How to Complete and Submit the NYC IRMAA Reimbursement Form

To claim the NYC IRMAA reimbursement, retired city employees fill out the Office of Labor Relations’ IRMAA Reimbursement Application, attach a Social Security notice showing the surcharge and proof of what was actually paid, and upload the packet through the city’s LeapFILE portal. Payments for the 2025 tax year are scheduled to hit pension bank accounts during the third week of October 2026.¹

The standard Part B reimbursement ($2,220.00 for 2025) is automatic once OLR has your Medicare card on file. IRMAA is different. The surcharge portion is never reimbursed automatically. You have to apply for it.²

Who Can File

Two things have to be true at the same time. You must be receiving a city pension and enrolled as the contract holder for city health benefits, and you must have paid more than the standard Medicare Part B premium during the year you’re claiming.¹ Medicare-eligible dependents on your city coverage can be included on the same application.

If you paid only the standard premium — $185.00 a month in 2025, $202.90 in 2026 — there is no IRMAA to reimburse, and this form doesn’t apply to you.³

One boundary worth naming up front: the city reimburses Part B IRMAA only. Part D IRMAA surcharges are not covered, even though Social Security bills them the same way.

Documents to Have in Hand

The application will not be processed without two specific documents for each person and each tax year you claim.⁴

The SSA benefit notice stating your Medicare Part B premium, including the IRMAA amount, for the year you’re claiming. If you didn’t keep it, request a replacement by calling SSA at 1-800-772-1213 or visiting your local Social Security office.
Proof of what you paid. If Medicare premiums come out of your Social Security check, that’s your SSA-1099. You can download it through your my Social Security account at ssa.gov. If you pay CMS directly, submit copies of the billing statements and payment records covering every month of the year.⁵

Both documents are required for each eligible person. Claiming for yourself and a spouse means two SSA notices and two sets of payment proof. Send all pages of each document. Partial copies stall the review.

Filling Out the Form

Download the current application from the Medicare Part B & IRMAA page on the OLR website. In 2026, the form covering the most recent tax year is titled “IRMAA 2025 Reimbursement Application.”¹

Retiree Information

Enter your last name, first name, and middle initial as they appear on your pension records. The Social Security field is pre-printed “XXX-XX-” and asks only for the last four digits. Add a current phone number and full mailing address. If you’ve moved since retiring, make sure the address matches what OLR already has, or update it separately.

Spouse or Dependent

If a Medicare-eligible spouse or dependent also paid IRMAA in the same tax year, list their name and partial SSN in the second section and include their SSA documents alongside yours. Reimbursement for both of you is paid to you, delivered the same way your pension is: direct deposit if that’s how your pension arrives.⁴

Tax Year Selection

The form lists available tax years with the standard monthly premium printed next to each. Check every year you’re claiming. A single form can cover up to three years, but each year needs its own complete documentation. For the 2025 year, only amounts paid above $185.00 per month ($2,220.00 for the year) are reimbursable.¹

Signature

Sign and date the bottom. Your signature certifies that you or your dependent were actually required to pay IRMAA and that you haven’t been reimbursed for the same amount from any other source. Unsigned forms are not processed.

How to Submit It

OLR prefers electronic submission through its LeapFILE portal at nycemployeebenefits.leapfile.net. No account is needed.⁶

Through LeapFILE

Open the portal, pick the appropriate category from the “Available Recipient” dropdown, and fill in the identifying fields. Click “Select Files to Send (Regular Upload),” then use “Choose File” to attach the completed application and each supporting document. You can add several files before finishing. Click “Upload and Send” and wait for the confirmation message.

Phone uploads work too. Photograph the signed form and documents, make sure every photo is fully legible with no cropped edges, and upload them the same way. Blurry images get sent back for resubmission.⁶

By Mail

If you can’t use the portal, mail the form and copies of your documents to:

NYC Office of Labor Relations
Health Benefits Program
22 Cortlandt Street, 12th Floor
New York, NY 10007²

Send copies, not originals. Nothing is returned. Certified mail or a tracked service gives you proof of arrival.

When You Get Paid

Reimbursements run on an annual cycle. For the 2025 tax year, OLR is scheduled to issue payments during the third week of October 2026, the same window used in prior years.¹ The money goes to the bank account where your pension is deposited.

Claiming a Past Year You Missed

You can go back three calendar years.¹ Each year you’re claiming still requires its own SSA notice and its own SSA-1099 or CMS billing records for that specific year. Past-year application forms live on the OLR Forms and Downloads page.² Some older tax years on the form carry a printed cutoff date; check next to the year’s checkbox before you file, because claims received after that date won’t be accepted for that year.

Lowering Your IRMAA Going Forward

If your income has dropped substantially since the tax year Social Security used to set your premium, whether because you retired, lost a spouse, divorced, or went through another qualifying life event, you can ask SSA for a new determination. File Form SSA-44 (Medicare Income-Related Monthly Adjustment Amount — Life-Changing Event) with Social Security.⁷ A successful request cuts or eliminates the surcharge at the source, which is faster than waiting for a city reimbursement a year later.

Getting Help

Call the OLR Health Benefits Program at (212) 513-0470, Monday through Friday from 10 a.m. to 4 p.m., holidays excepted. General questions can also go to healthbenefits@olr.nyc.gov, but do not email completed forms or documentation to that address.⁸

1
Office of Labor Relations. NYC Health Benefits Program – Medicare Part B & IRMAA
2
NYC Office of Labor Relations. Health Benefits Retiree Forms and Downloads
3
Centers for Medicare & Medicaid Services. 2026 Medicare Parts A and B Premiums and Deductibles
4
NYC Office of Labor Relations. Income-Related Monthly Adjustment Amount (IRMAA) Reimbursement Form
5
Social Security Administration. Get Tax Form (1099/1042S)
6
NYC Office of Labor Relations. How to Use LeapFILE to Submit Forms and Documents Electronically
7
Social Security Administration. Request to Lower an Income-Related Monthly Adjustment Amount (IRMAA)
8
NYC.gov. NYC Health Benefits Program