How To Become A Medicare Authorized Representative

Helping a Loved One with Medicare? Become Their Authorized Representative

Caregivers may have to jump through a few hoops when helping loved ones with Medicare – for a very good reason.

Medicare’s privacy policy prevents personal information from being released to anyone other than the covered beneficiary. While this protects the individual, it may create difficulty for a caregiver who needs that information to help their loved one receive proper coverage and care.

In order for Medicare to share your loved one’s personal health information with you, you must become their Authorized Representative.

What Is an Authorized Representative?

An Authorized Representative is a person chosen by a Medicare beneficiary to help with Medicare-related matters, such as the following:

• Researching and choosing Medicare coverage
• Handling Medicare claims and payments
• Appealing Medicare coverage decisions

How Do You Become an Authorized Representative for Your Loved One?

To name you as an Authorized Representative, your loved one must complete a form called the “Medicare Authorization to Disclose Personal Health Information.” If your loved one is unable to complete the form, you may do it as long as you have legal documentation giving you that right. The form lists the documents that Medicare accepts for this purpose, including in the case of a deceased loved one.

The form must be printed, completed and mailed to the address shown in the directions. It cannot be filled in or submitted online.

Download the Medicare Authorization to Disclose Personal Health Information form here

Note that your loved one may put a time limit on an authorization or may change or revoke it at any time.

What If Your Loved One Has a Private Medicare Plan?

Your loved one’s Medicare Advantage, Part D or Medicare supplement plan may also require authorization to share personal health information with you. Each plan has its own policy, so you’ll need to contact your loved one’s plan directly. You can get the information you need in the following ways:

• Call the number on the back of your loved one’s plan membership card to talk with a representative.
• View the privacy policy on the plan web site. Make sure the policy applies to your loved one’s specific plan, since insurance companies often offer many different plans.
• Read the plan Explanation of Benefits, which generally outlines how personal health information may be used and how it’s protected.

Finally, if you’re helping a loved one with Medicare decisions during the Medicare Annual Enrollment Period (AEP), be sure to read this article on tips for caregivers for AEP.