SSA-44 Form: IRMAA Life-Changing Event Evidence by Event
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Quick Answer
Form SSA-44 asks Social Security to price your Medicare Part B and Part D premiums on a more recent tax year, but only for one of eight events: death of a spouse, marriage, divorce or annulment, work reduction, work stoppage, loss of income-producing property, loss of pension income or an employer settlement payment. SSA's own manual calls that list “exclusive” (POMS HI 01120.005). Each event has its own evidence: a certified death certificate, a certified divorce decree, a signed employer statement or pay stubs for retirement, an insurance adjuster's statement for a disaster loss. A voluntary sale of a rental, capital gains and a Roth conversion are named as non-qualifying. The form itself says that if you do not owe an income-related surcharge (MAGI under $109,000.01 single or $218,000.01 joint on the return SSA used) you “should not fill out this form”. The form is optional, and you can ask by phone instead. Compiled from the 12-2025 edition of the form and SSA's manual as of October 20, 2026; the 2027 Medicare premiums and tiers had not been published on that date. Brackets and worked tier costs are on our IRMAA guide.
Key Takeaways
- The eight events are fixed. POMS HI 01120.001 lists them as death of spouse, marriage, divorce or annulment, work reduction, work stoppage, loss of income-producing property, loss of employer pension income and receipt of an employer payment, and HI 01120.005 says “Our list of LCEs for IRMAA purposes is exclusive.” Higher medical or living expenses, loss of child support or alimony and ordinary loss of dividend income are named as not qualifying.
- A sale you choose does not qualify. POMS HI 01120.035 says a “donation, gift, sale or transfer” of income-producing property is not a loss beyond your control, and HI 01120.005 names “Capital gains from the sale of property” and “Conversion of an IRA” as non-qualifying one-time income. Disaster, arson, eminent domain and theft can qualify; investment fraud needs proof of conviction.
- The evidence differs by event. For a death the form asks for a certified copy of the death certificate; for a divorce a certified copy of the decree; for a work stoppage or reduction an original signed employer statement, pay stubs or documents showing a transfer of your business, and without them SSA will accept your signed statement under penalty of perjury (Form SSA-44, page 8).
- The reduction has to be real. POMS HI 01120.005 defines a “significant” reduction as one that “decreases or eliminates” the surcharge for that tax year, and HI 01120.065 says SSA will not accept an updated estimate that could produce a higher surcharge than the IRS data. A retirement in a year with a large property gain may therefore change nothing (our arithmetic below).
- A report covers only the person who makes it. Each spouse has to contact SSA (HI 01120.005 and HI 01120.035). In our example a couple at tier 2 on the 2026 amounts pays $5,769.60 a year in surcharges, and one spouse's report removes at most $2,884.80 of it.
- The clock is short at the edges. A request filed January 1 to March 31 can reach back to January of the prior year if the event fell between October 1 and December 31 of that year (HI 01120.005). After a request SSA gives you 30 days for missing evidence, with a possible 90-day extension (HI 01120.001), and a formal appeal of the notice must be filed within 60 days of receipt (HI 01140.001).
CSV · 80 rows
Form SSA-44: the eight life-changing events, evidence and timing rules
80 rows: Form SSA-44 (12-2025) fields and the tier amounts it prints, the evidence the form and SSA's manual list for each of the eight events, the non-qualifying events, the timing, estimate and appeal rules, and the other routes outside the event list.
What the form is, and what it is not
Form SSA-44 is not an appeal. SSA makes its surcharge decision from the tax return the IRS supplies, normally the one from two years before the premium year and never more than three (POMS HI 01101.010; “2026 premiums are generally based on 2024 tax return information”). The form asks for a new initial determination, a fresh decision on a later year that SSA makes without reopening the first one. POMS HI 01120.001 says that if you meet the criteria “there is no need to appeal the prior determination”, and that the SSA-44 is “only for beneficiaries wishing to request a new initial determination, based on a valid LCE; use of the form is optional.” You can ask verbally or in writing. The form's own instructions give the phone route: 1-800-772-1213, 7 a.m. to 7 p.m. on business days.
Two limits from the same documents. First, SSA only reduces what the IRS data already imposed: “If the data received electronically from IRS does not indicate that a beneficiary owes an IRMAA, we cannot impose an IRMAA using beneficiary provided data.” Second, the form tells people under the line not to file: “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.” On the 12-2025 edition that line is a MAGI lower than $109,000.01, or $218,000.01 for married filing jointly, on the return SSA used (for the 2026 premium year, tax year 2024). MAGI is the amount on Form 1040 line 11 plus tax-exempt interest on line 2a.
The five steps on the form are the event and its date, an actual MAGI and filing status for the year you ask SSA to use (Step 2), an optional estimate for the year after (Step 3), the evidence (Step 4) and a signature “under penalty of perjury” (Step 5). The form's own warning: signing it is not a request to use a more recent year unless it comes with evidence of the event, a tax return or other evidence of the newer MAGI.
The eight events and the evidence for each
The middle column is the list printed on page 8 of the form. The right-hand column is what the Program Operations Manual says SSA will accept, which is wider for several events. The form adds that “in some cases, we may be able to accept another type of evidence” and tells you to ask an SSA representative if you do not have the listed document.
| Event (POMS section) | Evidence listed on Form SSA-44, page 8 | What SSA's manual also accepts | Watch for |
|---|---|---|---|
| Death of spouse (HI 01120.010) | A certified copy of a death certificate, a certified copy of the public record of death, or a certified copy of a coroner's certificate | Proof of death already on SSA records, plus MAGI and filing status for the year to be used | The effect on MAGI can be delayed; the manual says so for marriage, divorce and death |
| Marriage (HI 01120.015) | An original marriage certificate or a certified copy of a public record of marriage | Proof of the marriage plus tax information for the year to be used | Applies only to the reporting spouse; the new spouse must contact SSA |
| Divorce or annulment (HI 01120.020) | A certified copy of the decree of divorce or annulment | Proof that the marriage ended plus tax information for the year to be used | The form says to use it if you will not file a joint return with the ex-spouse for the year |
| Work reduction (HI 01120.025) | An original signed statement from your employer; copies of pay stubs; original or certified documents that show a transfer of your business | A statement from an employer; past and current pay stubs showing a change in hours; corporate minutes; a record of business transfer; your attestation under penalty of perjury | Examples in the manual are partial retirement and a change from full-time to part-time |
| Work stoppage (HI 01120.030) | The same three items as work reduction | A statement from an employer; a retirement letter; corporate minutes; a record of business transfer or sale; your attestation under penalty of perjury | Retirement, lay-off and the sale of a business or corporation are the manual's examples; it covers a reduction “before or after” you stop |
| Loss of income-producing property (HI 01120.035) | 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; for investment fraud also proof of conviction | A filed return showing the loss; a statement that you are uninsured plus the return later; insurance claims; an adjuster's statement; a formal statement from the policy owner to the insurer | The loss must not be at your direction; the manual says the property must “ordinarily” generate income used in MAGI |
| Loss of pension income (HI 01120.040) | A letter or statement from your pension fund administrator that explains the reduction or termination of your benefits | A letter on the change or end of the annuity, or the original distribution-choice documents; the plan description if the plan type is unclear | Only a traditional defined benefit or cash balance plan; the loss must come from plan failure or termination or a scheduled cessation you chose earlier |
| Employer settlement payment (HI 01120.043) | A letter from the employer stating the settlement terms of the bankruptcy court and how it affects you or your spouse | A statement from an employer; a court document showing settlement and terms; a statement from the employer's attorney | The payment must result from the employer's closure, bankruptcy or reorganization |
Source: Form SSA-44 (12-2025) pages 5 to 8; SSA POMS HI 01120.010, .015, .020, .025, .030, .035, .040 and .043 (saved October 20, 2026).
Three details sit in these pages and not in the usual advice. For work stoppage or reduction, the form says that without the listed proof SSA will accept your signed statement, and the manual says “If the beneficiary attests under penalty of perjury that the LCE caused the significant reduction in income, we accept that statement”; SSA does not develop the types of income in MAGI, only that MAGI fell after the event. For a property loss caused by fraud, the manual says “For claims of investment fraud (theft) proof of conviction of the theft is required and the only acceptable proof.” And for a loss of a rental, the manual tells its staff to review IRS Form 4684 (Casualties and Thefts) when a return is submitted.
What does not qualify
SSA's manual names events that look like hardships and are not events for this purpose. The right-hand column is our reading for readers of this site.
| Event or income | What the manual says | Why it matters to an investor (our reading) |
|---|---|---|
| Voluntary sale of income-producing property | Listed as a non-qualifying event (HI 01120.005); a sale or transfer is “not considered a loss beyond the beneficiary's control” (HI 01120.035) | Selling a rental, a DST interest or a fund stake is your decision, so it never counts as the loss of property |
| Capital gains from the sale of property | Listed among one-time income that raised the year SSA uses (HI 01120.005) | The gain stays in MAGI two years later; see the premium-year table in our IRMAA guide |
| Conversion of an IRA | Listed among one-time income (HI 01120.005) | A Roth conversion cannot be undone for Medicare purposes by filing the form |
| Lottery winnings, casino winnings, cashing bonds | Listed among one-time income (HI 01120.005) | Same rule: a one-time spike is not an event |
| Ordinary loss of dividend income | Not an LCE; loss of dividend income qualifies only “due to criminal theft” (HI 01120.005 and HI 01120.035) | A fund that cuts its distribution is an ordinary loss, not a qualifying one |
| Ordinary investment risk | “Ordinary risk of loss taken at the time of investment in income-producing property is considered at the beneficiary's direction.” (HI 01120.035) | A write-down, a vacancy or a failed deal is the risk you took |
| Investment fraud without a conviction | Proof of conviction is “the only acceptable proof” (HI 01120.035) | An allegation, a lawsuit or an SEC complaint is not proof for this purpose |
| Higher medical or living expenses; loss of child support or alimony | Listed as not LCEs (HI 01120.005) | Costs going up is not income going down by one of the eight causes |
| A vacation home or condo used for yourself; a coin or stamp collection | Not income-producing property unless shown on a return as income-producing, or if it does not generate income (HI 01120.035) | Loss of a personal-use property does not count |
Source: SSA POMS HI 01120.005 (paragraph D) and HI 01120.035 (paragraphs A and B), saved October 20, 2026. The right-hand column is our reading.
If you press a non-qualifying request, SSA's staff do not just refuse it: HI 01120.005E says that if you insist they process it and then issue a dismissal, and you may still file an appeal on the determination. A dismissal of a new-determination request is “not a determination subject to further administrative or judicial review”, but it can be a basis for good cause for filing an appeal late (HI 01140.001).
Routes that are not life-changing events
Four other requests also use a new initial determination and need no event. They matter because they are often confused with the SSA-44.
| Situation | Evidence | Limit | POMS |
|---|---|---|---|
| The IRS data SSA used was wrong | An IRS letter acknowledging the error and the correction, or an IRS transcript with the new data and the filed return | Applies to the same tax year; corrected data is used even if it disadvantages you | HI 01120.050 |
| You amended the return SSA used | A retained copy of the amended return plus an IRS receipt letter, or an IRS transcript or copy | Request within 3 calendar years after the close of the tax year the amended return was filed for; may be used even if it disadvantages you | HI 01120.045 |
| SSA used a 3-year-old return and you filed one for 2 years before | A signed copy of the filed return for the later year | Effective only for the premium year of the original decision | HI 01120.055 |
| You filed married filing separately but lived apart all year | Form 1040 with a D by the Social Security line, or your attestation under penalty of perjury, plus the spouse's last known address | Do not use the SSA-44 for this; the form says to call SSA | HI 01120.060 |
Source: SSA POMS HI 01120.045, .050, .055 and .060 and Form SSA-44 page 8, saved October 20, 2026.
Which year to ask for, and when
The form tells you which tax year to put in Step 2. Choose the premium year itself (an estimate) if your MAGI is lower in that year than the year before, for example if income was not reduced until then. Choose the year before the premium year if your MAGI is no lower in the premium year. The event date must be in that same year or an earlier one. For example, the form says that if SSA used your 2024 return for 2026, you can ask for your 2025 return if the event happened in 2025 or before. If SSA used a three-year-old return, you may ask for the return from two years before the premium year.
| Rule | What SSA's documents say | Source |
|---|---|---|
| When you can ask | “A beneficiary may request a new initial determination any time after an LCE and a significant reduction in MAGI has occurred.” The event may be long past. | HI 01120.005B |
| Effective date | If Part B covered the whole year, January of the year of the request; the decision is effective the year of the event or later, never before the event | HI 01120.005B |
| Reaching back a year | Only if the event fell October 1 to December 31 of the prior year and the request arrives January 1 to March 31, or there is good cause for being late | HI 01120.005B |
| Estimates | You may estimate MAGI if the return is not filed; you must later send the signed return, and SSA checks with the IRS | HI 01120.005; Form SSA-44 |
| Second year | SSA wants a second-year estimate; without one it uses the first-year estimate for the next premium year too | HI 01120.005A |
| Changing the estimate | You may update as often as needed, but SSA will not accept an update that could raise the surcharge above what the IRS data produced | HI 01120.065 |
| Missing evidence | A 30-day period to supply it, then dismissal; SSA may grant a 90-day extension on request | HI 01120.001G |
| Appeal of the notice | A request for reconsideration within 60 days of receipt; receipt is 5 days after the notice date; you can file the appeal and the request together | HI 01140.001B; HI 01120.001B |
Source: SSA POMS sections as shown, saved October 20, 2026.
Worked examples (our arithmetic)
All three use the tier amounts printed on the 12-2025 form (the 2026 amounts: Part B adjustment $202.90 and Part D $37.50 a month at tier 2, so $2,884.80 a year per person; $81.20 and $14.50 at tier 1, so $1,148.40). SSA had not published the 2027 amounts on October 20, 2026, so these illustrate how the rules behave and are not 2027 bills. Both spouses are enrolled in Parts B and D. The couple's joint MAGI on the 2025 return, which sets the 2027 premium year (our reading of HI 01101.010), is $300,000, inside the joint tier-2 band of $274,000.01 to $342,000.00.
| Case | 2026 facts (assumed) | Estimated 2026 MAGI | Result for the premium year after |
|---|---|---|---|
| A. One spouse retires | A $100,000 salary stops; nothing else changes; the retired spouse files a work stoppage SSA-44 with a retirement letter | $200,000, under $218,000 | Surcharge removed for the spouse who reports: $2,884.80 a year saved; $5,769.60 if both report |
| B. Same retirement, plus a $150,000 rental gain | Same salary stop; a rental is sold in 2026 at a $150,000 gain | $350,000, joint tier 3 | No help: tier 3 costs $4,620.00 a person, more than tier 2; SSA does not accept an updated estimate that raises the surcharge (our reading of HI 01120.065) |
| C. Same retirement, small $20,000 gain | Same salary stop; $20,000 of gain | $220,000, joint tier 1 | Tier 1 at $1,148.40 instead of $2,884.80: $1,736.40 a year saved for each spouse who reports |
Source: our arithmetic on the Form SSA-44 amounts: (Part B adjustment + Part D adjustment) x 12 per person. Tier 3 is (324.60 + 60.40) x 12 = $4,620.00. Joint bands: tier 1 above $218,000 to $274,000, tier 2 above $274,000 to $342,000, tier 3 above $342,000 to $410,000.
A. MAGI falls from $300,000 to $200,000, below the $218,000 line, so the event does what the manual wants: it “decreases or eliminates” the surcharge. The spouse who retired supplies the retirement letter or employer statement and a signed estimate for 2026, with the retirement date in Step 1. The spouse who did not retire is not covered by that report; the manual says the finding is not extended to a non-reporting spouse, so that spouse has to contact SSA too, and for a joint return both would be asking to use the same $200,000 figure.
B. The retirement is a valid event, but 2026 MAGI is $350,000 because the sale adds $150,000. That is a higher tier than the $300,000 on the return SSA used, not a lower one. HI 01120.065 says SSA will not accept an updated estimate “that could result in a higher IRMAA than SSA originally imposed using IRS tax data for the year”. The sale, which cannot qualify on its own, cancels the benefit of the event that can.
C. The same retirement with a $20,000 gain leaves MAGI $2,000 over the first threshold. It saves $1,736.40 a year per reporting spouse, not $2,884.80. The cliff does the work: a gain of $18,000 instead would have brought MAGI to exactly $218,000 and the surcharge to zero.
What a reader can do with this
- Match the event to the list before you collect papers. If your reason is a sale, a conversion, a fund's lower distribution or higher costs, the manual says it is not an event. If it is retirement, a divorce, a death, a disaster or a pension plan failure, start gathering the documents in the table.
- Check the number before the form. Take your actual or expected MAGI for the year you would ask SSA to use and compare it with the threshold and tier line on your notice. If the event does not move you down a tier, the form has nothing to change.
- Look at the year's other income. A gain, a Roth conversion or a large capital gain distribution in the same year can offset a salary that stops (case B). Our IRMAA guide shows what raises MAGI.
- Each spouse reports. A report covers only the person who makes it, so a couple should decide together who contacts SSA.
- Use the estimate, then send the return. SSA takes a signed estimate first and asks for the filed return later; keep both.
- After a death, plan the filing-status steps too. See the widow's tax penalty for how the survivor's thresholds change, and the Social Security taxation guide for how rental income feeds MAGI.
- Ask a professional about your own return. Tax-year choice, estimates and the interaction with a sale are individual.
This is analysis of public documents, not investment, legal or tax advice. A voluntary sale of income-producing property does not qualify. The decision to sell and the Medicare cost two years later belong in the same plan.
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Sources, read and saved on October 20, 2026: Social Security Administration, Form SSA-44 (12-2025), “Medicare Income-Related Monthly Adjustment Amount - Life-Changing Event” (ssa.gov/forms/ssa-44.pdf); SSA Program Operations Manual System HI 01101.010, HI 01101.020, HI 01101.030, HI 01120.001, HI 01120.005, HI 01120.010, HI 01120.015, HI 01120.020, HI 01120.025, HI 01120.030, HI 01120.035, HI 01120.040, HI 01120.043, HI 01120.045, HI 01120.050, HI 01120.055, HI 01120.060, HI 01120.065 and HI 01140.001 (secure.ssa.gov/poms.nsf). The 2027 premium status is from our check on October 20, 2026. Examples and annual totals are our arithmetic.
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