Medicare requires you to complete an authorization form if you want to give someone in your family or another trusted person permission to speak to Medicare on your behalf.
Family members and others helping someone with claims typically use this form. It’s different from a health care power of attorney, also called a health care proxy or health care surrogate, that allows someone to make health care decisions on your behalf if you’re unable to do so. Health care proxies must also have this written permission to speak to Medicare on your behalf.
Fill out Medicare’s Authorization to Disclose Personal Health Information form to let the agency know whom you’ve chosen to access your Medicare personal health information. The form doesn’t authorize that person to make medical decisions for you.
Medicare will disclose only information that you choose, offering options such as “limited information” or “any information” or allowing you to specify what to disclose, such as information about:
You can also identify when and how long you would like Medicare to disclose information, allow the agency to share information indefinitely and revoke your authorization in writing at any time. If a Medicare beneficiary is unable to sign the form, the personal representative can sign if the representative attaches the authorized legal documents, such as a power of attorney. The personal representative must also include his or her address, phone number and relationship to the beneficiary. You can either mail the signed form to the address listed or you can complete the authorization form by logging into your online Medicare account. Go to the My Accounts section and click on Manage my representatives.
If you’re requesting personal health information from Medicare for someone who has died, you must submit the authorization form and explain your relation to the beneficiary. You must also provide legal documentation indicating your authority to request the information, such as executor papers or the following court records containing a court stamp and judge’s signature:
State Health Insurance Assistance Program (SHIP) counselors aren’t required to have the authorization form. SHIP counselors provide free one-on-one guidance to help with questions about enrolling in Medicare, choosing a Part D or Medicare Advantage plan during open enrollment and other Medicare issues.
Published August 24, 2022
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