PART 418—MEDICARE SUBSIDIES

Table of Contents

Subpart A [Reserved]

Subpart B—Medicare Part B Income-Related Monthly Adjustment Amount

Introduction, General Provisions, and Definitions

418.1001What is this subpart about?
418.1005Purpose and administration.
418.1010Definitions.

Determination of the Income-Related Monthly Adjustment Amount

418.1101What is the income-related monthly adjustment amount?
418.1105What is the threshold?
418.1110What is the effective date of our initial determination about your income-related monthly adjustment amount?
418.1115What are the modified adjusted gross income ranges?
418.1120How do we determine your income-related monthly adjustment amount?
418.1125How will the income-related monthly adjustment amount affect your total Medicare Part B premium?
418.1130[Reserved]
418.1135What modified adjusted gross income information will we use to determine your income-related monthly adjustment amount?
418.1140What 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?
418.1145How do we determine your income-related monthly adjustment amount if IRS does not provide information about your modified adjusted gross income?
418.1150When will we use your amended tax return filed with IRS?

Determinations Using a More Recent Tax Year's Modified Adjusted Gross Income

418.1201When 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?
418.1205What is a major life-changing event?
418.1210What is not a major life-changing event?
418.1215What is a significant reduction in your income?
418.1220What is not a significant reduction in your income?
418.1225Which more recent tax year will we use?
418.1230What is the effective date of an income-related monthly adjustment amount initial determination that is based on a more recent tax year?
418.1235When will we stop using your more recent tax year's modified adjusted gross income to determine your income-related monthly adjustment amount?
418.1240Should you notify us if the information you gave us about your modified adjusted gross income for the more recent tax year changes?
418.1245What will happen if you notify us that your modified adjusted gross income for the more recent tax year changes?
418.1250What evidence will you need to support your request that we use a more recent tax year?
418.1255What kind of major life-changing event evidence will you need to support your request for us to use a more recent tax year?
418.1260What major life-changing event evidence will we not accept?
418.1265What kind of significant modified adjusted gross income reduction evidence will you need to support your request?
418.1270What modified adjusted gross income evidence will we not accept?

Determinations and the Administrative Review Process

418.1301What is an initial determination regarding your income-related monthly adjustment amount?
418.1305What is not an initial determination regarding your income-related monthly adjustment amount?
418.1310When may you request that we make a new initial determination?
418.1315How will we notify you and what information will we provide about our initial determination?
418.1320What is the effect of an initial determination?
418.1322How will a Medicare prescription drug coverage income-related monthly adjustment amount determination for the effective year affect your Medicare Part B?
418.1325When may you request a reconsideration?
418.1330Can you request a reconsideration when you believe the IRS information we used is incorrect?
418.1335What should you do if our initial determination is based on modified adjusted gross income information you believe to be incorrect?
418.1340What are the rules for our administrative review process?
418.1345Is reopening of an initial or reconsidered determination made by us ever appropriate?
418.1350What are the rules for review of a reconsidered determination or an administrative law judge decision?
418.1355What 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

418.2001What is this subpart about?
418.2005Purpose and administration.
418.2010Definitions.

Determination of the Income-Related Monthly Adjustment Amount

418.2101What is the income-related monthly adjustment amount?
418.2105What is the threshold?
418.2110What is the effective date of our initial determination about your income-related monthly adjustment amount?
418.2112Paying your income-related monthly adjustment amount.
418.2115What are the modified adjusted gross income ranges?
418.2120How do we determine your income-related monthly adjustment amount?
418.2125How will the income-related monthly adjustment amount affect your total Medicare prescription drug coverage premium?
418.2135What modified adjusted gross income information will we use to determine your income-related monthly adjustment amount?
418.2140What 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?
418.2145How do we determine your income-related monthly adjustment amount if the IRS does not provide information about your modified adjusted gross income?
418.2150When will we use your amended tax return filed with the IRS?

Determinations Using a More Recent Tax Year's Modified Adjusted Gross Income

418.2201When 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?
418.2205What is a major life-changing event?
418.2210What is not a major life-changing event?
418.2215What is a significant reduction in your income?
418.2220What is not a significant reduction in your income?
418.2225Which more recent tax year will we use?
418.2230What is the effective date of an income-related monthly adjustment amount initial determination based on a more recent tax year?
418.2235When will we stop using your more recent tax year's modified adjusted gross income to determine your income-related monthly adjustment amount?
418.2240Should you notify us if the information you gave us about your modified adjusted gross income for the more recent tax year changes?
418.2245What will happen if you notify us that your modified adjusted gross income for the more recent tax year changes?
418.2250What evidence will you need to support your request that we use a more recent tax year?
418.2255What 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?
418.2260What major life-changing event evidence will we not accept?
418.2265What kind of evidence of a significant modified adjusted gross income reduction will you need to support your request?
418.2270What modified adjusted gross income evidence will we not accept?

Determinations and the Administrative Review Process

418.2301What is an initial determination regarding your income-related monthly adjustment amount?
418.2305What is not an initial determination regarding your income-related monthly adjustment amount?
418.2310When may you request that we make a new initial determination?
418.2315How will we notify you and what information will we provide about our initial determination?
418.2320What is the effect of an initial determination?
418.2322How will a Medicare Part B income-related monthly adjustment amount determination for the effective year affect your Medicare prescription drug coverage?
418.2325When may you request a reconsideration?
418.2330Can you request a reconsideration when you believe that the IRS information we used is incorrect?
418.2332Can you request a reconsideration when you believe that the CMS information we used is incorrect?
418.2335What should you do if we base our initial determination on modified adjusted gross income information you believe to be incorrect?
418.2340What are the rules for our administrative review process?
418.2345Is reopening of an initial or reconsidered determination made by us ever appropriate?
418.2350What are the rules for review of a reconsidered determination or an ALJ decision?
418.2355What 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

418.3001What is this subpart about?
418.3005Purpose and administration of the program.
418.3010Definitions.

Eligibility for a Medicare Prescription Drug Subsidy

418.3101How do you become eligible for a subsidy?
418.3105Who does not need to file an application for a subsidy?
418.3110What happens when you apply for a subsidy?
418.3115What events will make you ineligible for a subsidy?
418.3120What happens if your circumstances change after we determine you are eligible for a subsidy?
418.3123When is a change in your subsidy effective?
418.3125What are redeterminations?

Filing of Application

418.3201Must you file an application to become eligible for a subsidy?
418.3205What makes an application a claim for a subsidy?
418.3210What is a prescribed application for a subsidy?
418.3215Who may file your application for a subsidy?
418.3220When is your application considered filed?
418.3225How long will your application remain in effect?
418.3230When will we use your subsidy inquiry as your filing date?

Income

418.3301What is income?
418.3305What is not income?
418.3310Whose income do we count?
418.3315What is earned income?
418.3320How do we count your earned income?
418.3325What earned income do we not count?
418.3330What is unearned income?
418.3335What types of unearned income do we count?
418.3340How do we count your unearned income?
418.3350What types of unearned income do we not count?

Resources

418.3401What are resources?
418.3405What types of resources do we count?
418.3410Whose resources do we count?
418.3415How do we determine countable resources?
418.3420How are funds held in financial institution accounts counted?
418.3425What resources do we exclude from counting?

Adjustments and Terminations

418.3501What could cause us to increase or reduce your subsidy or terminate your subsidy eligibility?
418.3505How would an increase, reduction or termination affect you?
418.3510When would an increase, reduction or termination start?
418.3515How could you qualify for a subsidy again?

Determinations and the Administrative Review Process

418.3601When do you have the right to administrative review?
418.3605What is an initial determination?
418.3610Is there administrative or judicial review for administrative actions that are not initial determinations?
418.3615Will we mail you a notice of the initial determination?
418.3620What is the effect of an initial determination?
418.3625What is the process for administrative review?
418.3630How do you request administrative review?
418.3635Can anyone request administrative review on your behalf?
418.3640How do we determine if you had good cause for missing the deadline to request administrative review?
418.3645Can you request that the decision-maker be disqualified?
418.3650How do we make our decision upon review?
418.3655How will we notify you of our decision after our review?
418.3665Can your request for a hearing or case review be dismissed?
418.3670How will you be notified of the dismissal?
418.3675How does our decision affect you?
418.3678What is the process for correcting Agency clerical errors?
418.3680What happens if your case is remanded by a Federal court?

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