Form SSA-44: requesting a new initial determination
If your income has fallen because of a life-changing event, you do not have to wait for the two-year lookback to move past it. Form SSA-44 asks Social Security to use a more recent tax year instead. It is one page and there is no fee. No deadline stops you asking — but when you ask decides which year gets adjusted, and a late request can leave a prior year’s surcharge standing even when it succeeds. The timing rules are below.
Checked against Form SSA-44, Medicare Income-Related Monthly Adjustment Amount — Life-Changing Event, revision 12-2025 (8 pages, OMB 0960-0784). Download it from ssa.gov, not from a third-party form site. We are not affiliated with SSA.
Do you qualify?
The form has 8 checkboxes and no “other”. Your situation has to be one of these. The wording below is the form’s own, from the instructions on page 6.
SSA's own public summary page lists only 'marriage, divorce, the death of a spouse, loss of income, and an employer settlement payment'. That is an abbreviation, not the list - the form has eight checkboxes and no 'other'.
| Event | What it means |
|---|---|
| Marriage | You entered into a legal marriage. |
| Divorce/Annulment | Your legal marriage ended, and you will not file a joint return with your spouse for the year. |
| Death of Your Spouse | Your spouse died. |
| Work Stoppage | You or your spouse stopped working. The instructions treat stoppage and reduction as one category, but the form has a separate checkbox for each. |
| Work Reduction | You or your spouse reduced the hours that you work. |
| Loss of Income-Producing Property | Loss of income-producing property that was not at your direction — not a sale or transfer. Includes property in a Presidentially or Gubernatorially-declared disaster area, destruction of livestock or crops by natural disaster or disease, loss by arson, or loss of investment property through fraud or theft. |
| Loss of Pension Income | You or your spouse experienced a scheduled cessation, termination, or reorganization of an employer's pension plan. |
| Employer Settlement Payment | You or your spouse receive a settlement from an employer or former employer because of the employer's bankruptcy or reorganization. |
What does not qualify
The form covers circumstances that changed income going forward, not a single expensive year. A one-off gain raises the premium for twelve months, after which SSA uses the next return.
- A Roth conversion, however large
- Selling a property, or any capital gain you chose to realise
- A one-off IRA or 401(k) withdrawal
- An inheritance, or income from one
- Winning a lawsuit or the lottery
- Simply having had an unusually high-income year
On the checkbox line this reads simply as loss of pension income, but the instructions narrow it to a scheduled cessation, termination or reorganization of an employer's pension plan. POMS narrows it further, to traditional defined-benefit or cash-balance plans in specified failure or termination situations. A pension that merely pays less does not qualify.
A large Roth conversion can raise MAGI by two or three brackets, but it is not one of the eight life-changing events on the form. SSA-44 does not apply to a one-year increase in MAGI from a conversion or a sale.
The five steps
Your name and Social Security number go at the top of page 1 — not in a numbered step, and it is your own SSN, which can differ from the number on your Medicare card. SSA estimates the whole thing takes about 45 minutes.
mm/yyyy. One rule catches people out: “The life-changing event date must be in the same year or an earlier year than the tax year you ask us to use to decide your income-related premium adjustment.” So if SSA used your 2024 return for 2026, an event in 2025 lets you ask for 2025 instead.What to attach
SSA wants evidence of two separate things: that the event happened, and that your income is what you say. If you have already filed for the year in Step 2, you must provide a signed copy of that return or an IRS transcript. If you gave an estimate, you must show the signed return once you file it.
| Event | What SSA accepts |
|---|---|
| Marriage | An original marriage certificate, or a certified copy of a public record of marriage. |
| Divorce/Annulment | A certified copy of the decree of divorce or annulment. |
| Death of Your Spouse | A certified copy of a death certificate, of the public record of death, or of a coroner's certificate. |
| Work Stoppage or Reduction | An original signed statement from your employer, copies of pay stubs, or original or certified documents showing a transfer of your business. In the absence of such proof, SSA will accept your own signed statement on the form, under penalty of perjury. |
| Loss of Income-Producing Property | An original insurance adjuster's statement of loss, or a letter from a State or Federal government about the uncompensated loss. Where the loss was investment fraud or theft, SSA also requires proof of conviction. |
| Loss of Pension Income | A letter or statement from your pension fund administrator explaining the reduction or termination. |
| Employer Settlement Payment | A letter from the employer stating the settlement terms of the bankruptcy court and how it affects you or your spouse. |
Attach the required evidence and we will mail your original documents or certified copies back to you — or show your original documents or certified copies to an SSA employee instead. This is worth knowing, because the instinct is to send photocopies and keep the originals — and photocopies are not what the form asks for.
For work stoppage or reduction specifically, if you cannot get an employer statement or pay stubs, SSA will accept your own signed statement on the form, under penalty of perjury. Retirees who left without paperwork are not stuck.
How to submit it — and when you need not
Page 5 of the form says outright that it is optional: “You do not have to complete this form in order to ask that we use your information about your modified adjusted gross income for a more recent tax year. If you prefer, you may call 1-800-772-1213 and speak to a representative to request an appointment at one of our field offices.” Lines are open 7 a.m. to 7 p.m. on business days on 1-800-772-1213 (TTY 1-800-325-0778).
If you do file it, there are three routes:
| Route | Detail |
|---|---|
| Online | Sign in to a my Social Security account to fill out and submit the SSA-44 online. See ssa.gov. |
| Fax or post | Fax or mail the completed form and evidence to a Social Security office - find yours with the office locator. The form itself gives no central mailing address - it goes to your servicing office. Office locator. |
| In person | Show original documents or certified copies to an SSA employee, or call to schedule a field-office appointment. |
From outside the United States, contact a Federal Benefits Unit.
Amended return: An amended tax return is not what this form is for. SSA says to call 1-800-772-1213 instead.
Married filing separately, lived apart all year: If SSA used a year when your filing status was married filing separately but you lived apart from your spouse at all times that year, call 1-800-772-1213 to explain. The form explicitly says: do not use this form to report that change.
You may use an estimate. SSA later checks it against IRS records, and will ask for the filed return. If your estimate changes or you amend the return, you must contact SSA — otherwise there may be retroactive assessments or refunds.
Timing: no deadline, but dates still matter
No filing deadline appears on the SSA-44, and SSA's own lower-IRMAA page states none. POMS: a request may be made at any time after a life-changing event and a significant reduction in MAGI. The event may have occurred at any time in the past.
What timing does affect is which year gets adjusted. POMS: a new determination is not normally backdated to a prior premium year. The exception is where the event fell in the last three calendar months of the immediately preceding premium year AND SSA receives the request by 31 March of the current premium year. So an event in October, November or December is worth acting on before 31 March — otherwise the prior year’s surcharge stands even if the request succeeds.
Once a request is open, a different clock starts: POMS: once a request is open, failure to supply the required evidence within 30 days leads to dismissal. A 90-day extension may be granted before dismissal. This is an evidence clock, not a filing deadline.
The 60-day figure you may have read is a different process. The 60-day window people often cite is the appeal period for reconsidering an IRMAA notice - a different process. It is not an SSA-44 filing rule.
The timing rules above are SSA policy from POMS HI 01120, not text printed on the form.
What the form is worth
One page of form, for a surcharge that runs a full twelve months. In 2026, being in the first IRMAA tier rather than the standard tier costs $1148.40 across the year — and the higher tiers cost multiples of that. Someone who retired last year, and whose surcharge is based on their final full salary year, is often several tiers up from where their actual income now sits.
The 2026 brackets show which tier a given MAGI falls in and what the tier below it costs; the difference between the two is what a successful SSA-44 is worth in that case. If you are not sure what IRMAA is or why you got it, start with how IRMAA works.