CMS-10106 Form: How to Authorize Medicare to Share Information About Your Parent

You call Medicare to dispute a billing error on your parent's account, and the agent tells you they can't discuss anything with you. Your parent has dementia and can't handle the call themselves. You're stuck — not because the system is broken, but because you haven't filed the right form.

The CMS-10106 is the form Medicare uses to authorize 1-800-MEDICARE to share a beneficiary's personal health information with someone else. It is separate from CMS-1696, the Appointment of Representative form used for claims, appeals, grievances, and requests, and separate from a healthcare power of attorney or a broader HIPAA authorization.

What CMS-10106 Actually Does

Form CMS-10106, officially titled "Authorization to Disclose Personal Health Information Release Form," authorizes 1-800-MEDICARE to share information with the person or organization named on the form. It can authorize access to:

• Medicare eligibility information
• Medicare claims information
• Health and drug plan enrollment information
• Premium payment information, if selected on the form

The form is free, available on the CMS website, and must be signed by the person with Medicare or an authorized personal representative. If your parent can still sign documents, the form's estimated completion time is about 15 minutes.

CMS-10106 vs. Power of Attorney vs. HIPAA Authorization

These documents cover different purposes. The right combination depends on whether you need information access, appeal representation, medical decision-making authority, or financial authority.

CMS-10106 authorizes 1-800-MEDICARE to disclose the information selected on the form. It does not appoint you to file an appeal or act as the representative for a Medicare claim.

CMS-1696 (Appointment of Representative) appoints a person to act on a beneficiary's behalf for a Medicare claim, appeal, grievance, or request. The enrollee and the person accepting the appointment complete the form, or use a conforming written instrument, and submit it with the action.

Healthcare Power of Attorney (HCPOA) can grant broader authority to make medical decisions when a parent becomes incapacitated, subject to state law and the document's terms. A legally recognized personal representative may have access to relevant protected health information under HIPAA without a separate authorization, but provider procedures vary.

HIPAA Authorization permits healthcare providers, insurers, and pharmacies to share the protected health information covered by the authorization. It does not replace a Medicare appointment-of-representative process for an appeal.

How to File CMS-10106

Step 1: Download the form from CMS.gov. Search "CMS-10106" — it's a three-page PDF.

Step 2: Enter the beneficiary's name, Medicare number, date of birth, and contact information, then name the person or organization that may receive information from 1-800-MEDICARE.

Step 3: Select the information to be shared, the period of authorization, and the reason for disclosure. The person with Medicare signs the form. If a personal representative signs, attach documentation showing the authority to act, such as a power of attorney.

Step 4: Keep a copy of the signed form and any attached authority documents for your records.

Step 5: Submit the completed form online through the secure Medicare.gov account or by mail to the 1-800-MEDICARE Written Authorization Department, PO Box 1270, Lawrence, KS 66044.

When Your Parent Can No Longer Sign

This is where many families get stuck. If your parent has advanced dementia or is otherwise unable to sign:

• A durable power of attorney may allow you to sign as the personal representative when it gives you the relevant authority. Attach a copy of the POA to the CMS-10106.
• A court-appointed guardianship order may establish the authority to sign. Submit the guardianship documentation alongside the form.
• If neither exists, CMS-10106 cannot be signed for your parent without appropriate authority. You may need to seek state-law advice about guardianship or another legal process; cost and timing vary by jurisdiction.

The critical takeaway: get the CMS-10106 signed now, while your parent can still participate. Waiting until a crisis means navigating a far more expensive and time-consuming legal process.

Building the Complete Legal Authority Package

For dual-eligible parents — those on both Medicare and Medicaid — you need a coordinated set of documents to avoid getting blocked by different agencies:

1. CMS-10106 — authorization for 1-800-MEDICARE to disclose selected information
2. CMS-1696 — appointment of a representative for Medicare claims, appeals, grievances, or requests
3. Durable Financial Power of Attorney — bank accounts, asset management, Medicaid applications
4. Healthcare Power of Attorney — medical decisions if parent becomes incapacitated
5. HIPAA Authorization — information sharing with providers and other covered entities when needed
6. State Medicaid Representative Form — each state has its own authorized representative process for Medicaid matters

File the applicable documents before you need them. The Dual Eligible Coordination Guide includes a complete legal authority chapter with a step-by-step walkthrough for assembling this package, plus a checklist to track which documents are executed and where originals are stored.

Common Mistakes to Avoid

Filing with the wrong entity. The CMS-1696 or other appointment document goes with the claim, appeal, grievance, or request to the relevant MAC or plan. CMS-10106 is sent to 1-800-MEDICARE through the online Medicare account or the Written Authorization Department.

Assuming one document covers everything. Financial institutions, Medicare, Medicaid, and healthcare providers each have their own authorization requirements. Use the process required by the organization handling the request.

Waiting until a crisis. Courts and administrative agencies move slowly. If you need guardianship because your parent can no longer sign documents, you're looking at weeks or months of delay while bills pile up.

The legal authority gap is one of the most common — and most preventable — crises in eldercare. Fifteen minutes of paperwork now saves weeks of emergency legal proceedings later.

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