Updated October 18, 2026. Quick answer: Form SSA-44 is Social Security’s form for asking it to set your Medicare income-related monthly adjustment amount (IRMAA) from a more recent, lower-income tax year after a life-changing event. The form lists eight events, wants evidence of the event and of your income, and is optional, because the instructions say you can call SSA instead. It starts a new initial determination, which is not the same thing as a formal appeal.
Related reading on this site: Social Security and Medicare forms.
Quick reference
| Item | As printed on the form |
|---|---|
| What the form is | A request to use a more recent tax year to decide IRMAA |
| Events on the form | Eight checkboxes in Step 1 |
| Income the form asks for | Adjusted gross income plus tax-exempt interest (MAGI) |
| Signed under | Penalty of perjury |
| Phone alternative | 1-800-772-1213 (TTY 1-800-325-0778) |
What Form SSA-44 does and does not do
The form opens with its purpose: “If you had a major life-changing event and your income has gone down, you may use this form to request a reduction in your income-related monthly adjustment amount.”
It is not required. The instructions page says “You do not have to complete this form in order to ask that we use your information about your modified adjusted gross income for a more recent tax year.” The POMS, the manual SSA staff work from, agrees that the form is only a convenience: “Beneficiaries may use the optional Form SSA-44” to report a life-changing event with a significant reduction in income.
It is also only for people who were actually charged IRMAA. The form says “If you do not have to pay an income-related monthly adjustment amount, you should not fill out this form even if you experienced a life-changing event.”
Because the form asks SSA to make a fresh decision from newer tax data, it is a new initial determination request rather than an appeal. Our page on why a new determination is not an appeal compares the routes.
The eight events and the evidence for each
Step 1 gives the list. It reads “Check any life-changing event and fill in the date(s) that the events occurred (mm/yyyy).” The POMS counts the same list: “A Life-Changing Event (LCE) can be one or more of the following eight events:” death of spouse, marriage, divorce or annulment, work reduction, work stoppage, loss of income-producing property, loss of employer pension, and a settlement payment from a current or former employer. The printed instructions group work stoppage and work reduction in one row, which is why the table below has seven rows for eight checkboxes.
| Event on the form | Use this category if, as printed | Evidence the form asks for, as printed |
|---|---|---|
| Marriage | “You entered into a legal marriage.” | “An original marriage certificate: or a certified copy of a public record of marriage.” |
| Divorce or annulment | “Your legal marriage ended, and you will not file a joint return with your spouse for the year.” | “A certified copy of the decree of divorce or annulment.” |
| Death of your spouse | “Your spouse died.” | “A certified copy of a death certificate, certified copy of the public record of death, or a certified copy of a coroner’s certificate.” |
| Work stoppage or work reduction | “You or your spouse stopped working or reduced the hours that you work.” | “An original signed statement from your employer; copies of pay stubs; original or certified documents that show a transfer of your business.” |
| Loss of income-producing property | “You or your spouse experienced a loss of income-producing property that was not at your direction” (the form’s examples include disaster-area losses, arson, and fraud or theft). | “An original copy of an insurance company adjuster’s statement of loss or a letter from a State or Federal government about the uncompensated loss.” |
| Loss of pension income | “You or your spouse experienced a scheduled cessation, termination, or reorganization of an employer’s pension plan.” | “A letter or statement from your pension fund administrator that explains the reduction or termination of your benefits.” |
| Employer settlement payment | “You or your spouse receive a settlement from an employer or former employer” | “A letter from the employer stating the settlement terms” |
Event dates have a timing rule. The instructions say “The life-changing event date must be in the same year or an earlier year than the tax year you ask us to use to decide your income-related premium adjustment.”
How the five steps work
| Part of the form | What it asks |
|---|---|
| Step 1 | Check any life-changing event and fill in the date(s) that the events occurred (mm/yyyy). |
| Step 2 | Reductions that have already occurred: tax year, adjusted gross income, tax-exempt interest and tax filing status. |
| Step 3 | Anticipated reductions next year, completed only if you expect next year’s MAGI to be lower still. |
| Step 4 | Documentation: evidence of your MAGI and of the life-changing event. |
| Step 5 | Signature, phone number and mailing address. |
Step 2 is where the numbers go. The instructions define them: “Your MAGI is your adjusted gross income as used on line 11 of IRS form 1040 plus your tax-exempt interest income as used on line 2a of IRS form 1040.” If you are giving an estimate, the form says “your estimate should be what you expect to enter on your tax return for that year.”
Step 3 is optional. The form says to complete it “only if you expect that your MAGI for next year will be even lower.” “If you do not complete Step 3, we will use the information from Step 2 next year to determine your income-related monthly adjustment amounts” unless one of the listed conditions happens first. The POMS repeats the point for staff: “If you receive an SSA-44 without a second tax year estimate, contact the beneficiary to request a second year estimate.”
Step 4 is evidence, and there are two ways to give it. The form says you can “Attach the required evidence and we will mail your original documents or certified copies back to you;” or show originals or certified copies to an SSA employee. Step 5 is the signature. By signing, “I declare under penalty of perjury that I have examined the information on this form and it is true and correct to the best of my knowledge.”
Which tax year to put in Step 2
| Tax year to enter in Step 2 | When the instructions point to it |
|---|---|
| The premium year itself | Your MAGI is lower this year than last year |
| 1 year before the premium year | Your MAGI is not lower this year than last year |
| 2 years before the premium year | Only if SSA used IRS information from 3 years before the premium year |
The instructions give a rule and an example. The year you choose “must be more recent than the year of the tax return information we used.” The letter SSA sent tells you which tax year it used. The premium-year rule starts with “Choose this year (the “premium year”)” when your modified adjusted gross income is lower this year than last year.
The other case is “Choose last year (the year before the “premium year,” which is the year for which you want us to adjust your IRMAA)” when your MAGI is not lower this year than last year. There is also a three-year exception: “If we used IRS information about your MAGI 3 years before the premium year, you may ask us to use information from 2 years before the premium year.”
If you are unsure which year fits, the form says “If you have any questions about what year you should use, you should call SSA.”
When the new determination takes effect
The POMS ties the effective date to when the event hit your income and when you ask. A request may come at any time: “A beneficiary may request a new initial determination any time after an LCE and a significant reduction in MAGI has occurred.” The retroactive rule is narrower: “Ordinarily, we do not make a determination retroactive to a prior premium year on a new initial determination, unless the LCE causing the reduction occurs in the last three calendar months of the immediately prior premium year and we receive the request for a new initial determination for the preceding premium year by March 31, of the current premium year.”
For a current-year event the POMS says the Part B decision is effective “January (or the first month of Part B entitlement) of the current year.” It also records that SSA does not extend your report to a spouse: “A report of an LCE with a significant reduction in MAGI applies only to the beneficiary reporting.”
What does not count
The list of events is closed. The POMS says “Our list of LCEs for IRMAA purposes is exclusive.” Its examples of reductions that are not life-changing events include “Higher medical expenses;” “Higher living expenses;” and “Voluntary sale of income-producing property.” One-time income that raised the old year’s MAGI is also not an event. The POMS lists “Conversion of an IRA;” among them, which is why a Roth conversion does not qualify on its own. See a Roth conversion is not an IRMAA event. If the event is not on the list, the POMS still lets you push the case: “if the beneficiary insists, they may still file an appeal on the IRMAA determination”.
The edition read for this page is Form SSA-44 (12-2025) as ssa.gov served it on 2026-10-18, together with SSA’s Program Operations Manual System sections HI 01120.001 and HI 01120.005. The dollar bands inside the form belong to the premium year the edition was printed for, so check the edition printed on the copy you send, because a later edition can change the table, the list of events and the evidence SSA asks for.
Common mistakes
- Filing the form when no IRMAA was charged. The form says not to fill it out if you do not have to pay an income-related monthly adjustment amount, even after a life-changing event.
- Using an event the list does not contain. The POMS calls the list exclusive and names higher medical expenses, higher living expenses and the voluntary sale of income-producing property as examples that do not qualify.
- Picking the wrong tax year in Step 2. The year must be more recent than the year SSA used, and the form says to call SSA when you are unsure which year fits.
- Sending copies when the form asks for original or certified evidence, or leaving out the evidence of your MAGI. Signing the form alone is not a request for a more recent tax year unless evidence accompanies it.
Related: why a new determination is not an appeal, the IRMAA two year lookback, losing a spouse as an IRMAA event, why selling a business does not qualify, and IRMAA explained.
Sources
- Form SSA-44 (12-2025), Medicare Income-Related Monthly Adjustment Amount, Life-Changing Event: https://www.ssa.gov/forms/ssa-44.pdf
- SSA POMS HI 01120.005, Life Changing Events: https://secure.ssa.gov/poms.nsf/lnx/0601120005
- SSA POMS HI 01120.001, Overview of New Initial Determinations on the IRMAA Using Beneficiary Provided Information: https://secure.ssa.gov/poms.nsf/lnx/0601120001
Read from the Social Security Administration documents linked above on October 18, 2026. General information, not legal or benefits advice. Your own facts decide the outcome, and Social Security at 1-800-772-1213 is the right place to confirm anything consequential.