How to Access Your Parents’ Medicare: Enroll and Manage Their Care

The best time to think about your parents' Medicare is when they're healthy. Medical care becomes a bigger part of life as we age and having a Plan B for managing that care is necessary to ensure your parent or loved one gets the care they need.

So, suppose a medical event incapacitates them or they are unable to manage their care due to a cumulative decline in their physical and/or mental health. In that case, they will be looked after by a trusted family member or loved one. However, access to medical information and one's Medicare account is highly regulated and is generally off-limits to anyone except the patient, unless they give explicit permission. The same goes for decision-making authority.

You can protect them (or older readers may protect themselves) by having the correct paperwork in order and ready when needed. When you are enrolled in Original Medicare, the process is straightforward and can be resolved by filling out a form and submitting it to Medicare online or by mail. Medicare Advantage plans require a different strategy because various private companies manage them.

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How to get permission to access your parent’s Medicare

If you've been to the doctor, you know how prevalent HIPAA (the Health Insurance Portability and Accountability Act of 1996) permission forms are during the intake process. It is intended to protect all patients against the unauthorized disclosure of Protected Health Information (PHI). But when you need to assist a loved one, it can seem more like a roadblock than a safeguard.

To access the Medicare account of your parent or loved one, you'll need the Medicare patient to execute an Authorization to Disclose Personal Health Information (CMS-10106). The form can be filled out and submitted online or you can print a PDF copy and send the completed form to: 1-800-MEDICARE Written Authorization Dept. PO Box 1270 Lawrence, KS 66044.

The form allows the Medicare patient to limit the information that a representative may discuss or have access to. So, if your parent is having billing issues or payment problems, they can authorize you to handle only those matters. The patient can even select "Other" when asked to "choose the information you want 1-800-MEDICARE to share" and specify the information or transaction your representative and CMS may discuss and resolve.

Here is the information they will need to fill out the form.

• They should clarify how much and what kind of personal health information Medicare can share.
• They must designate for how long they want to share the information, or if they want to share it indefinitely.
• The reason why they are authorizing the disclosure.
• Your name, as the person to whom they authorize the disclosure.
• Whether you have a power of attorney to act on their behalf. You’ll need a copy of the document as proof.

*Be aware that section 2C of this form is intended only for residents of New York. This section requires New York residents to either include or exclude information about alcohol and drug abuse, mental health treatment and HIV. New York state residents should read the instructions for section 2 carefully.*

Medicare will also ask the beneficiary how long they want to allow their representative to access the information and why the access is being granted. Finally, if the beneficiary is unable to sign the form, a personal representative can do so, but must attach a power of attorney (POA) for the signature and the application to be valid.

The Medicare beneficiary can cancel or revoke the authorization at any time. To cancel the authorization, a written request must be sent to the address above.

Don't forget to keep a copy for your records.

How to enroll your parent in Medicare

Even if you have a health care proxy to make medical decisions for your parent, you’ll still need the separate Medicare authorization form to talk with Medicare about claims, eligibility, enrollment, premiums and payments to providers.

So, in addition to authorizing you to access their Medicare information, they can designate you as a medical representative who can enroll them on their behalf on the Authorization to Disclose Personal Health Information form. As I mentioned above, you will need to attach a power of attorney.

Another option is to go to a Social Security Administration (SSA) office. If your parent or loved one is mobile, it may be easier for you to visit an SSA office to enroll them in person. You can use the Social Security Administration website to find your closest Social Security office.

What to do if your parent can’t authorize access to their Medicare due to incapacity

If your parent can’t grant you authorization due to illness or injury, such as a stroke or dementia, your only option may be to get a court order to manage their care.

If they are deemed to be incapacitated, you’ll be appointed their legal guardian and able to make decisions regarding their care, as well as speak to their physicians and Medicare representatives. You’ll also be responsible for their daily needs such as basic safety, food, housing and care.

Medicare Advantage plans

The process to gain access to your parent's Medicare Advantage plan won't be much different, but it includes more or different steps, as the private insurance companies that manage these plans may have other safeguards in place.

You should contact a plan representative to find out how to apply for and be granted the ability to manage your loved one's medical needs.

Planning ahead will save valuable time

Being able to control and direct the health care of your incapacitated parent is essential to their well-being. If your parent can’t authorize you due to illness, you might need a court order for guardianship. Additionally, if your parent isn’t yet enrolled in Medicare, you’ll need a power of attorney to enroll them.

Power of attorney requirements vary by state. A Certified Elder Law attorney (CELA) has specialized training and practice in elder law and may be better at addressing the legal aspects of your loved one's medical needs.

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