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Title 20
PART 418
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Part 418
Part 418 - Medicare Subsidies
PART 418 - MEDICARE SUBSIDIES
Source:
70 FR 77675, Dec. 30, 2005, unless otherwise noted.
Source: 70 FR 77675, Dec. 30, 2005, unless otherwise noted.
20:2.0.1.1.10.1
SUBPART A
Subpart A [Reserved]
20:2.0.1.1.10.2
SUBPART B
Subpart B - Medicare Part B Income-Related Monthly Adjustment Amount
20:2.0.1.1.10.2.470
SUBJGRP 470
Introduction, General Provisions, and Definitions
20:2.0.1.1.10.2.470.1
SECTION 418.1001
418.1001 What is this subpart about
20:2.0.1.1.10.2.470.2
SECTION 418.1005
418.1005 Purpose and administration.
20:2.0.1.1.10.2.470.3
SECTION 418.1010
418.1010 Definitions.
20:2.0.1.1.10.2.471
SUBJGRP 471
Determination of the Income-Related Monthly Adjustment Amount
20:2.0.1.1.10.2.471.4
SECTION 418.1101
418.1101 What is the income-related monthly adjustment amount
20:2.0.1.1.10.2.471.5
SECTION 418.1105
418.1105 What is the threshold
20:2.0.1.1.10.2.471.6
SECTION 418.1110
418.1110 What is the effective date of our initial determination about your income-related monthly adjustment amount
20:2.0.1.1.10.2.471.7
SECTION 418.1115
418.1115 What are the modified adjusted gross income ranges
20:2.0.1.1.10.2.471.8
SECTION 418.1120
418.1120 How do we determine your income-related monthly adjustment amount
20:2.0.1.1.10.2.471.9
SECTION 418.1125
418.1125 How will the income-related monthly adjustment amount affect your total Medicare Part B premium
20:2.0.1.1.10.2.471.10
SECTION 418.1130
418.1130 [Reserved]
20:2.0.1.1.10.2.471.11
SECTION 418.1135
418.1135 What modified adjusted gross income information will we use to determine your income-related monthly adjustment amount
20:2.0.1.1.10.2.471.12
SECTION 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
20:2.0.1.1.10.2.471.13
SECTION 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
20:2.0.1.1.10.2.471.14
SECTION 418.1150
418.1150 When will we use your amended tax return filed with IRS
20:2.0.1.1.10.2.472
SUBJGRP 472
Determinations Using a More Recent Tax Year's Modified Adjusted Gross Income
20:2.0.1.1.10.2.472.15
SECTION 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
20:2.0.1.1.10.2.472.16
SECTION 418.1205
418.1205 What is a major life-changing event
20:2.0.1.1.10.2.472.17
SECTION 418.1210
418.1210 What is not a major life-changing event
20:2.0.1.1.10.2.472.18
SECTION 418.1215
418.1215 What is a significant reduction in your income
20:2.0.1.1.10.2.472.19
SECTION 418.1220
418.1220 What is not a significant reduction in your income
20:2.0.1.1.10.2.472.20
SECTION 418.1225
418.1225 Which more recent tax year will we use
20:2.0.1.1.10.2.472.21
SECTION 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
20:2.0.1.1.10.2.472.22
SECTION 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
20:2.0.1.1.10.2.472.23
SECTION 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
20:2.0.1.1.10.2.472.24
SECTION 418.1245
418.1245 What will happen if you notify us that your modified adjusted gross income for the more recent tax year changes
20:2.0.1.1.10.2.472.25
SECTION 418.1250
418.1250 What evidence will you need to support your request that we use a more recent tax year
20:2.0.1.1.10.2.472.26
SECTION 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
20:2.0.1.1.10.2.472.27
SECTION 418.1260
418.1260 What major life-changing event evidence will we not accept
20:2.0.1.1.10.2.472.28
SECTION 418.1265
418.1265 What kind of significant modified adjusted gross income reduction evidence will you need to support your request
20:2.0.1.1.10.2.472.29
SECTION 418.1270
418.1270 What modified adjusted gross income evidence will we not accept
20:2.0.1.1.10.2.473
SUBJGRP 473
Determinations and the Administrative Review Process
20:2.0.1.1.10.2.473.30
SECTION 418.1301
418.1301 What is an initial determination regarding your income-related monthly adjustment amount
20:2.0.1.1.10.2.473.31
SECTION 418.1305
418.1305 What is not an initial determination regarding your income-related monthly adjustment amount
20:2.0.1.1.10.2.473.32
SECTION 418.1310
418.1310 When may you request that we make a new initial determination
20:2.0.1.1.10.2.473.33
SECTION 418.1315
418.1315 How will we notify you and what information will we provide about our initial determination
20:2.0.1.1.10.2.473.34
SECTION 418.1320
418.1320 What is the effect of an initial determination
20:2.0.1.1.10.2.473.35
SECTION 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
20:2.0.1.1.10.2.473.36
SECTION 418.1325
418.1325 When may you request a reconsideration
20:2.0.1.1.10.2.473.37
SECTION 418.1330
418.1330 Can you request a reconsideration when you believe that the IRS information we used is incorrect
20:2.0.1.1.10.2.473.38
SECTION 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
20:2.0.1.1.10.2.473.39
SECTION 418.1340
418.1340 What are the rules for our administrative review process
20:2.0.1.1.10.2.473.40
SECTION 418.1345
418.1345 Is reopening of an initial or reconsidered determination made by us ever appropriate
20:2.0.1.1.10.2.473.41
SECTION 418.1350
418.1350 What are the rules for review of a reconsidered determination or an administrative law judge decision
20:2.0.1.1.10.2.473.42
SECTION 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)
20:2.0.1.1.10.3
SUBPART C
Subpart C - Income-Related Monthly Adjustments to Medicare Prescription Drug Coverage Premiums
20:2.0.1.1.10.3.474
SUBJGRP 474
Introduction, General Provisions, and Definitions
20:2.0.1.1.10.3.474.1
SECTION 418.2001
418.2001 What is this subpart about
20:2.0.1.1.10.3.474.2
SECTION 418.2005
418.2005 Purpose and administration.
20:2.0.1.1.10.3.474.3
SECTION 418.2010
418.2010 Definitions.
20:2.0.1.1.10.3.475
SUBJGRP 475
Determination of the Income-Related Monthly Adjustment Amount
20:2.0.1.1.10.3.475.4
SECTION 418.2101
418.2101 What is the income-related monthly adjustment amount
20:2.0.1.1.10.3.475.5
SECTION 418.2105
418.2105 What is the threshold
20:2.0.1.1.10.3.475.6
SECTION 418.2110
418.2110 What is the effective date of our initial determination about your income-related monthly adjustment amount
20:2.0.1.1.10.3.475.7
SECTION 418.2112
418.2112 Paying your income-related monthly adjustment amount.
20:2.0.1.1.10.3.475.8
SECTION 418.2115
418.2115 What are the modified adjusted gross income ranges
20:2.0.1.1.10.3.475.9
SECTION 418.2120
418.2120 How do we determine your income-related monthly adjustment amount
20:2.0.1.1.10.3.475.10
SECTION 418.2125
418.2125 How will the income-related monthly adjustment amount affect your total Medicare prescription drug coverage premium
20:2.0.1.1.10.3.475.11
SECTION 418.2135
418.2135 What modified adjusted gross income information will we use to determine your income-related monthly adjustment amount
20:2.0.1.1.10.3.475.12
SECTION 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
20:2.0.1.1.10.3.475.13
SECTION 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
20:2.0.1.1.10.3.475.14
SECTION 418.2150
418.2150 When will we use your amended tax return filed with the IRS
20:2.0.1.1.10.3.476
SUBJGRP 476
Determinations Using a More Recent Tax Year's Modified Adjusted Gross Income
20:2.0.1.1.10.3.476.15
SECTION 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
20:2.0.1.1.10.3.476.16
SECTION 418.2205
418.2205 What is a major life-changing event
20:2.0.1.1.10.3.476.17
SECTION 418.2210
418.2210 What is not a major life-changing event
20:2.0.1.1.10.3.476.18
SECTION 418.2215
418.2215 What is a significant reduction in your income
20:2.0.1.1.10.3.476.19
SECTION 418.2220
418.2220 What is not a significant reduction in your income
20:2.0.1.1.10.3.476.20
SECTION 418.2225
418.2225 Which more recent tax year will we use
20:2.0.1.1.10.3.476.21
SECTION 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
20:2.0.1.1.10.3.476.22
SECTION 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
20:2.0.1.1.10.3.476.23
SECTION 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
20:2.0.1.1.10.3.476.24
SECTION 418.2245
418.2245 What will happen if you notify us that your modified adjusted gross income for the more recent tax year changes
20:2.0.1.1.10.3.476.25
SECTION 418.2250
418.2250 What evidence will you need to support your request that we use a more recent tax year
20:2.0.1.1.10.3.476.26
SECTION 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
20:2.0.1.1.10.3.476.27
SECTION 418.2260
418.2260 What major life-changing event evidence will we not accept
20:2.0.1.1.10.3.476.28
SECTION 418.2265
418.2265 What kind of evidence of a significant modified adjusted gross income reduction will you need to support your request
20:2.0.1.1.10.3.476.29
SECTION 418.2270
418.2270 What modified adjusted gross income evidence will we not accept
20:2.0.1.1.10.3.477
SUBJGRP 477
Determinations and the Administrative Review Process
20:2.0.1.1.10.3.477.30
SECTION 418.2301
418.2301 What is an initial determination regarding your income-related monthly adjustment amount
20:2.0.1.1.10.3.477.31
SECTION 418.2305
418.2305 What is not an initial determination regarding your income-related monthly adjustment amount
20:2.0.1.1.10.3.477.32
SECTION 418.2310
418.2310 When may you request that we make a new initial determination
20:2.0.1.1.10.3.477.33
SECTION 418.2315
418.2315 How will we notify you and what information will we provide about our initial determination
20:2.0.1.1.10.3.477.34
SECTION 418.2320
418.2320 What is the effect of an initial determination
20:2.0.1.1.10.3.477.35
SECTION 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
20:2.0.1.1.10.3.477.36
SECTION 418.2325
418.2325 When may you request a reconsideration
20:2.0.1.1.10.3.477.37
SECTION 418.2330
418.2330 Can you request a reconsideration when you believe that the IRS information we used is incorrect
20:2.0.1.1.10.3.477.38
SECTION 418.2332
418.2332 Can you request a reconsideration when you believe that the CMS information we used is incorrect
20:2.0.1.1.10.3.477.39
SECTION 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
20:2.0.1.1.10.3.477.40
SECTION 418.2340
418.2340 What are the rules for our administrative review process
20:2.0.1.1.10.3.477.41
SECTION 418.2345
418.2345 Is reopening of an initial or reconsidered determination made by us ever appropriate
20:2.0.1.1.10.3.477.42
SECTION 418.2350
418.2350 What are the rules for review of a reconsidered determination or an ALJ decision
20:2.0.1.1.10.3.477.43
SECTION 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)
20:2.0.1.1.10.4
SUBPART D
Subpart D - Medicare Part D Subsidies
20:2.0.1.1.10.4.478
SUBJGRP 478
Introduction, General Provisions, and Definitions
20:2.0.1.1.10.4.478.1
SECTION 418.3001
418.3001 What is this subpart about
20:2.0.1.1.10.4.478.2
SECTION 418.3005
418.3005 Purpose and administration of the program.
20:2.0.1.1.10.4.478.3
SECTION 418.3010
418.3010 Definitions.
20:2.0.1.1.10.4.479
SUBJGRP 479
Eligibility for a Medicare Prescription Drug Subsidy
20:2.0.1.1.10.4.479.4
SECTION 418.3101
418.3101 How do you become eligible for a subsidy
20:2.0.1.1.10.4.479.5
SECTION 418.3105
418.3105 Who does not need to file an application for a subsidy
20:2.0.1.1.10.4.479.6
SECTION 418.3110
418.3110 What happens when you apply for a subsidy
20:2.0.1.1.10.4.479.7
SECTION 418.3115
418.3115 What events will make you ineligible for a subsidy
20:2.0.1.1.10.4.479.8
SECTION 418.3120
418.3120 What happens if your circumstances change after we determine you are eligible for a subsidy
20:2.0.1.1.10.4.479.9
SECTION 418.3123
418.3123 When is a change in your subsidy effective
20:2.0.1.1.10.4.479.10
SECTION 418.3125
418.3125 What are redeterminations
20:2.0.1.1.10.4.480
SUBJGRP 480
Filing of Application
20:2.0.1.1.10.4.480.11
SECTION 418.3201
418.3201 Must you file an application to become eligible for a subsidy
20:2.0.1.1.10.4.480.12
SECTION 418.3205
418.3205 What makes an application a claim for a subsidy
20:2.0.1.1.10.4.480.13
SECTION 418.3210
418.3210 What is a prescribed application for a subsidy
20:2.0.1.1.10.4.480.14
SECTION 418.3215
418.3215 Who may file your application for a subsidy
20:2.0.1.1.10.4.480.15
SECTION 418.3220
418.3220 When is your application considered filed
20:2.0.1.1.10.4.480.16
SECTION 418.3225
418.3225 How long will your application remain in effect
20:2.0.1.1.10.4.480.17
SECTION 418.3230
418.3230 When will we use your subsidy inquiry as your filing date
20:2.0.1.1.10.4.481
SUBJGRP 481
Income
20:2.0.1.1.10.4.481.18
SECTION 418.3301
418.3301 What is income
20:2.0.1.1.10.4.481.19
SECTION 418.3305
418.3305 What is not income
20:2.0.1.1.10.4.481.20
SECTION 418.3310
418.3310 Whose income do we count
20:2.0.1.1.10.4.481.21
SECTION 418.3315
418.3315 What is earned income
20:2.0.1.1.10.4.481.22
SECTION 418.3320
418.3320 How do we count your earned income
20:2.0.1.1.10.4.481.23
SECTION 418.3325
418.3325 What earned income do we not count
20:2.0.1.1.10.4.481.24
SECTION 418.3330
418.3330 What is unearned income
20:2.0.1.1.10.4.481.25
SECTION 418.3335
418.3335 What types of unearned income do we count
20:2.0.1.1.10.4.481.26
SECTION 418.3340
418.3340 How do we count your unearned income
20:2.0.1.1.10.4.481.27
SECTION 418.3350
418.3350 What types of unearned income do we not count
20:2.0.1.1.10.4.482
SUBJGRP 482
Resources
20:2.0.1.1.10.4.482.28
SECTION 418.3401
418.3401 What are resources
20:2.0.1.1.10.4.482.29
SECTION 418.3405
418.3405 What types of resources do we count
20:2.0.1.1.10.4.482.30
SECTION 418.3410
418.3410 Whose resources do we count
20:2.0.1.1.10.4.482.31
SECTION 418.3415
418.3415 How do we determine countable resources
20:2.0.1.1.10.4.482.32
SECTION 418.3420
418.3420 How are funds held in financial institution accounts counted
20:2.0.1.1.10.4.482.33
SECTION 418.3425
418.3425 What resources do we exclude from counting
20:2.0.1.1.10.4.483
SUBJGRP 483
Adjustments and Terminations
20:2.0.1.1.10.4.483.34
SECTION 418.3501
418.3501 What could cause us to increase or reduce your subsidy or terminate your subsidy eligibility
20:2.0.1.1.10.4.483.35
SECTION 418.3505
418.3505 How would an increase, reduction or termination affect you
20:2.0.1.1.10.4.483.36
SECTION 418.3510
418.3510 When would an increase, reduction or termination start
20:2.0.1.1.10.4.483.37
SECTION 418.3515
418.3515 How could you qualify for a subsidy again
20:2.0.1.1.10.4.484
SUBJGRP 484
Determinations and the Administrative Review Process
20:2.0.1.1.10.4.484.38
SECTION 418.3601
418.3601 When do you have the right to administrative review
20:2.0.1.1.10.4.484.39
SECTION 418.3605
418.3605 What is an initial determination
20:2.0.1.1.10.4.484.40
SECTION 418.3610
418.3610 Is there administrative or judicial review for administrative actions that are not initial determinations
20:2.0.1.1.10.4.484.41
SECTION 418.3615
418.3615 Will we mail you a notice of the initial determination
20:2.0.1.1.10.4.484.42
SECTION 418.3620
418.3620 What is the effect of an initial determination
20:2.0.1.1.10.4.484.43
SECTION 418.3625
418.3625 What is the process for administrative review
20:2.0.1.1.10.4.484.44
SECTION 418.3630
418.3630 How do you request administrative review
20:2.0.1.1.10.4.484.45
SECTION 418.3635
418.3635 Can anyone request administrative review on your behalf
20:2.0.1.1.10.4.484.46
SECTION 418.3640
418.3640 How do we determine if you had good cause for missing the deadline to request administrative review
20:2.0.1.1.10.4.484.47
SECTION 418.3645
418.3645 Can you request that the decision-maker be disqualified
20:2.0.1.1.10.4.484.48
SECTION 418.3650
418.3650 How do we make our decision upon review
20:2.0.1.1.10.4.484.49
SECTION 418.3655
418.3655 How will we notify you of our decision after our review
20:2.0.1.1.10.4.484.50
SECTION 418.3665
418.3665 Can your request for a hearing or case review be dismissed
20:2.0.1.1.10.4.484.51
SECTION 418.3670
418.3670 How will you be notified of the dismissal
20:2.0.1.1.10.4.484.52
SECTION 418.3675
418.3675 How does our decision affect you
20:2.0.1.1.10.4.484.53
SECTION 418.3678
418.3678 What is the process for correcting Agency clerical errors
20:2.0.1.1.10.4.484.54
SECTION 418.3680
418.3680 What happens if your case is remanded by a Federal court