What Are Medicare Authorized Representatives and Advance Directives?

A Medicare Authorized Representative is someone who may legally make Medicare decisions on behalf of a beneficiary. Learn how to set up an Authorized Representative and find out what advance directives include.

Navigating through Medicare can be difficult. And for some beneficiaries, these tasks may be downright impossible due to their condition. 

In such cases, a beneficiary may select an Authorized Representative to help with Medicare-related decisions.

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What can a Medicare Authorized Representative do?

Authorized Representatives can help Medicare beneficiaries with a number of tasks, including:

  • Researching and selecting Medicare coverage
  • Handling Medicare plan payments and claims
  • Filing Medicare complaints and appeals

The Medicare privacy policy prevents a beneficiary’s personal information from being released to anyone other than the beneficiary and their Authorized Representative.

Caregivers who do not take the proper steps to become a Medicare Authorized Representative could find themselves in the difficult situation of not being permitted to help their loved one make Medicare decisions or take important Medicare steps. 

How to become a Medicare Authorized Representative

In order to designate an Authorized Representative, a Medicare beneficiary must complete the Medicare Authorization to Disclose Personal Health Information form (CMS-10106), which can be found here. The form must be printed, completed and mailed to the address provided in the instructions. It may not be submitted online. 

If a beneficiary is unable to complete the form on their own, you may complete it on their behalf as long as you have legal documentation that gives you the right to do so. You can find a list of the acceptable documents on the CMS-10106 form. 

A beneficiary has the option to limit how long someone may serve as their Authorized Representative, and they may change or revoke the Authorized Representative relationship at any time. 

Authorized Representation for private Medicare plans

A Medicare Advantage (Medicare Part C) plans, Medicare Part D prescription drug plans or Medicare Supplement Insurance (Medigap) plans may also require an authorization for a caregiver to act on a beneficiary’s behalf.

Each plan may have its own unique policy regarding authorized representatives, so contact your plan carrier directly for more information about Authorized Representation.

You may also be able to find this information in your plan’s Explanation of Benefits (EOB) or other material supplied by your plan carrier.  

Advance directives for Medicare beneficiaries

An advance directive is a document that outlines how you would like medical decisions to be made on your behalf if you are incapacitated or otherwise unable to make those decisions yourself. 

Types of advance directives include:

  • A living will
  • A medical power of attorney 
  • Do not resuscitate (DNR) orders
  • Physician Orders for Life-Sustaining Treatment (POLST)
  • Organ and tissue donation

Advance directives are recognized in every state, but each state may have different rules and procedures for filing. Advance directive forms may be obtained from doctor’s offices, hospitals, law offices, senior centers, nursing homes, your state health department or your local Area on Aging.

Many caregivers or other loved ones may serve as both an Authorized Representative and a medical power of attorney for a Medicare beneficiary.

Learn more about your Medicare coverage options

Depending on where you live, you may have access to Medicare Advantage plans and Medicare Part D prescription drug coverage. To learn more about what types of plans, benefits, coverage and costs are available in your area, call today to speak with a licensed insurance agent.

You can also compare plans online for free from your home, with no obligation to enroll.

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