Title 20

PART 418

Part 418 - Medicare Subsidies

PART 418 - MEDICARE SUBSIDIES Source:70 FR 77675, Dec. 30, 2005, unless otherwise noted.

20:2.0.1.1.10.1SUBPART A
Subpart A [Reserved]
20:2.0.1.1.10.2SUBPART B
Subpart B - Medicare Part B Income-Related Monthly Adjustment Amount
20:2.0.1.1.10.2.470SUBJGRP 470
   Introduction, General Provisions, and Definitions
20:2.0.1.1.10.2.470.1SECTION 418.1001
   418.1001 What is this subpart about
20:2.0.1.1.10.2.470.2SECTION 418.1005
   418.1005 Purpose and administration.
20:2.0.1.1.10.2.470.3SECTION 418.1010
   418.1010 Definitions.
20:2.0.1.1.10.2.471SUBJGRP 471
   Determination of the Income-Related Monthly Adjustment Amount
20:2.0.1.1.10.2.471.4SECTION 418.1101
   418.1101 What is the income-related monthly adjustment amount
20:2.0.1.1.10.2.471.5SECTION 418.1105
   418.1105 What is the threshold
20:2.0.1.1.10.2.471.6SECTION 418.1110
   418.1110 What is the effective date of our initial determination about your income-related monthly adjustment amount
20:2.0.1.1.10.2.471.7SECTION 418.1115
   418.1115 What are the modified adjusted gross income ranges
20:2.0.1.1.10.2.471.8SECTION 418.1120
   418.1120 How do we determine your income-related monthly adjustment amount
20:2.0.1.1.10.2.471.9SECTION 418.1125
   418.1125 How will the income-related monthly adjustment amount affect your total Medicare Part B premium
20:2.0.1.1.10.2.471.10SECTION 418.1130
   418.1130 [Reserved]
20:2.0.1.1.10.2.471.11SECTION 418.1135
   418.1135 What modified adjusted gross income information will we use to determine your income-related monthly adjustment amount
20:2.0.1.1.10.2.471.12SECTION 418.1140
   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
20:2.0.1.1.10.2.471.13SECTION 418.1145
   418.1145 How do we determine your income-related monthly adjustment amount if IRS does not provide information about your modified adjusted gross income
20:2.0.1.1.10.2.471.14SECTION 418.1150
   418.1150 When will we use your amended tax return filed with IRS
20:2.0.1.1.10.2.472SUBJGRP 472
   Determinations Using a More Recent Tax Year's Modified Adjusted Gross Income
20:2.0.1.1.10.2.472.15SECTION 418.1201
   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
20:2.0.1.1.10.2.472.16SECTION 418.1205
   418.1205 What is a major life-changing event
20:2.0.1.1.10.2.472.17SECTION 418.1210
   418.1210 What is not a major life-changing event
20:2.0.1.1.10.2.472.18SECTION 418.1215
   418.1215 What is a significant reduction in your income
20:2.0.1.1.10.2.472.19SECTION 418.1220
   418.1220 What is not a significant reduction in your income
20:2.0.1.1.10.2.472.20SECTION 418.1225
   418.1225 Which more recent tax year will we use
20:2.0.1.1.10.2.472.21SECTION 418.1230
   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
20:2.0.1.1.10.2.472.22SECTION 418.1235
   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
20:2.0.1.1.10.2.472.23SECTION 418.1240
   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
20:2.0.1.1.10.2.472.24SECTION 418.1245
   418.1245 What will happen if you notify us that your modified adjusted gross income for the more recent tax year changes
20:2.0.1.1.10.2.472.25SECTION 418.1250
   418.1250 What evidence will you need to support your request that we use a more recent tax year
20:2.0.1.1.10.2.472.26SECTION 418.1255
   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
20:2.0.1.1.10.2.472.27SECTION 418.1260
   418.1260 What major life-changing event evidence will we not accept
20:2.0.1.1.10.2.472.28SECTION 418.1265
   418.1265 What kind of significant modified adjusted gross income reduction evidence will you need to support your request
20:2.0.1.1.10.2.472.29SECTION 418.1270
   418.1270 What modified adjusted gross income evidence will we not accept
20:2.0.1.1.10.2.473SUBJGRP 473
   Determinations and the Administrative Review Process
20:2.0.1.1.10.2.473.30SECTION 418.1301
   418.1301 What is an initial determination regarding your income-related monthly adjustment amount
20:2.0.1.1.10.2.473.31SECTION 418.1305
   418.1305 What is not an initial determination regarding your income-related monthly adjustment amount
20:2.0.1.1.10.2.473.32SECTION 418.1310
   418.1310 When may you request that we make a new initial determination
20:2.0.1.1.10.2.473.33SECTION 418.1315
   418.1315 How will we notify you and what information will we provide about our initial determination
20:2.0.1.1.10.2.473.34SECTION 418.1320
   418.1320 What is the effect of an initial determination
20:2.0.1.1.10.2.473.35SECTION 418.1322
   418.1322 How will a Medicare prescription drug coverage income-related monthly adjustment amount determination for the effective year affect your Medicare Part B
20:2.0.1.1.10.2.473.36SECTION 418.1325
   418.1325 When may you request a reconsideration
20:2.0.1.1.10.2.473.37SECTION 418.1330
   418.1330 Can you request a reconsideration when you believe that the IRS information we used is incorrect
20:2.0.1.1.10.2.473.38SECTION 418.1335
   418.1335 What should you do if our initial determination is based on modified adjusted gross income information you believe to be incorrect
20:2.0.1.1.10.2.473.39SECTION 418.1340
   418.1340 What are the rules for our administrative review process
20:2.0.1.1.10.2.473.40SECTION 418.1345
   418.1345 Is reopening of an initial or reconsidered determination made by us ever appropriate
20:2.0.1.1.10.2.473.41SECTION 418.1350
   418.1350 What are the rules for review of a reconsidered determination or an administrative law judge decision
20:2.0.1.1.10.2.473.42SECTION 418.1355
   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)
20:2.0.1.1.10.3SUBPART C
Subpart C - Income-Related Monthly Adjustments to Medicare Prescription Drug Coverage Premiums
20:2.0.1.1.10.3.474SUBJGRP 474
   Introduction, General Provisions, and Definitions
20:2.0.1.1.10.3.474.1SECTION 418.2001
   418.2001 What is this subpart about
20:2.0.1.1.10.3.474.2SECTION 418.2005
   418.2005 Purpose and administration.
20:2.0.1.1.10.3.474.3SECTION 418.2010
   418.2010 Definitions.
20:2.0.1.1.10.3.475SUBJGRP 475
   Determination of the Income-Related Monthly Adjustment Amount
20:2.0.1.1.10.3.475.4SECTION 418.2101
   418.2101 What is the income-related monthly adjustment amount
20:2.0.1.1.10.3.475.5SECTION 418.2105
   418.2105 What is the threshold
20:2.0.1.1.10.3.475.6SECTION 418.2110
   418.2110 What is the effective date of our initial determination about your income-related monthly adjustment amount
20:2.0.1.1.10.3.475.7SECTION 418.2112
   418.2112 Paying your income-related monthly adjustment amount.
20:2.0.1.1.10.3.475.8SECTION 418.2115
   418.2115 What are the modified adjusted gross income ranges
20:2.0.1.1.10.3.475.9SECTION 418.2120
   418.2120 How do we determine your income-related monthly adjustment amount
20:2.0.1.1.10.3.475.10SECTION 418.2125
   418.2125 How will the income-related monthly adjustment amount affect your total Medicare prescription drug coverage premium
20:2.0.1.1.10.3.475.11SECTION 418.2135
   418.2135 What modified adjusted gross income information will we use to determine your income-related monthly adjustment amount
20:2.0.1.1.10.3.475.12SECTION 418.2140
   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
20:2.0.1.1.10.3.475.13SECTION 418.2145
   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
20:2.0.1.1.10.3.475.14SECTION 418.2150
   418.2150 When will we use your amended tax return filed with the IRS
20:2.0.1.1.10.3.476SUBJGRP 476
   Determinations Using a More Recent Tax Year's Modified Adjusted Gross Income
20:2.0.1.1.10.3.476.15SECTION 418.2201
   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
20:2.0.1.1.10.3.476.16SECTION 418.2205
   418.2205 What is a major life-changing event
20:2.0.1.1.10.3.476.17SECTION 418.2210
   418.2210 What is not a major life-changing event
20:2.0.1.1.10.3.476.18SECTION 418.2215
   418.2215 What is a significant reduction in your income
20:2.0.1.1.10.3.476.19SECTION 418.2220
   418.2220 What is not a significant reduction in your income
20:2.0.1.1.10.3.476.20SECTION 418.2225
   418.2225 Which more recent tax year will we use
20:2.0.1.1.10.3.476.21SECTION 418.2230
   418.2230 What is the effective date of an income-related monthly adjustment amount initial determination based on a more recent tax year
20:2.0.1.1.10.3.476.22SECTION 418.2235
   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
20:2.0.1.1.10.3.476.23SECTION 418.2240
   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
20:2.0.1.1.10.3.476.24SECTION 418.2245
   418.2245 What will happen if you notify us that your modified adjusted gross income for the more recent tax year changes
20:2.0.1.1.10.3.476.25SECTION 418.2250
   418.2250 What evidence will you need to support your request that we use a more recent tax year
20:2.0.1.1.10.3.476.26SECTION 418.2255
   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
20:2.0.1.1.10.3.476.27SECTION 418.2260
   418.2260 What major life-changing event evidence will we not accept
20:2.0.1.1.10.3.476.28SECTION 418.2265
   418.2265 What kind of evidence of a significant modified adjusted gross income reduction will you need to support your request
20:2.0.1.1.10.3.476.29SECTION 418.2270
   418.2270 What modified adjusted gross income evidence will we not accept
20:2.0.1.1.10.3.477SUBJGRP 477
   Determinations and the Administrative Review Process
20:2.0.1.1.10.3.477.30SECTION 418.2301
   418.2301 What is an initial determination regarding your income-related monthly adjustment amount
20:2.0.1.1.10.3.477.31SECTION 418.2305
   418.2305 What is not an initial determination regarding your income-related monthly adjustment amount
20:2.0.1.1.10.3.477.32SECTION 418.2310
   418.2310 When may you request that we make a new initial determination
20:2.0.1.1.10.3.477.33SECTION 418.2315
   418.2315 How will we notify you and what information will we provide about our initial determination
20:2.0.1.1.10.3.477.34SECTION 418.2320
   418.2320 What is the effect of an initial determination
20:2.0.1.1.10.3.477.35SECTION 418.2322
   418.2322 How will a Medicare Part B income-related monthly adjustment amount determination for the effective year affect your Medicare prescription drug coverage
20:2.0.1.1.10.3.477.36SECTION 418.2325
   418.2325 When may you request a reconsideration
20:2.0.1.1.10.3.477.37SECTION 418.2330
   418.2330 Can you request a reconsideration when you believe that the IRS information we used is incorrect
20:2.0.1.1.10.3.477.38SECTION 418.2332
   418.2332 Can you request a reconsideration when you believe that the CMS information we used is incorrect
20:2.0.1.1.10.3.477.39SECTION 418.2335
   418.2335 What should you do if we base our initial determination on modified adjusted gross income information you believe to be incorrect
20:2.0.1.1.10.3.477.40SECTION 418.2340
   418.2340 What are the rules for our administrative review process
20:2.0.1.1.10.3.477.41SECTION 418.2345
   418.2345 Is reopening of an initial or reconsidered determination made by us ever appropriate
20:2.0.1.1.10.3.477.42SECTION 418.2350
   418.2350 What are the rules for review of a reconsidered determination or an ALJ decision
20:2.0.1.1.10.3.477.43SECTION 418.2355
   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)
20:2.0.1.1.10.4SUBPART D
Subpart D - Medicare Part D Subsidies
20:2.0.1.1.10.4.478SUBJGRP 478
   Introduction, General Provisions, and Definitions
20:2.0.1.1.10.4.478.1SECTION 418.3001
   418.3001 What is this subpart about
20:2.0.1.1.10.4.478.2SECTION 418.3005
   418.3005 Purpose and administration of the program.
20:2.0.1.1.10.4.478.3SECTION 418.3010
   418.3010 Definitions.
20:2.0.1.1.10.4.479SUBJGRP 479
   Eligibility for a Medicare Prescription Drug Subsidy
20:2.0.1.1.10.4.479.4SECTION 418.3101
   418.3101 How do you become eligible for a subsidy
20:2.0.1.1.10.4.479.5SECTION 418.3105
   418.3105 Who does not need to file an application for a subsidy
20:2.0.1.1.10.4.479.6SECTION 418.3110
   418.3110 What happens when you apply for a subsidy
20:2.0.1.1.10.4.479.7SECTION 418.3115
   418.3115 What events will make you ineligible for a subsidy
20:2.0.1.1.10.4.479.8SECTION 418.3120
   418.3120 What happens if your circumstances change after we determine you are eligible for a subsidy
20:2.0.1.1.10.4.479.9SECTION 418.3123
   418.3123 When is a change in your subsidy effective
20:2.0.1.1.10.4.479.10SECTION 418.3125
   418.3125 What are redeterminations
20:2.0.1.1.10.4.480SUBJGRP 480
   Filing of Application
20:2.0.1.1.10.4.480.11SECTION 418.3201
   418.3201 Must you file an application to become eligible for a subsidy
20:2.0.1.1.10.4.480.12SECTION 418.3205
   418.3205 What makes an application a claim for a subsidy
20:2.0.1.1.10.4.480.13SECTION 418.3210
   418.3210 What is a prescribed application for a subsidy
20:2.0.1.1.10.4.480.14SECTION 418.3215
   418.3215 Who may file your application for a subsidy
20:2.0.1.1.10.4.480.15SECTION 418.3220
   418.3220 When is your application considered filed
20:2.0.1.1.10.4.480.16SECTION 418.3225
   418.3225 How long will your application remain in effect
20:2.0.1.1.10.4.480.17SECTION 418.3230
   418.3230 When will we use your subsidy inquiry as your filing date
20:2.0.1.1.10.4.481SUBJGRP 481
   Income
20:2.0.1.1.10.4.481.18SECTION 418.3301
   418.3301 What is income
20:2.0.1.1.10.4.481.19SECTION 418.3305
   418.3305 What is not income
20:2.0.1.1.10.4.481.20SECTION 418.3310
   418.3310 Whose income do we count
20:2.0.1.1.10.4.481.21SECTION 418.3315
   418.3315 What is earned income
20:2.0.1.1.10.4.481.22SECTION 418.3320
   418.3320 How do we count your earned income
20:2.0.1.1.10.4.481.23SECTION 418.3325
   418.3325 What earned income do we not count
20:2.0.1.1.10.4.481.24SECTION 418.3330
   418.3330 What is unearned income
20:2.0.1.1.10.4.481.25SECTION 418.3335
   418.3335 What types of unearned income do we count
20:2.0.1.1.10.4.481.26SECTION 418.3340
   418.3340 How do we count your unearned income
20:2.0.1.1.10.4.481.27SECTION 418.3350
   418.3350 What types of unearned income do we not count
20:2.0.1.1.10.4.482SUBJGRP 482
   Resources
20:2.0.1.1.10.4.482.28SECTION 418.3401
   418.3401 What are resources
20:2.0.1.1.10.4.482.29SECTION 418.3405
   418.3405 What types of resources do we count
20:2.0.1.1.10.4.482.30SECTION 418.3410
   418.3410 Whose resources do we count
20:2.0.1.1.10.4.482.31SECTION 418.3415
   418.3415 How do we determine countable resources
20:2.0.1.1.10.4.482.32SECTION 418.3420
   418.3420 How are funds held in financial institution accounts counted
20:2.0.1.1.10.4.482.33SECTION 418.3425
   418.3425 What resources do we exclude from counting
20:2.0.1.1.10.4.483SUBJGRP 483
   Adjustments and Terminations
20:2.0.1.1.10.4.483.34SECTION 418.3501
   418.3501 What could cause us to increase or reduce your subsidy or terminate your subsidy eligibility
20:2.0.1.1.10.4.483.35SECTION 418.3505
   418.3505 How would an increase, reduction or termination affect you
20:2.0.1.1.10.4.483.36SECTION 418.3510
   418.3510 When would an increase, reduction or termination start
20:2.0.1.1.10.4.483.37SECTION 418.3515
   418.3515 How could you qualify for a subsidy again
20:2.0.1.1.10.4.484SUBJGRP 484
   Determinations and the Administrative Review Process
20:2.0.1.1.10.4.484.38SECTION 418.3601
   418.3601 When do you have the right to administrative review
20:2.0.1.1.10.4.484.39SECTION 418.3605
   418.3605 What is an initial determination
20:2.0.1.1.10.4.484.40SECTION 418.3610
   418.3610 Is there administrative or judicial review for administrative actions that are not initial determinations
20:2.0.1.1.10.4.484.41SECTION 418.3615
   418.3615 Will we mail you a notice of the initial determination
20:2.0.1.1.10.4.484.42SECTION 418.3620
   418.3620 What is the effect of an initial determination
20:2.0.1.1.10.4.484.43SECTION 418.3625
   418.3625 What is the process for administrative review
20:2.0.1.1.10.4.484.44SECTION 418.3630
   418.3630 How do you request administrative review
20:2.0.1.1.10.4.484.45SECTION 418.3635
   418.3635 Can anyone request administrative review on your behalf
20:2.0.1.1.10.4.484.46SECTION 418.3640
   418.3640 How do we determine if you had good cause for missing the deadline to request administrative review
20:2.0.1.1.10.4.484.47SECTION 418.3645
   418.3645 Can you request that the decision-maker be disqualified
20:2.0.1.1.10.4.484.48SECTION 418.3650
   418.3650 How do we make our decision upon review
20:2.0.1.1.10.4.484.49SECTION 418.3655
   418.3655 How will we notify you of our decision after our review
20:2.0.1.1.10.4.484.50SECTION 418.3665
   418.3665 Can your request for a hearing or case review be dismissed
20:2.0.1.1.10.4.484.51SECTION 418.3670
   418.3670 How will you be notified of the dismissal
20:2.0.1.1.10.4.484.52SECTION 418.3675
   418.3675 How does our decision affect you
20:2.0.1.1.10.4.484.53SECTION 418.3678
   418.3678 What is the process for correcting Agency clerical errors
20:2.0.1.1.10.4.484.54SECTION 418.3680
   418.3680 What happens if your case is remanded by a Federal court