SSA - POMS: NL 00703.633 - MBA Less than SMI Premium (LESSDO) - Prior Year Premium Balance Less than 3 Months (2024)

TN 81 (07-20)

Document Identifier for Word Processor: E4032

A.Requesting instructions

This letter is used when COLA or No COLA applies, a premium arrearage balance from the prior year(s) exists, and the prior year(s) balance is less than three months premiums at the standard rate. See HI 01001.041B.3.b.

B.Exhibit letter

LIS004

We are writing to give you new information about the (1) benefits which (2) on this Social Security record.

CHKC09

Your Benefits

CHK084 (1) monthly benefit amount is $(2) effective (3) and (4) monthly Medicare medical insurance premium is $(5).

HIBC01

Information About Medicare

HIB704

Since (1) monthly benefit amount is less than (2) Medicare premium, we will withhold (3) monthly benefits to pay part of (4) Medicare premium. The difference between the premiums (5) for (6) and (7) monthly benefit amount for (8) is $(9).

In addition, our records show that (10) $(11) in past due premiums for (12).

Enclosed is a bill for the total amount due of $(13), and a return envelope. We will continue to bill (14) on a yearly basis as long as (15) monthly benefit is lower than the monthly Medicare medical insurance premium.

CTDO

Suspect Social Security Fraud?

Please visit http://oig.ssa.gov/r or call the Inspector General's Fraud Hotline at 1-800-269-0271 (TTY 1-866-501-2101).

If You Have Questions

We invite you to visit our website at www.socialsecurity.gov on the Internet to find general information about Social Security. If you have any specific questions, you may call us toll-free at 1-800-772-1213, or call your local Social Security office at 1-(3)-(4)-(5). We can answer most questions over the phone. If you are deaf or hard of hearing, you may call our TTY number, 1-800-325-0778. You can also write or visit any Social Security office. The office that serves your area is located at:

(6)

(7)

(8)

(9)(10)-(11)

If you do call or visit an office, please have this letter with you. It will help us answer your questions. Also, if you plan to visit an office, you may call ahead to make an appointment. This will help us serve you more quickly when you arrive at the office.

HBN001

MEDICARE PREMIUM BILL

CENTERS FOR MEDICARE & MEDICAID SERVICES (CMS)

BILLING DATE: (1)

MEDICAL PREMIUMS FOR

PERIOD ENDING: (2)

CURRENT AMOUNT DUE: (3)

PAYMENT DUE BY: (4)

  • Return the bottom portion of this notice with your payment and use the enclosed envelope to mail your payment.

  • You must pay by check or money order. Include your Medicare number at the top of your check or money order. Make the check or money order payable to: CMS MEDICARE INSURANCE.

  • If you have changed your address, be sure to write your new address in the space provided below.

  • If you have any questions concerning this Medicare Premium Bill, please write or visit any Social Security Office.

PLEASE DETACH AT DOTTED LINE

----------------------------------------------------------------

CMS-500A

Medicare Number: (5) Amount Due: $(6)

Name: (7)

Make Checks Payable To:

CMS MEDICARE INSURANCE

Send To:

Medicare Premium Collection Center

P.O. Box 790355

St. Louis, MO 63179-0355

( ) Check here if your address has changed.

Show new address below.

________________________________________

________________________________________

PAYMENTS BY CHECK

When you provide a check as a payment, you authorize the Medicare Premium Collection Center (MPCC) to use the information from your check to make a one-time electronic funds transfer from your bank account. When the MPCC uses information from your check to make an electronic funds transfer, they may withdraw funds from your bank account as soon as the same day they receive your payment. You will not get your check back from your bank. If the MPCC cannot process your payment electronically, they will process it as a check transaction. Your bank statement will show the transaction as "CMS Medicare" and this is your proof of payment.

C.Exhibit fill-ins

LIS004

1. disability, retirement, wife's, husband's, child's, widow's, widower's, mother's, father's, disabled widow's, disabled widower's, disabled divorced widow, disabled divorced widower's, Medicare, or null

2. you receive or Beneficiary's name receives

CHK084

  1. 1.

    Your, His or Her

  2. 2.

    Monthly benefit amount

  3. 3.

    Month YYYY

  4. 4.

    your, his or her

  5. 5.

    Current SMI premium amount

HIB704

  1. 1.

    your, his or her

  2. 2.

    your, his or her

  3. 3.

    your, his or her

  4. 4.

    your, his or her

  5. 5.

    you owe, he owes or she owes

  6. 6.

    Month YYYY through Month YYYY

  7. 7.

    your, his or her

  8. 8.

    Month YYYY through Month YYYY

  9. 9.

    Money amount difference

  10. 10.

    you owe, he owes or she owes

  11. 11.

    Billing Amount for arrearage

  12. 12.

    Month YYYY through Month YYYY

  13. 13.

    Total Billing Amount

  14. 14.

    you, him or her

  15. 15.

    your, his or her

CTDO

  1. 1.

    Zipcode

  2. 2.

    Zip+4 or DO Code

  3. 3.

    Telephone Area Code

  4. 4.

    Phone Exchange

  5. 5.

    Phone Number

  6. 6.

    Local Office Address Line #1

  7. 7.

    Local Office Address Line #2

  8. 8.

    Local Office Address Line #3

  9. 9.

    City & State of Local Office

  10. 10.

    Local Office Zipcode

  11. 11.

    Zip+4 of Local Office

HBN001

  1. 1.

    Billing Date (Equal to the Date of the Notice)

  2. 2.

    Month YYYY

  3. 3.

    SMI premiums due

  4. 4.

    Month DD, YYYY

  5. 5.

    Medicare Beneficiary Identifier

  6. 6.

    SMI premiums due

  7. 7.

    Beneficiary’s Full Name

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0900703633

NL 00703.633 - MBA Less than SMI Premium (LESSDO) - Prior Year Premium Balance Less than 3 Months - 01/03/2019
Batch run: 07/30/2020
Rev:01/03/2019

SSA - POMS: NL 00703.633 - MBA Less than SMI Premium (LESSDO) - Prior Year Premium Balance Less than 3 Months (2024)

FAQs

What is MBA in Social Security? ›

It also produces the Primary Insurance Amount (PIA), Maximum Family Benefit (MFB), the actuarial reduction or increment factor (for early or delayed retirement), and the Monthly Benefit Amount (MBA). The Calculator can produce a benefit for any historical case from the first Social Security benefit paid (1940).

What is the Social Security premium penalty? ›

You'll pay an extra 10% for each year you could have signed up for Part B, but didn't. You may also pay a higher premium depending on your income.

Who qualifies for the $255 Social Security death benefit? ›

A surviving spouse, surviving divorced spouse, unmarried child, or dependent parent may be eligible for monthly survivor benefits based on the deceased worker's earnings. In addition, a one-time lump sum death payment of $255 can be made to a qualifying spouse or child if they meet certain requirements.

When a spouse dies, how much Social Security does the survivor get? ›

Surviving spouse, at full retirement age or older, generally gets 100% of the worker's basic benefit amount. Surviving spouse, age 60 or older, but under full retirement age, gets between 71% and 99% of the worker's basic benefit amount.

Is there really a $16728 Social Security bonus? ›

As retirement approaches, maximizing Social Security benefits becomes a top priority for many Americans. One widely discussed figure is the $16,728 Social Security bonus, which isn't a literal bonus but rather a potential increase in benefits through strategic planning.

What is the Social Security secret bonus? ›

What Is the Social Security Bonus? There is no specific “bonus” retirees can collect from the Social Security Administration. For example, you're not eligible to get a $5,000 bonus check on top of your regular benefits just because you worked in a specific career. Social Security doesn't randomly award money to people.

What is the 10 year rule for Social Security? ›

If you've worked and paid taxes into the Social Security system for at least 10 years and have earned a minimum of 40 work credits, you can collect your own benefits as early as age 62.

Is the BNC for Social Security the same as a claim number? ›

Is BNC Number the Same as a Claim Number? A BNC number is not the same as a claim number. Social Security uses your Social Security number for benefit claims. This number consists of nine digits and an alphanumeric suffix that identifies the type of beneficiary and their qualification category.

What is an MBA in social impact? ›

An MBA specialization in social impact allows students to build in-depth expertise in a chosen career path, while customizing academic preparation to lead transformational social change in any sector. It encourages students to graduate with a common language and comprehensive understanding of positive social impact.

What are the three types of SSI? ›

• Benefit Types:
  • - Aged (age 65 and older)
  • - Disability (any age, includes children)
  • - Blindness (any age, includes children)

How much are survivor benefits per month? ›

According to the Social Security Administration, the average survivor benefit paid in December 2023 was $1,501.60 per month.

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