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Notes

20 C.F.R. §§ 418.1001–418.1010

3 sections in range

§418.1001. What is this subpart about?

20 C.F.R. § 418.1001

This subpart relates to section 1839(i) of the Social Security Act (the Act), as amended. Section 1839(i) establishes an income-related monthly adjustment to the Medicare Part B premium. Beneficiaries enrolled in Medicare Part B who have modified adjusted gross income over a threshold amount established in the statute will pay an income-related monthly adjustment amount in addition to the Medicare Part B standard monthly premium and any applicable premium increases as described in 42 CFR 408.20. The regulations in this subpart explain how we decide whether you are required to pay an income-related monthly adjustment amount, and if you are, the amount of your adjustment. The rules are divided into the following groups of sections:
(a)
Sections 418.1001 through 418.1010 contain the introduction, a statement of the general purpose of the income-related monthly adjustment amount, general provisions that apply to the income-related monthly adjustment amount, and definitions of terms that we use in this subpart.
(b)
Sections 418.1101 through 418.1150 describe what information about your modified adjusted gross income we will use to determine if you are required to pay an income-related monthly adjustment amount. In these sections, we also describe how the income-related monthly adjustment amount will affect your total Medicare Part B premium.
(c)
Sections 418.1201 through 418.1270 contain an explanation of the standards that you must meet for us to grant your request to use modified adjusted gross income information that you provide for a more recent tax year rather than the information described in paragraph (b) of this section. These sections explain when we may consider such a request, and the evidence that you will be required to provide. These sections also explain when income-related monthly adjustment amount determinations based on information you provide will be effective, and how long they will remain in effect. Additionally, these sections describe how retroactive adjustments of the income-related monthly adjustment amount will be made based on information you provide, updated information you provide, and information we later receive from the Internal Revenue Service (IRS).
(d)
Sections 418.1301 through 418.1355 contain the rules that we will apply when you disagree with our determination regarding your income-related monthly adjustment amount. These sections explain your appeal rights and the circumstances under which you may request that we make a new initial determination of your income-related monthly adjustment amount.
Notes, amendments, and revision history

Amendments

[71 FR 62931, Oct. 27, 2006, as amended at 78 FR 57259, Sept. 18, 2013; 83 FR 55628, Nov. 7, 2018]

Authority

Authority: Secs. 702(a)(5) and 1839(i) of the Social Security Act (42 U.S.C. 902(a)(5) and 1395r(i)).

Source

Source: 71 FR 62931, Oct. 27, 2006, unless otherwise noted.

Source

Source: 70 FR 77675, Dec. 30, 2005, unless otherwise noted.

Amendments

[71 FR 62931, Oct. 27, 2006, as amended at 78 FR 57259, Sept. 18, 2013; 83 FR 55628, Nov. 7, 2018]

§418.1005. Purpose and administration.

20 C.F.R. § 418.1005

(a)
The purpose of the income-related monthly adjustment amount is to reduce the Federal subsidy of the Medicare Part B program for beneficiaries with modified adjusted gross income above an established threshold. These beneficiaries will pay a greater share of actual program costs. Medicare Part B premiums paid by beneficiaries cover approximately 25 percent of total Medicare Part B program costs and the remaining 75 percent of program costs are subsidized by the Federal Government's contributions to the Federal Supplementary Medical Insurance Trust Fund. The reduction in the Medicare Part B premium subsidy results in an increase in the total amount that affected beneficiaries pay for Medicare Part B coverage. A beneficiary with modified adjusted gross income above the threshold amount will pay:
(1)
The Medicare Part B standard monthly premium; plus
(2)
Any applicable increase in the standard monthly premium for late enrollment or reenrollment; plus
(3)
An income-related monthly adjustment amount.
(b)
The Centers for Medicare & Medicaid Services (CMS) in the Department of Health and Human Services (HHS) publishes the Medicare Part B standard monthly premium each year. CMS also establishes rules for entitlement to a nonstandard premium, as well as premium penalties for late enrollment or reenrollment (42 CFR 408.20 through 408.27).
(c)
We use information that we get from IRS to determine if beneficiaries who are enrolled in Medicare Part B are required to pay an income-related monthly adjustment amount. We also change income-related monthly adjustment amount determinations using information provided by a beneficiary under certain circumstances. In addition, we notify beneficiaries when the social security benefit amounts they receive will change based on our income-related monthly adjustment amount determination.
Notes, amendments, and revision history

Authority

Authority: Secs. 702(a)(5) and 1839(i) of the Social Security Act (42 U.S.C. 902(a)(5) and 1395r(i)).

Source

Source: 71 FR 62931, Oct. 27, 2006, unless otherwise noted.

Source

Source: 70 FR 77675, Dec. 30, 2005, unless otherwise noted.

§418.1010. Definitions.

20 C.F.R. § 418.1010

(a)
Terms relating to the Act and regulations. For the purposes of this subpart:
(1)
Administrator means the Administrator of the Centers for Medicare & Medicaid Services (CMS) in HHS.
(2)
CMS means the Centers for Medicare & Medicaid Services in HHS.
(3)
Commissioner means the Commissioner of Social Security.
(4)
HHS means the Department of Health and Human Services which oversees the Centers for Medicare & Medicaid Services, the Office of Medicare Hearings and Appeals (OMHA) and the Medicare Appeals Council (MAC).
(5)
IRS means the Internal Revenue Service in the Department of the Treasury.
(6)
MAC means the Medicare Appeals Council in HHS.
(7)
OMHA means the Office of Medicare Hearings and Appeals in HHS.
(8)
Section means a section of the regulations in this part unless the context indicates otherwise.
(9)
The Act means the Social Security Act, as amended.
(10)
Title means a title of the Act.
(11)
We, our,— or us means the Social Security Administration (SSA).
(b)
Miscellaneous. For the purposes of this subpart:
(1)
Amended tax return means a Federal income tax return for which an amended tax return using the required IRS form(s) has been filed by an individual or couple and accepted by IRS.
(2)
Effective year means the calendar year for which we make an income-related monthly adjustment amount determination.
(3)
Federal premium subsidy— is the portion of the full cost of providing Medicare Part B coverage that is paid by the Federal Government through transfers into the Federal Supplementary Medical Insurance Trust Fund.
(4)
Income-related monthly adjustment amount— is an additional amount of premium that you will pay for Medicare Part B coverage if you have income above the threshold. The amount of your income-related monthly adjustment amount is based on your modified adjusted gross income.
(5)
Medicare Part B standard monthly premium means the monthly Medicare Part B premium amount which is set annually by CMS, according to regulations in 42 CFR 408.20 through 408.27.
(6)
Modified adjusted gross income— is your adjusted gross income as defined by the Internal Revenue Code, plus the following forms of tax-exempt income:
(i)
Tax-exempt interest income;
(ii)
Income from United States savings bonds used to pay higher education tuition and fees;
(iii)
Foreign earned income;
(iv)
Income derived from sources within Guam, American Samoa, or the Northern Mariana Islands; and
(v)
Income from sources within Puerto Rico.
(7)
Modified adjusted gross income ranges— are the groupings of modified adjusted gross income above the threshold. There are four ranges for most individuals, based on their tax filing status. There are two ranges for those with a tax filing status of married, filing separately, who also lived with their spouse for part of the year. The dollar amounts of the modified adjusted gross income ranges are specified in § 418.1115.
(8)
Non-standard premium means a Medicare Part B premium that some beneficiaries pay for Medicare Part B, rather than the standard premium. The rules for applying a non-standard premium are in 42 CFR 408.20(e). The non-standard premium does not apply to beneficiaries who must pay an income-related monthly adjustment amount.
(9)
Premium— is a payment that an enrolled beneficiary pays for Medicare Part B coverage. The rules that CMS uses to annually establish the premium amount are found in 42 CFR 408.20 through 408.27.
(10)
Representative— means, for the purposes of the initial determination and reconsidered determination, an individual as defined in § 404.1703 of this chapter, and for purposes of an ALJ hearing or review by the MAC, an individual as defined in 42 CFR 405.910.
(11)
Tax filing status means the filing status shown on your individual income tax return. It may be single, married filing jointly, married filing separately, head of household, or qualifying widow(er) with dependent child.
(12)
Tax year means the year for which your Federal income tax return has been filed or will be filed with the IRS.
(13)
Threshold means a modified adjusted gross income amount above which the beneficiary will have to pay an income-related monthly adjustment amount described in paragraph (b)(4) of this section. The dollar amount of the threshold is specified in § 418.1105.
(14)
You— or your means the person or representative of the person who is subject to the income-related monthly adjustment amount.
Notes, amendments, and revision history

Authority

Authority: Secs. 702(a)(5) and 1839(i) of the Social Security Act (42 U.S.C. 902(a)(5) and 1395r(i)).

Source

Source: 71 FR 62931, Oct. 27, 2006, unless otherwise noted.

Source

Source: 70 FR 77675, Dec. 30, 2005, unless otherwise noted.