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Electronic Code of Federal Regulations

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e-CFR Data is current as of August 27, 2014

Title 20Chapter IIIPart 418


TITLE 20—Employees' Benefits

CHAPTER III—SOCIAL SECURITY ADMINISTRATION

PART 418—MEDICARE SUBSIDIES

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Subpart A—[RESERVED]

rule

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 that 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)?
rule

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)?
rule

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?


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