Medicare Irmaa Life Changing Event Form - Fax or mail your completed form and evidence to a social. Web you may use this form if you received a notice that your monthly medicare part b (medical insurance) or prescription drug coverage premiums include an income. If you’ve been notified that your premiums for either.
Web you may use this form if you received a notice that your monthly medicare part b (medical insurance) or prescription drug coverage premiums include an income. If you’ve been notified that your premiums for either. Fax or mail your completed form and evidence to a social.