Part B

Basic Information

• Tax Return Used for Calculation: $[CurrentYear - 2 = Basis Year]$
• MAGI: $[AGI + Untaxed Foreign Income + Non-Taxable SS + Tax Exempt Interest$

Exceptions

If your income has gone down due to any of the following situations, and the change makes a difference in the income level we consider, contact us to explain that you have new information and may need a new decision about your income-related monthly adjustment amount:

• You married, divorced, or became widowed.
• You or your spouse stopped working or reduced your work hours.
• You or your spouse lost income-producing property because of a disaster or other event beyond your control.
• You or your spouse experienced a scheduled cessation, termination, or reorganization of an employer’s pension plan.
• You or your spouse received a settlement from an employer or former employer because of the employer’s closure, bankruptcy, or reorganization.

If any of the above applies to you, we need to see documentation verifying the event and the reduction in your income.

Premium Tables: https://www.ssa.gov/benefits/medicare/medicare-premiums.html

Key Numbers:

MFJ

176,000

222,000

276,000

330,000

750,000

Single

88,000

111,000

138,000

165,000

500,000