This is what CaseWhy Appeals writes for a case like this one; your letter uses your facts and your notice's rule.
September 27, 2026
Social Security Administration — c/o your local Social Security office
RE: Requesting a new initial determination of my income-related monthly adjustment amount under 20 CFR § 418.1310 — Dorothy Sample, plan member ID ••••DEMO, denial dated 2026-07-15, A life-changing event lowered our income since the tax year SSA used
On 2026-07-15, Social Security denied the item or service described below. The stated reason was: "Your monthly adjustment amount is based on your income as reported on your most recent tax return provided by the IRS."
I am appealing Social Security's determination that my family member's Medicare Part B premium should remain based on an outdated tax year. Under 20 CFR § 418.1310(a)(1), Social Security is required to make a new initial determination when a beneficiary provides a copy of a filed Federal income tax return for the tax year two years prior to the effective year. The regulation explicitly permits such requests beginning with the date the beneficiary receives notice of the income-related monthly adjustment amount until the end of the effective year. Social Security's stated reason for denial—that the higher premium is based on an older tax year—does not address whether the required documentation was submitted or whether the timeframe for requesting reconsideration has expired. The governing rule does not permit Social Security to maintain a premium based on outdated income information when current tax return documentation is available.
The regulatory framework at 20 CFR § 418.1310 establishes clear procedures for correcting income-related premium determinations, and Social Security is bound by these procedures. When a beneficiary submits tax return documentation showing that the income used to calculate the adjustment amount no longer reflects current circumstances, Social Security must follow the rules in § and to make a new initial determination and any necessary retroactive adjustments back to January 1 of the effective year. Social Security's denial based solely on the age of the tax year used in the original calculation does not constitute a valid reason to refuse reconsideration under the governing regulation. The agency is required to process requests for new determinations when the statutory conditions are met, regardless of whether the prior determination was based on older income data.
Additionally, 20 CFR § 418.2322 provides that any income-related monthly adjustment amount determination made for Medicare Part B will also apply to Part D prescription drug coverage for the same effective year. This interconnection between Part B and Part D premiums underscores the importance of ensuring that income-related adjustments are based on current financial information. Social Security's failure to reconsider the premium determination based on more recent tax year data means that both the Part B premium and any associated Part D adjustment amount remain locked to outdated income information, contrary to the regulatory requirement that determinations reflect the most current available documentation.
The facts as I understand them:
One of these events happened: marriage, divorce or annulment, death of a spouse, work stoppage or reduction, loss of income-producing property, loss of pension income, or an employer settlement payment.
The event happened in the same year or an earlier year than the tax year SSA used to set my premium.
My income for the year I'm asking SSA to use is actually lower than the year they used.
Requesting a new initial determination of my income-related monthly adjustment amount under 20 CFR § 418.1310
Signed by the enrollee.