Medicare Irmaa Appeal Form Ssa-44. Transferring your appeal rights to your provider or supplier so they can file an appeal if medicare decides not to pay for an item or service. This form can be used if you receive a notice that your monthly medicare part b or prescription drug coverage premiums include an irmaa and you experience a life.
This form essentially asks the ssa to look at your magi. Transferring your appeal rights to your provider or supplier so they can file an appeal if medicare decides not to pay for an item or service.