20 CFR Part 418
PART 418—MEDICARE SUBSIDIES
- PART 418—MEDICARE SUBSIDIES
- Chapter III—Social Security Administration
- Subpart A [Reserved]
- Subpart B—Medicare Part B Income-Related Monthly Adjustment Amount
- Introduction, General Provisions, and Definitions
- § 418.1001 What is this subpart about?
- § 418.1005 Purpose and administration.
- § 418.1010 Definitions.
- Determination of the Income-Related Monthly Adjustment Amount
- § 418.1101 What is the income-related monthly adjustment amount?
- § 418.1105 What is the threshold?
- § 418.1110 What is the effective date of our initial determination about your income-related monthly adjustment amount?
- § 418.1115 What are the modified adjusted gross income ranges?
- § 418.1120 How do we determine your income-related monthly adjustment amount?
- § 418.1125 How will the income-related monthly adjustment amount affect your total Medicare Part B premium?
- § 418.1130 [Reserved]
- § 418.1135 What modified adjusted gross income information will we use to determine your income-related monthly adjustment amount?
- § 418.1140 What will happen if the modified adjusted gross income information from IRS is different from the modified adjusted gross income information we used to determine your income-related monthly adjustment amount?
- § 418.1145 How do we determine your income-related monthly adjustment amount if IRS does not provide information about your modified adjusted gross income?
- § 418.1150 When will we use your amended tax return filed with IRS?
- Determinations Using a More Recent Tax Year's Modified Adjusted Gross Income
- § 418.1201 When will we determine your income-related monthly adjustment amount based on the modified adjusted gross income information that you provide for a more recent tax year?
- § 418.1205 What is a major life-changing event?
- § 418.1210 What is not a major life-changing event?
- § 418.1215 What is a significant reduction in your income?
- § 418.1220 What is not a significant reduction in your income?
- § 418.1225 Which more recent tax year will we use?
- § 418.1230 What is the effective date of an income-related monthly adjustment amount initial determination that is based on a more recent tax year?
- § 418.1235 When will we stop using your more recent tax year's modified adjusted gross income to determine your income-related monthly adjustment amount?
- § 418.1240 Should you notify us if the information you gave us about your modified adjusted gross income for the more recent tax year changes?
- § 418.1245 What will happen if you notify us that your modified adjusted gross income for the more recent tax year changes?
- § 418.1250 What evidence will you need to support your request that we use a more recent tax year?
- § 418.1255 What kind of major life-changing event evidence will you need to support your request for us to use a more recent tax year?
- § 418.1260 What major life-changing event evidence will we not accept?
- § 418.1265 What kind of significant modified adjusted gross income reduction evidence will you need to support your request?
- § 418.1270 What modified adjusted gross income evidence will we not accept?
- Determinations and the Administrative Review Process
- § 418.1301 What is an initial determination regarding your income-related monthly adjustment amount?
- § 418.1305 What is not an initial determination regarding your income-related monthly adjustment amount?
- § 418.1310 When may you request that we make a new initial determination?
- § 418.1315 How will we notify you and what information will we provide about our initial determination?
- § 418.1320 What is the effect of an initial determination?
- § 418.1322 How will a Medicare prescription drug coverage income-related monthly adjustment amount determination for the effective year affect your Medicare Part B?
- § 418.1325 When may you request a reconsideration?
- § 418.1330 Can you request a reconsideration when you believe that the IRS information we used is incorrect?
- § 418.1335 What should you do if our initial determination is based on modified adjusted gross income information you believe to be incorrect?
- § 418.1340 What are the rules for our administrative review process?
- § 418.1345 Is reopening of an initial or reconsidered determination made by us ever appropriate?
- § 418.1350 What are the rules for review of a reconsidered determination or an administrative law judge decision?
- § 418.1355 What are the rules for reopening a decision by an administrative law judge of the Office of Medicare Hearings and Appeals (OMHA) or by the Medicare Appeals Council (MAC)?
- Subpart C—Income-Related Monthly Adjustments to Medicare Prescription Drug Coverage Premiums
- Introduction, General Provisions, and Definitions
- § 418.2001 What is this subpart about?
- § 418.2005 Purpose and administration.
- § 418.2010 Definitions.
- Determination of the Income-Related Monthly Adjustment Amount
- § 418.2101 What is the income-related monthly adjustment amount?
- § 418.2105 What is the threshold?
- § 418.2110 What is the effective date of our initial determination about your income-related monthly adjustment amount?
- § 418.2112 Paying your income-related monthly adjustment amount.
- § 418.2115 What are the modified adjusted gross income ranges?
- § 418.2120 How do we determine your income-related monthly adjustment amount?
- § 418.2125 How will the income-related monthly adjustment amount affect your total Medicare prescription drug coverage premium?
- § 418.2135 What modified adjusted gross income information will we use to determine your income-related monthly adjustment amount?
- § 418.2140 What will happen if the modified adjusted gross income information from the IRS is different from the modified adjusted gross income information we used to determine your income-related monthly adjustment amount?
- § 418.2145 How do we determine your income-related monthly adjustment amount if the IRS does not provide information about your modified adjusted gross income?
- § 418.2150 When will we use your amended tax return filed with the IRS?
- Determinations Using a More Recent Tax Year's Modified Adjusted Gross Income
- § 418.2201 When will we determine your income-related monthly adjustment amount based on the modified adjusted gross income information that you provide for a more recent tax year?
- § 418.2205 What is a major life-changing event?
- § 418.2210 What is not a major life-changing event?
- § 418.2215 What is a significant reduction in your income?
- § 418.2220 What is not a significant reduction in your income?
- § 418.2225 Which more recent tax year will we use?
- § 418.2230 What is the effective date of an income-related monthly adjustment amount initial determination based on a more recent tax year?
- § 418.2235 When will we stop using your more recent tax year's modified adjusted gross income to determine your income-related monthly adjustment amount?
- § 418.2240 Should you notify us if the information you gave us about your modified adjusted gross income for the more recent tax year changes?
- § 418.2245 What will happen if you notify us that your modified adjusted gross income for the more recent tax year changes?
- § 418.2250 What evidence will you need to support your request that we use a more recent tax year?
- § 418.2255 What kind of evidence of a major life-changing event will you need to support your request for us to use a more recent tax year?
- § 418.2260 What major life-changing event evidence will we not accept?
- § 418.2265 What kind of evidence of a significant modified adjusted gross income reduction will you need to support your request?
- § 418.2270 What modified adjusted gross income evidence will we not accept?
- Determinations and the Administrative Review Process
- § 418.2301 What is an initial determination regarding your income-related monthly adjustment amount?
- § 418.2305 What is not an initial determination regarding your income-related monthly adjustment amount?
- § 418.2310 When may you request that we make a new initial determination?
- § 418.2315 How will we notify you and what information will we provide about our initial determination?
- § 418.2320 What is the effect of an initial determination?
- § 418.2322 How will a Medicare Part B income-related monthly adjustment amount determination for the effective year affect your Medicare prescription drug coverage?
- § 418.2325 When may you request a reconsideration?
- § 418.2330 Can you request a reconsideration when you believe that the IRS information we used is incorrect?
- § 418.2332 Can you request a reconsideration when you believe that the CMS information we used is incorrect?
- § 418.2335 What should you do if we base our initial determination on modified adjusted gross income information you believe to be incorrect?
- § 418.2340 What are the rules for our administrative review process?
- § 418.2345 Is reopening of an initial or reconsidered determination made by us ever appropriate?
- § 418.2350 What are the rules for review of a reconsidered determination or an ALJ decision?
- § 418.2355 What are the rules for reopening a decision by an ALJ of the Office of Medicare Hearings and Appeals (OMHA) or by the Medicare Appeals Council (MAC)?
- Subpart D—Medicare Part D Subsidies
- Introduction, General Provisions, and Definitions
- § 418.3001 What is this subpart about?
- § 418.3005 Purpose and administration of the program.
- § 418.3010 Definitions.
- Eligibility for a Medicare Prescription Drug Subsidy
- § 418.3101 How do you become eligible for a subsidy?
- § 418.3105 Who does not need to file an application for a subsidy?
- § 418.3110 What happens when you apply for a subsidy?
- § 418.3115 What events will make you ineligible for a subsidy?
- § 418.3120 What happens if your circumstances change after we determine you are eligible for a subsidy?
- § 418.3123 When is a change in your subsidy effective?
- § 418.3125 What are redeterminations?
- Filing of Application
- § 418.3201 Must you file an application to become eligible for a subsidy?
- § 418.3205 What makes an application a claim for a subsidy?
- § 418.3210 What is a prescribed application for a subsidy?
- § 418.3215 Who may file your application for a subsidy?
- § 418.3220 When is your application considered filed?
- § 418.3225 How long will your application remain in effect?
- § 418.3230 When will we use your subsidy inquiry as your filing date?
- Income
- § 418.3301 What is income?
- § 418.3305 What is not income?
- § 418.3310 Whose income do we count?
- § 418.3315 What is earned income?
- § 418.3320 How do we count your earned income?
- § 418.3325 What earned income do we not count?
- § 418.3330 What is unearned income?
- § 418.3335 What types of unearned income do we count?
- § 418.3340 How do we count your unearned income?
- § 418.3350 What types of unearned income do we not count?
- Resources
- § 418.3401 What are resources?
- § 418.3405 What types of resources do we count?
- § 418.3410 Whose resources do we count?
- § 418.3415 How do we determine countable resources?
- § 418.3420 How are funds held in financial institution accounts counted?
- § 418.3425 What resources do we exclude from counting?
- Adjustments and Terminations
- § 418.3501 What could cause us to increase or reduce your subsidy or terminate your subsidy eligibility?
- § 418.3505 How would an increase, reduction or termination affect you?
- § 418.3510 When would an increase, reduction or termination start?
- § 418.3515 How could you qualify for a subsidy again?
- Determinations and the Administrative Review Process
- § 418.3601 When do you have the right to administrative review?
- § 418.3605 What is an initial determination?
- § 418.3610 Is there administrative or judicial review for administrative actions that are not initial determinations?
- § 418.3615 Will we mail you a notice of the initial determination?
- § 418.3620 What is the effect of an initial determination?
- § 418.3625 What is the process for administrative review?
- § 418.3630 How do you request administrative review?
- § 418.3635 Can anyone request administrative review on your behalf?
- § 418.3640 How do we determine if you had good cause for missing the deadline to request administrative review?
- § 418.3645 Can you request that the decision-maker be disqualified?
- § 418.3650 How do we make our decision upon review?
- § 418.3655 How will we notify you of our decision after our review?
- § 418.3665 Can your request for a hearing or case review be dismissed?
- § 418.3670 How will you be notified of the dismissal?
- § 418.3675 How does our decision affect you?
- § 418.3678 What is the process for correcting Agency clerical errors?
- § 418.3680 What happens if your case is remanded by a Federal court?
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