Forms › SSA-44
Fill out Social Security Form SSA-44 (Medicare Income-Related Monthly Adjustment Amount – Life-Changing Event) free in your browser, then download and print it. The official current form opens here — click the fields and type. Nothing is uploaded, no signup, no watermark.
Form SSA-44 asks the Social Security Administration to reduce your income-related monthly adjustment amount (IRMAA) for Medicare Part B and Part D premiums after a life-changing event — such as marriage, divorce, the death of a spouse, or reduced work — lowered your income.
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File the SSA-44 if a life-changing event such as retirement, divorce, or a spouse's death reduced your income and you are paying a higher IRMAA surcharge on your Medicare premiums based on an older, higher tax return. You provide proof of the event and your newer income.
Yes — completely free, with no signup and no watermark. You fill it in your browser and download it.
No. The form opens and is filled entirely in your browser. Nothing is uploaded, so your personal and financial details stay on your device.
Yes. This is the official, current SSA-44 published by the U.S. government, which is public domain. You fill the genuine document.