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 | |
418.1001 | 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 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? |
Source: 70 FR 77675, Dec. 30, 2005, unless otherwise noted.