Medicare Authorization

The two forms that let someone help you.

If a family member or trusted person needs to speak to Medicare on your behalf — or access your records — these are the two official CMS forms that make it possible.

CMS-10106

Authorization to Disclose Personal Health Information

Allows Medicare to share your health information — claims, coverage details, and records — with a person you designate. This is the HIPAA authorization form.

Use this when
  • A family member needs to see your Medicare claims or coverage details
  • You want someone to call 1-800-MEDICARE on your behalf
  • A caregiver needs access to your health information to help manage care

CMS-1696

Appointment of Representative

Formally designates someone to act as your representative in Medicare matters — including appeals, hearings, and formal decisions. More authority than the disclosure form.

Use this when
  • Someone needs to file a Medicare appeal on your behalf
  • You want a family member to handle formal Medicare decisions
  • You are managing Medicare for a parent and need legal standing to act

Which form do you need?

The CMS-10106 is for information access — it lets someone see your records and speak to Medicare about your coverage. It does not give them authority to make decisions or file appeals on your behalf.

The CMS-1696 goes further — it appoints someone as your official representative, giving them standing to act in Medicare proceedings, including formal appeals and hearings.

Many caregivers complete both. If you are unsure which applies to your situation, ask Fern — describe what you are trying to do and Fern will tell you what to verify.

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