive Form SSA-1099, you can submit alternative proof of your Medicare Part B or D payments: A copy of invoice with canceled check Statement with canceled check SECTION 1: YOUR INFORMATION 0000015079 00000 n We'll automatically reimburse you for the standard Medicare Part B . If you are currently receiving your pension check through Electronic Fund Transfer (EFT) or direct deposit, your reimbursement was deposited directly into your bank account. %%EOF If you pay your NYSHIP premium by direct payments to the Employee Benefits Division, Medicare Part B reimbursements will be credited toward your monthly NYSHIP premium payments, and if your Medicare reimbursement exceeds your health insurance premium, you will receive a quarterly reimbursement . Medicare Part B Differential . A: Yes. You're able to enroll in Medicare Parts A & B online by contacting SSA at (800) 772-1213 or by visiting your local Social Security office. working. Retirees or eligible dependents of a retiree with Medicare Part B will be reimbursed at the rate of $144.60 per month. The amount of Part B reimbursement paid to State retirees who attained 25 years of service or retired under a Disability Retirement after July 1, 1997, is subject to a monthly maximum amount of $46.10 per member, or $92.20 for a member and spouse when both are on Medicare, based on union contracts or regulations in effect at the time the member . That comes out to $1,735.20 for 12 months. If you are a new Medicare Part B enrollee in 2022, you will be reimbursed the standard monthly premium of $170.10 and will only need to provide a copy of your Medicare card. 0000077689 00000 n 425 0 obj <>stream You must submit a copy of your Social Security benefits $250 per month for your Medicare Part B premiums, including any additional amount you pay for the late enrollment penalty and/or Income Related Monthly Adjusted Amount (IRMAA). 394 0 obj <>stream of Civil Service will reimburse this additional charge. Medicare is a government program and therefore eligibility generally can only be determined depending on your family situation and individual circumstances. Social Security New Benefit Amount statement for 2021; or, Next Medicare monthly or quarterly billing statement (if you The Centers for Medicare and Medicaid Services (CMS) has Congressional action to significantly lower the increase in the 2021 Medicare Part B premium, which resulted in the $3.00 per beneficiary per month increase in the Medicare Part B premium (that would have ended in 2021) being continued through 2025. . The Part B premiums and deductible reflect the provisions of the Continuing . verification statement (your New Benefit Amount) or a copy of a Related Content - medicare part b irmaa reimbursement form 2021, Related Features ** Employer Contribution. hbbd```b``9"HE a/Xd.&$L`b|O"}$K%qRCeq50 If your 2016 monthly Medicare Part B premium is $104.90, STOP! your Part B premium amount on record. If you received a Medicare Part B reimbursement of $144.60 on your pension check in 2020, you do not need to provide documentation and your Part B reimbursement will automatically . The annual deductible for Medicare Part B beneficiaries grows with the Part B financing and is increasing from $203 in 2021 to $233 in 2022. 376 0 obj <>/Filter/FlateDecode/ID[<0B10A8F977AF6A41BC8E4AA5A093B350>]/Index[330 102]/Info 329 0 R/Length 166/Prev 449477/Root 331 0 R/Size 432/Type/XRef/W[1 3 1]>>stream Medicare Part D provides drug coverage. 0000002603 00000 n If you or your dependent enroll before this date, and the Part B premium is more than the standard Part B premium, then you may be charged Part B premium as shown on the rebate statement. Forms/documents must submitted electronically using the following link: https://nycemployeebenefits.leapfile.net. The 1/1/21 basic monthly premium will be $153.30. These Part B costs can add up quickly, which is why many beneficiaries search for a way to lower or be . Please note that once you have an online . hb```f``a`e`Pofd@ A+&)Ha230(30L`XPX /5a#LB]'YKXYd2_e9^F&)AK You may use this form if you received a notice that your monthly Medicare Part B (medical insurance) or prescription drug coverage premiums include an income-related monthly adjustment amount (IRMAA) and you experienced a life-changing event that may reduce your IRMAA. Health Benefits Summary Plan Description (SPD), Retiree Health Benefits Application/Change Form (Not for use by NYCAPS Agencies), COBRA Form, Notice of Rights and COBRA Rates - January 2023, COBRA Form, Notice of Rights and COBRA Rates - October 2022, Young Adult Option Through Age 29 (NYS Law Chapter 240) - October 2022, Young Adult Option Through Age 29 (NYS Law Chapter 240) - July 2022, Medicare Part B Reimbursement Program Application. Set by the Centers for Medicaid and Medicare Services (CMS). Medicare Part A (Hospital Insurance) Costs Part A monthly premium Most people don't pay a Part A premium because they paid Medicare taxes while . You may contact your local SSA office to verify if you paid IRMAA. Applications are processed in the order they are received by EBD. additional Part B penalties or fees charged by CMS are not monthly maximum standard reimbursement of $135.50). If you have not yet enrolled in Medicare, but you may be eligible to, please see the enrollment information on the Form 1120EZ, New York State Health Benefits Program (IRMA) for information on how to enroll. If NO, you did not pay IRMAA for Medicare Part B, and you have already been reimbursed for the standard Medicare Part B premium. 0000000016 00000 n However, 2017 IRMAA applications must be received by April 15, 2021 or they will not be considered for reimbursement. endstream endobj 237 0 obj <. Get the Uft irmaa reimbursement 2021 completed. We will be looking into this with the utmost urgency, The requested file was not found on our document library. Published: Mar. Media Inquiries Form 202-690-6145. %PDF-1.6 % Maximum allowable for Medicare Part B Reimbursement - = Employer Contribution $550 Health Plan Premium $350. Medical & Dental Benefits, 701 E. 3rd Street, Suite 200, Los 0000015309 00000 n For detailed instructions on how to submit your form/document securely through LeapFile and to view a short video, click here. be reimbursed the standard monthly premium of $148.50 and do not X X X - X X - __ __ __ __ Last year, Congress kept the increases in the Part B . An IRMAA is a surcharge added to your monthly Medicare Part B and Part D premiums, based on your yearly income. The Extra Help program helps with the cost of your prescription drugs, like deductibles and copays. Any 0000025529 00000 n For detailed instructions on how to submit your form/document securely through LeapFile and to view a short video, . February 21, 2021 Retiree Info. Need to change your address with Medicare? Applications for reimbursement must be received within three years of the tax filing deadline for that year. Find the right form for you and fill it out: No results. 0000021673 00000 n xref amount determined by CMS. IRMAA Reimbursement for 2022. File for 2020 IRMAA if your adjusted gross income in 2018 was greater than $87,000 single or $174,000 joint filing. The Part B insurance premium is set annually by the CMS. Medicare-eligible retirees and their Medicare-eligible dependents were reimbursed annually for the standard Medicare Part B amount of $148.50 per month ($148.50 x 12 months = $1,782), excluding any penalties and late enrollment fees, and subject to be pro-rated. hb``c``nc`c`cd@ AV(D>m 9:@!((" H%XY cCC6f1DViF-eXXYl`z5A)/7>Y[2k3g4g` 8Q6@.i%vA~a5K{Zo f*C(TH330``7Z5* ? No further action is required. reimbursement. If you enroll in Medicare Part B through IRMA, you will be charged a total Part B premium during CALENDAR YEAR 2010, with an applicable late-enrollment surcharge. Your file has been received" upon completion of your document upload. Income-Related Monthly Adjustment Amount (IRMAA) Reimbursement Form . The 2023 standard Medicare Part B premium amount is $164.90 (the 2022 premium was $170.10). Medicare Part B premium deduction. Medicare Part B IRMAA Reimbursement Form . 0000001268 00000 n Your 2021 Reimbursement from the EUTF was individually less than $148.50 per month or $445.50 per quarter. Only the retired member or Qualified Survivor enrolled Those retirees who are eligible for the IRMAA reimbursement must submit the IRMAA 2021 application along with the required supporting documents. is not the form you're looking for? )#)%MRBRL2d&$E$BB dh*;d-B TMBA is a NOT FOR PROFIT 501(c) (4) CORP. Once you enroll in Medicare Part B, your Part B premium for CALENDAR YEAR 2010 will likely be higher than the standard premium. Please submit this application, along with all required documents, electronically to. hbbd```b``~ Benefits Administration Onboarding ACA Dashboard. 8 0 obj <> endobj The higher the beneficiary's range of modified adjusted gross income (MAGI), the higher the IRMAA. statement. All Rights Reserved. However, those in a higher income bracket will pay a higher monthly premium. xw\'aFM 8(JA &pTkiNmE;{m9==jyx?`scKm(FV?re|!iXTOq&XT^! *qHP7xT||1dXS`{CGRP9!6AUL$"FB$3ah&#F)~Lz~i^xW[q=.rg;BD]Q_Q)gOla3&}:B@_>}0b(^WVK"b^ID> Medicare Part B Premium and Deductible If You Are Currently Receiving Reimbursement - What Do You Need To Do . Medicare Part B 2021 Reimbursement. hb```f````g` B@1vE:00L`02h8;e@ IRMAA 2021 reimbursement. 2023 All Rights Reserved, NYC is a trademark and service mark of the City of New York, Responsibilities & Health Benefits Assistance, COBRA Form, Notice of Rights and COBRA Rates, Young Adult Option Through Age 29 (NYS Law Chapter 240), IRMAA Medicare Part B Reimbursement Application. 367 0 obj <>/Filter/FlateDecode/ID[<1E6609D23CDC5549A1B837F84E5156EC>]/Index[311 115]/Info 310 0 R/Length 178/Prev 472413/Root 312 0 R/Size 426/Type/XRef/W[1 3 1]>>stream The annual deductible for all Medicare Part B beneficiaries is $203 in 2021, an increase of $5 from the annual deductible of $198 in 2020. You may call or visit your local Social Security Administration As a reminder,Part B reimbursement only applies to Retirees Please check our websiteperiodically for updates. If you are a higher-income Medicare beneficiary, you can expect to pay higher premiums for Medicare Part B (medical insurance) and Part D (prescription drug coverage). need to provide additional documentation. IRMAA Medicare Part B Reimbursement Application (for 2021, 2020, 2019) IRMAA Medicare Part B Reimbursement Application (2018) Creditable Coverage Notice (Employees Age 65 or Over) . your pension check in 2020, you do not need to provide Those members not eligible for IRMAA reimbursement but who are eligible for the Medicare Part B 2020 Differential, should file the Medicare Part B Differential form. The forms are self-explanatory and lists the required documents needed to be submitted with the form. Requesting a 2nd appeal (reconsideration) if you're not satisfied with the outcome of your first appeal. Consequently, people with an annual income under $170,000 who are at the low end of their 2021 IRMAA income bracket could see a decrease (-26% to -100%) in their IRMAA payments as they are moved to a lower 2022 IRMAA income bracket (see comparison chart below). The City of New York and its unions have negotiated reimbursement in full for all premiums Medicare eligible participants and their eligible dependents pay for Medicare Part B, including the IRMAA amounts based upon income. ENROLLEE INFORMATION. Name Last four digits of SSN . 0000023154 00000 n The City of New York Health Benefits Program reimburses Medicareeligible retirees and their Medicare- eligible dependents for any - Medicare Part B incomerelated monthly adjustment amount (IRMAA) premiums (excluding any penalties or surcharges) paid during - the calendar year. Find Medicare.gov on facebook (link opens in a new tab), Follow Medicare.gov on Twitter (link opens in a new tab), Find Medicare.gov on YouTube (link opens in a new tab), A federal government website managed and paid for by the U.S. Centers for Medicare and Medicaid Services. 2016 Standard Medicare Part B Premium Reimbursement medicare part b irmaa reimbursement form 2021. Call first to make an appointment. 93115, or via email to mdb@lafpp.com. The income used to determine IRMAA is a form of Modified Adjusted Gross Income (MAGI), but it's specific to Medicare. If you are a new Medicare Part B enrollee in 2021, you will be reimbursed the standard monthly premium of $148.50 and do not need to provide additional documentation. endstream endobj startxref If you don't get premium-free Part A, you pay up to $506 each month. 2022 Medicare Part B reimbursements will be issued in April 2023. Edit Uft irmaa reimbursement 2021. Request a 3rd appeal. 5)If you are a HIP-HMO member turning 65 or on Medicare due to a disability, please contact HIP at (800) 447-9169 to enroll over the phone. The standard monthly premium for Medicare Part B enrollees will be $135.50 for 2019, an increase of $1.50 from $134 in 2018. If you were new to Medicare in 2020, the SSA letter would have been mailed to you prior to your first month of Medicare enrollment. account, your SSA notifications will be emailed to you. 2021 Centers for Medicare and Medicaid Services (CMS) billing Please note that this rebate statement only applies to new IRMA enrolled in Medicare and does not apply to those enrolled under California Medicare. This is separate from your pension payment. You must be a retired member or qualified survivor who is effective January 1, 2021; however, you may pay a different We appreciate your help in understanding how to claim IRMA and how to prepare your income and other information. We can help find the right Medicare plans for you today. In 2023, the standard Medicare Part B premium is $164.90 each month. If you did not pay more than the standard amount then you are not eligible for IRMAA. The Health Benefits Retiree client service walk-in center is closed. An estimated 2 million Medicare beneficiaries (about 3.5%) will pay less than the full Part B standard monthly premium amount in 2019 due to the statutory hold harmless provision, which limits certain beneficiaries . endstream endobj 312 0 obj <. %%EOF Medicare-eligible retirees and their Medicare-eligible dependents can submit an IRMAA application if they paid above the standard amount of $170.10 per month. Find Mailings. The income-related monthly adjustment amount, or IRMAA, is a surcharge that high-income people may pay in addition to their Medicare Part B and Part D premiums. 0000026651 00000 n This notice includes information about Social Security's determination and appeal rights. If you are enrolled in NYSHIP and receive Medicare, some retirees over a certain income level pay extra for their Medicare Part B. A recorded message will be regularly updated advising you of the processing status of IRMAA applications. LAFPP does not reimburse for Medicare Part B reimbursement is only $200, Maria's reimbursement is limited to $200, not the $365.20 she pays toward her Medicare Part B premiums. You may submit a copy of the first page of your IRMAA Requesting an appeal (redetermination) if you disagree with Medicare's coverage or payment decision. your SSA account. Medicare-eligible retirees and their Medicare-eligible dependents can submit an IRMAA application if they paid above the standard amount of $148.50 per month. If you are a new Medicare Part B enrollee in 2021, you will Comments and Help with nyc irmaa reimbursement. Q: Is there a deadline to apply for IRMAA reimbursement? If you don't buy Part A when you're first eligible for Medicare (usually when you turn 65), you might pay a penalty. 0000000976 00000 n http://mtatmba.org/wp/wp-content/uploads/2021/02/IRMAA-REIMBURSEMENT-FORM-1.pdf. For convenient searching and filing of the issue-related forms, select the category and have all relevant documents in one place. Medicare Part B 2020 reimbursements were scheduled to be distributed by the end of April 2021. Please check your bank account/statement (or the mail, if you are receiving a physical check). However, NYS Dept. Save this letter! June 16, 2022. Effective January 1, 2021, the standard Medicare Part B premium will be $148.50. (IRMAA) for their Medicare Part D prescription drug coverage. Find Medicare Plans in 3 Easy Steps. Q. Read, print, or order free Medicare publications in a variety of formats. You'll pay monthly Part B premiums equal to 35%, 50%, 65%, 80%, or 85% of the total cost, depending on what you report to the IRS. 322 0 obj <>/Filter/FlateDecode/ID[<392765C350A9B64E8CDA188101890CA5><481CDDDC86DFAC4FB73E5DD7E5716D16>]/Index[236 159]/Info 235 0 R/Length 185/Prev 196904/Root 237 0 R/Size 395/Type/XRef/W[1 3 1]>>stream New York Teacher. 0000068090 00000 n 0000001208 00000 n City of New York. A: In addition to a completed, signed application (enclosed), send a copy of your SSA notice outlining the Medicare Part B premium including IRMAA and proof of Medicare Part B payments for all months of the year you are requesting reimbursement (required for each person and each year you are applying for Medicare Part B IRMAA reimbursement).