Medicare Appeal Forms & Resources
Tools and forms to appeal decisions for IRMAA, Part D denials, and more.
IRMAA (Income Related Monthly Adjustment Amount)
If you believe your income has changed and you qualify for a reduction in IRMAA, download and complete Form SSA-44 (Request for Reconsideration of Income-Related Monthly Adjustment Amount). Submit the completed form and supporting documentation directly to the Social Security Administration by following the instructions on the form. If you have questions about the process, feel free to reach out for guidance on locating additional resources.
Form: https://www.ssa.gov/forms/ssa-44.pdf
Part B Late Enrollment Penalty
If you did miss your window and now owe a late-enrollment penalty, you aren’t stuck—both Part B and Part D penalties can be appealed. Follow the instructions on the letter you received: for Part B, submit a reconsideration request to SSA (using the form or process outlined in your notice) within 60 days of that letter. Continue to pay your penalty while your appeal is under review, you will receive a refund if your appeal is approved.
Part D Late Enrollment Penalty
For Part D, complete the “Part D LEP Reconsideration Request Form C2C” and send it to the Independent Review Entity by the deadline, attaching any evidence of prior creditable coverage. Be sure to keep paying your penalty while your appeal is under review, if it succeeds, you’ll receive a refund for those payments.
Form: https://www.cms.gov/files/document/part-d-lep-reconsideration-request-form-c2c.pdf
More Information: https://www.cms.gov/medicare/appeals-grievances/prescription-drug/late-enrollment-penalty-appeals
Tips for a successful appeal:
- Provide clear documentation
- Meet all filing deadlines
- Keep copies of every submission
- Follow up often
