What You Need Before Calling Medicare, a Plan, or an Agent for Someone Else

Helpers often need permission, documentation, or the person present before anyone can discuss details. Here is what to gather, what to expect, and where the limits sit.

Medicare, plans, and Social Security have strict rules about who can talk to them about a beneficiary’s coverage. As a helper, you cannot just call and ask questions — you need either the beneficiary present on the call, written authorization on file, or a legal authority (power of attorney, guardianship). This article walks through what is usually needed for a productive call, the difference between informal helping and formal authority, and the steps to get formal authority on file before you need it.

Permission is not a formality. It is how the system protects the person you are helping from someone less careful than you.

The short answer

Helpers need permission to discuss details on the phone with Medicare, a plan, an agent, or Social Security. The lowest-friction option is to have the beneficiary on the call with you. The next step up is written authorization filed with each agency or plan separately — Medicare’s authorized representative form, the plan’s authorization form, SSA’s representative payee or authorization-to-disclose forms. Power of attorney is a legal document and is treated separately by each agency. Before any call, gather the cards, dates of birth, address on file, and Medicare number, and have the person present if you can. Before any decision-level call, have authorization on file.

How this applies to you

If you are calling to ask a general question (how Medicare works, what a notice means, how to find a SHIP counselor). You do not need authorization. You are not asking about a specific person’s coverage. Call freely.

If you are calling about your parent’s or spouse’s specific coverage (a bill, a denial, a benefit, a network question). You need the person present, or authorization on file. Calling without it usually results in the agent saying “I can’t discuss that with you” and ending the call.

If you are calling to make a change (enrolling, disenrolling, adding a plan, filing an appeal). You need legal authority — power of attorney, court-appointed guardianship, or formal authorized-representative status filed with the relevant agency. Informal authority is not enough for decisions.

If you are calling in an emergency (a medication denied today, a hospitalization, a coverage lapse). Even in an emergency, the rules still apply. Three-way calls (you, the person you are helping, and the agency) work in these moments. Get the person on the line, even briefly, to give verbal permission.

Why the rules are strict

Medicare beneficiaries are protected populations. Federal privacy law (HIPAA) and Medicare’s own rules limit who can access protected health information and discuss coverage details. The rules exist because abuse exists — adult children who change parents’ coverage without consent, agents who claim authorization they do not have, scammers who pose as family. The friction the rules create for you, a well-meaning helper, is the same friction that protects your parent from a less-careful relative or a stranger.

This means a few practical things:

• The agency on the other end of the call defaults to not sharing. They will ask verification questions before any conversation about coverage.
• The bar to ask questions is lower than the bar to make changes.
• Each agency — Medicare, the plan, Social Security, the pharmacy — keeps its own list of who is authorized. Authorization with one does not transfer to another.

What to gather before any call

A short list. Bring all of it to every call, even if some pieces seem unnecessary.

The Medicare Beneficiary Identifier (MBI). The 11-character code on the Medicare card. The agency will ask for it.

The person’s full legal name — first, middle, last — exactly as it appears on the card.

Date of birth.

The full address on file with Medicare and any plan. This is sometimes different from the current address; agencies sometimes have an older one. If the address has changed recently, that itself may be the reason a call is not going through.

A phone number on file. Some plans verify against the phone number they have, not the one you are calling from.

The plan card if the call is to a plan — Medicare Advantage, Medigap, or Part D.

A pen and paper. Write down: the date and time of the call, the name of the person you spoke with, what you asked, what they said, and any reference or confirmation number they give you.

The person you are helping, if at all possible. Even sitting next to you while you make the call is enough to clear most permission requests with a quick verbal confirmation.

The three levels of authority — informal, written, legal

The system recognizes three rough levels of helper authority. Knowing which level applies to which situation prevents the most common frustration: thinking you have authority you do not.

Level 1 — Informal helping (with the person present or on the line)

The lowest-friction level. The beneficiary is on the call, gives verbal permission, and stays on the line while you handle the conversation. The agent can speak with you in their presence.

Good for: asking questions, getting explanations, sorting bills, understanding notices.

Not enough for: making enrollment changes, filing appeals on the person’s behalf, accessing account histories outside of a single call.

No paperwork required. The verbal permission only lasts for the call.

Level 2 — Written authorization on file

The beneficiary fills out an authorization form for a specific agency or plan, naming you as someone authorized to speak on their behalf. Each agency has its own form, and the authorization is specific to that agency.

• Medicare’s CMS-1696 (Appointment of Representative) — used for claims and appeals at Medicare. Found at Medicare.gov/claims-appeals/file-an-appeal/appoint-a-representative.
• Plan authorization forms — each Medicare Advantage, Medigap, and Part D plan has its own. The plan can mail or email it.
• Social Security authorization forms — SSA has separate forms for general representation (SSA-1696), for authorized representative payee status (SSA-11), and for limited disclosure (SSA-3288). Each is used for a different purpose.

Good for: ongoing conversations with that specific agency or plan, including discussing claims and filing appeals (Medicare’s form covers appeals specifically).

Not enough for: acting outside the scope of the form, or for any agency or plan where you have not also filed.

Paperwork required. Forms have to be signed by the beneficiary (in some cases witnessed or notarized) and filed with each agency separately.

Level 3 — Legal authority

A formal legal document — usually a durable power of attorney (POA) for health care or finances, or court-appointed guardianship or conservatorship. These are governed by state law and vary significantly state to state.

Good for: acting on the person’s behalf in a broad range of situations, including making coverage decisions.

Not automatic at any agency. Each agency — Medicare, the plan, SSA, the pharmacy — has its own process for recognizing a POA. Some accept a copy on file; some require their own additional form. You almost always need to do paperwork at each agency even if you have a valid POA. Bring the original or a certified copy when you first contact each one.

Legal authority questions are legal questions. This article does not provide legal advice. If you do not have a POA or are unsure whether you do, talk with an attorney or your state’s bar association referral service. Many areas have free or low-cost elder law clinics.

The conversation about authority — before you need it

The most important practical advice in this article is one sentence: set up authority before the emergency, not during it.

This means having a conversation with your parent or spouse, calmly, when nothing is wrong. The conversation might sound like:

“I want to help if something comes up with your coverage. Can we fill out the form that lets the plan and Medicare talk to me?”

Or, depending on the relationship:

“If you ever can’t make a decision yourself, who do you want making it for you? Is that written down anywhere?”

These are not easy conversations. They sit alongside conversations about wills, end-of-life wishes, and finances — all the topics families avoid until they cannot. Doing the paperwork while the person is well, calm, and in control means the helper has the authority they need when it matters, and the person being helped retains full decision-making the rest of the time. Authorization is not the same as taking over. Filing the form gives you permission to talk to the agency on their behalf; it does not give you permission to make decisions they have not asked you to make.

When the person cannot give consent

This is the hardest situation, and the one where families most often need legal help. If your parent has lost the capacity to give informed consent — through advanced dementia, severe stroke, or other cognitive impairment — and you do not already have legal authority in place, you cannot create it after the fact through the agency alone. Agencies cannot accept “she can’t sign because she’s confused” as authorization.

In these situations:

• If a POA was signed before the impairment began and is still valid, use it. Bring it to each agency.
• If no POA exists, talk to an attorney about guardianship or conservatorship. It is a court process. It is not fast.
• In the meantime, contact your state’s SHIP. SHIP counselors can sometimes help with limited tasks while legal authority is being established, and they can advise on what is and is not possible.
• The state’s Adult Protective Services can be a resource when there is a question of urgent need and no clear authority.

This is legal territory, and it is the territory in which a real attorney earns their fee. We do not provide legal advice here. Get one.

Specific calls — what to expect

A short field guide to the most common calls helpers make.

Calling 1-800-MEDICARE. Long wait times, but the agents are well-trained. Have the MBI, name, date of birth, and address. If the beneficiary is on the line, the agent will ask them a verification question. Useful for general questions, MSN questions, and provider/plan finder questions. Not the right call for plan-specific issues — that is the plan’s number.

Calling a Medicare Advantage plan. The number is on the back of the plan card. Have the plan card and member ID. The plan will ask verification questions; the beneficiary on the line is the fastest path. Plan calls are needed for: prior authorization questions, denial questions, formulary questions, network questions, billing disputes, appeals.

Calling a Part D plan. Same shape as MA plan calls. The pharmacy can often answer questions about a specific prescription more quickly than the plan.

Calling Social Security. 1-800-772-1213. SSA handles Medicare enrollment, Part B premium changes, IRMAA appeals (using Form SSA-44), and the SSA-1099. SSA does not handle plan questions — those go to the plan.

Calling an agent or broker. Different from the above — agents are not bound by the same authorization rules, but they are commission-paid. Read the Ads, Calls & Free Help hub before any agent call. Helpers should be especially careful here.

A small note about call notes

Every call should produce a written record. A simple template:

Three months from now, you will want this. So will the person you are helping. So will the SHIP counselor if you bring the situation to them. Note-taking is the single highest-leverage habit a helper can build.

You do not need to know all of this on day one. You need to know which level of authority a situation requires before you act.