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Code of Federal Regulations (Last Updated: May 6, 2024) |
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Title 20 - Employees' Benefits |
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Chapter III - Social Security Administration |
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Part 418 - Medicare Subsidies |
| Subpart A - XXX |
| Subpart B - Medicare Part B Income-Related Monthly Adjustment Amount |
| 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? |
| Introduction, General Provisions, and Definitions |
| § 418.1001 - What is this subpart about? |
| § 418.1005 - Purpose and administration. |
| § 418.1010 - Definitions. |
| 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)? |
| 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? |
| § 418.1145 - 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? |
| 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. |
| 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? |
| 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? |
| § 418.2145 - 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 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. |
| 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? |
| 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? |
| 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? |
| 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? |
| 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? |
| § 418.3345 - How do we determine the value of in-kind support and maintenance? |
| § 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? |