Form SSA-44, Medicare Income-Related Monthly Adjustment Amount - Life-Changing Event is a form used to notify the Social Security Administration (SSA) about a change in income and request a reduction of the income-related monthly adjustment amount (IRMAA) of the Medicare premium because of a life-changing event.
The most recent version of this form was issued by the SSA on November 1, 2019. A fillable version of the form - also known as the SSA Form 44 - is available for download below.
Life-changing events include the following: marriage, divorce or annulment, the death of the spouse, work stoppage or reduction, loss of income-producing property, loss or reduction of pension income, and employer settlement payment.
Form SSA-44 can be filed in a local SSA office and all supporting documentation can be presented in person. Alternatively, the form can be downloaded, filled out digitally, printed out, and mailed to the local SSA office with originals or certified copies of the supporting documentation.