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Would you like a family member or caregiver to be able to call Medicare on your behalf?

If yes, you need to appoint an authorized Medicare representative.  An authorized representative is the person you choose to help with or handle affairs related to your health care services. This can be a family member, caregiver, friend, or an advocate.  An Authorized Representative is a person chosen by a Medicare beneficiary to help with Medicare-related matters, such as the following:

There are two ways to give permission to Medicare for an authorized representative:

1.  Print and fill out form CMS-10106:  Authorization to Disclose Personal Health Information

     and then mail the form to Medicare.

OR

2.  Submit the form online through your Medicare account

If you don't have a Medicare account, signing up is easy and it gives you electronic access to your health information.  Once you've signed up, fill out and submit the form online by following these steps:

  1. Click on your name in the top right corner of the page.
  2. Click "My account."
  3. Select "Manage my representatives."
  4. Click “Medicare Authorization to Disclose Personal Health Information form." 
  5. Enter the requested information and click the "Continue" button.

 CMS-10106:  Authorization to Disclose Personal Health Information

Sign up for a Medicare account

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