How to Appoint a Medicare Representative

Navigating Medicare can be a complex process, especially when you are dealing with a medical condition or an appeal. The rules and procedures can be difficult to understand, and the amount of paperwork can be overwhelming. Fortunately, you do not have to manage it all alone. You have the right to appoint a representative to act on your behalf. This article will explain who a representative is, the simple process of appointing one, and why having an advocate can be so helpful.

What is a Medicare Representative?

A Medicare representative is a person you choose to act on your behalf in dealing with Medicare or your Medicare health plan. This person can be a family member, a friend, a caregiver, a doctor, an advocate, or even an attorney. Once you officially appoint a representative, that person has the authority to:

  • File claims and appeal requests for you.

  • Submit evidence and documentation on your behalf.

  • Receive copies of all correspondence and decisions.

  • Communicate with Medicare and your plan about your case.

  • Act on your behalf during an Administrative Law Judge hearing.

Having a representative can provide you with peace of mind and ensure that important deadlines and procedural requirements are met, even if you are unable to manage them yourself due to health or other reasons.

The Appointment of Representative Form (CMS-1696)

To officially appoint someone, you must complete the "Appointment of Representative" form, which is officially known as Form CMS-1696. This form is the easiest and most reliable way to ensure that the appointment is valid. The form serves as the legal document that authorizes another person to act for you.

You can find this form on the official CMS website at www.cms.gov. It is a straightforward document that requires information from both you (the person appointing the representative) and the person you are appointing. You both must sign and date the form.

While the CMS-1696 form is highly recommended, it is important to know that Medicare regulations also permit an equivalent written notice. This means you can write your own document to appoint a representative, but it must contain all the same essential information as the official form to be considered valid. To avoid any delays or rejections, using the official form is the best practice.

Key Information Required on the Form

The CMS-1696 form requires several critical pieces of information to be valid:

  • Your information: Your name, address, phone number, and Medicare number.

  • The representative's information: The representative's name, address, phone number, and their professional status or relationship to you (e.g., attorney, daughter, friend).

  • A statement of authorization: A clear statement that you are authorizing this person to act on your behalf.

  • Disclosure authorization: A statement that you authorize the disclosure of your health information to your representative.

  • Purpose and scope: A written explanation of the purpose and scope of the representation (i.e., what matters they can handle).

  • Signatures: The signatures and dates of signature from both you and your appointed representative.

Why You Should Consider Appointing a Representative

There are many reasons why having a representative can be beneficial:

  1. Expertise and Focus: An appointed representative, such as an attorney or an advocate, may have experience with Medicare appeals and can focus on the details of your case while you focus on your health.

  2. Peace of Mind: Knowing that a trusted person is handling the details of your appeal can reduce your stress and the risk of missing a critical deadline.

  3. Communication: The representative can manage all communication with Medicare, your plan, and the appeals contractors, which saves you from making many phone calls and dealing with complex correspondence.

  4. Advocacy: Your representative can serve as your advocate, making sure that your side of the story is heard and that your case is presented with all the necessary documentation.

Appointing a representative is a simple but powerful step. It ensures that your interests are protected and that you have the support you need to navigate the Medicare system and get the coverage you deserve. You are not alone in this process; do not be afraid to seek help and empower a trusted person to act on your behalf.