Helping a parent with Medicare

Start with permission

Everything in this guide rests on one thing: your parent agreeing to your help. With that, you can do most of the work. Without it, Medicare, Social Security, the plans and the doctors will mostly talk only to your parent.

Permission isn't the same as decision-making. Your parent still chooses the plan, signs the forms and can change their mind. If your parent can no longer make those decisions, that's a legal matter, usually a power of attorney or guardianship, and an elder-law attorney is the right person to ask about it.

Doctors work the same way. A doctor has to get your parent's permission before talking with you about their care. Once they have it, the doctor can talk with you directly during a visit, and Medicare.gov says that time is part of what Part B already pays for, so there's no separate bill.

Talking to Medicare for your parent

1-800-MEDICARE (1-800-633-4227) will discuss your parent's information with you in two situations: your parent gives verbal permission while you're both on the phone, or your parent has named you in writing. The written version is the Authorization to Disclose Personal Health Information, form CMS-10106.

• Online is faster. Filled in through your parent's Medicare.gov account, it lets you call on their behalf right away. Medicare's fact sheet describes the steps: in their account, "Edit my account settings," then "Manage My Representatives," then "Add Representative."
• On paper, from Medicare.gov's Other Forms page, it's signed by your parent and mailed to the address on the form. Expect to wait a few weeks before Medicare will talk to you.
• Your parent chooses any information or limited information (for example, only claims or only plan enrollment), and whether the permission lasts indefinitely or between set dates. The form has a box for New York residents about sharing information on mental health treatment, alcohol and drug abuse, and HIV.
• Your parent can cancel it at any time by writing to the address on the form.

The form lets Medicare share information with you. It doesn't let you make decisions for your parent. If a claim or coverage decision goes against them and you're helping with an appeal, Medicare has a separate way to appoint you as their representative, explained on its appeals page.

Social Security: payee or representative

Social Security uses two terms that sound alike and mean different things.

• Representative payee. Social Security appoints a payee to receive and manage the benefits of someone who can't manage them. It usually looks to family or friends first. A payee has to spend the money on the person's needs, save what isn't needed and keep records. Social Security says a power of attorney, being an authorized representative, or a joint bank account is not the same as being a payee. If you're worried your parent can no longer handle their benefits, call Social Security at 1-800-772-1213 to discuss it. People can also name, in advance, up to three people who could serve as their payee if it's ever needed.
• Appointed representative. Someone your parent appoints, using form SSA-1696, to act for them on a claim or an appeal and to see their Social Security record for that purpose. It isn't about managing monthly payments.

For questions about Social Security benefits themselves, see my Social Security page.

Sitting in on a call with an agent

You're welcome on any call with me, and I'd rather you were there. But the federal marketing rules for Medicare Advantage and Part D are clear about whose meeting it is. Before an agent talks about specific plans in a one-on-one appointment, the Scope of Appointment has to be agreed and recorded with the person who has Medicare. It lists the kinds of plans to be discussed, it has to be in writing when we meet in person, and it lasts 12 months. An agent can't market products outside that scope, or non-health products such as annuities, at that appointment.

In practice, that means your parent needs to agree to the Scope of Appointment themselves. Enrollment follows the same idea: CMS lets an "authorized representative" sign only if that person is legally able to act for the beneficiary under state law. A son or daughter without that legal authority can help with everything else, but can't agree or sign for their parent.

Keep two lists

The most useful thing you can do costs nothing. Keep an up-to-date list, on paper or on your phone, of:

• Every doctor your parent sees, including specialists they visit only once a year, with the practice name and town.
• Every prescription, with the drug name, strength and how often it's taken, plus the pharmacy they use.

Add the Medicare card and any plan card. With those lists I can check networks and drug costs properly, and so can anyone else who helps your parent.

Read the Annual Notice of Change each fall

If your parent has a Medicare Advantage or Part D plan, the plan mails an Annual Notice of Change every fall, saying what changes on January 1. It's easy to put aside, and it's where premium, copay and drug changes show up first. My guide to reading the Annual Notice of Change goes through what to look for. To see which enrollment window is open for your parent right now, use the enrollment check.

Watch for scams

People with Medicare get a lot of calls, and some of them aren't what they claim to be. Medicare.gov is plain about it:

• Medicare will never call your parent to sell anything or visit them at home. Medicare, or someone representing it, only calls asking for personal information in limited situations, such as returning a call your parent made.
• Your parent shouldn't join a health or drug plan over the phone unless they called and asked for help.
• Your parent shouldn't give their Medicare or Social Security number to anyone except their doctors or people they know should have it.
• Your parent shouldn't accept money or gifts in exchange for "free" medical care.

If you suspect fraud, call 1-800-MEDICARE. For a Medicare Advantage or drug plan, you can also call the I-MEDIC line at 1-877-772-3379. Checking your parent's Medicare statements against their calendar is one of the simplest ways to catch a problem.

If the costs are a strain

If your parent is struggling with premiums or drug costs, New York has programs that can help: the Medicare Savings Program, Extra Help with Part D, EPIC, and for some people Medicaid. They're explained on the help paying for Medicare page, and Medicaid for people 65 and older has its own guide. If your parent is still approaching 65, start with the turning 65 checklist.

How a call with me works when you're on the line

Most of these calls follow the same pattern.

1. You book a time when your parent can be there too, in person or by phone.
2. I check with your parent first. I'll ask them, not you, whether they're happy for you to be part of the conversation, and we go through the Scope of Appointment with them.
3. We go through the lists. Doctors, prescriptions, pharmacy, and what they have now. This is where your help usually matters most.
4. I explain the options in plain English, including staying put if the current plan still works. I'm appointed with several carriers, not every one, and I'll say so when it matters.
5. Your parent decides. If they want to enroll, they sign, or someone legally able to act for them does. If they want to think about it, or talk it over with you after the call, that's fine. There's no fee for my help.

If you'd also like a second opinion that covers every plan, the free county HIICAP counselors are there for that. When you're ready, book a call.

We do not offer every plan available in your area. Currently we represent 10 organizations which offer 81 products in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options. 1-800-MEDICARE (TTY 1-877-486-2048) is available 24 hours a day, 7 days a week. Insurers' legal names and home offices: carriers page.