Essential Forms for Assisting Your Parents with Medicare Planning
1. Authorization to Disclose Personal Health Information (HIPAA Release Form)
- Purpose: Allows you to access your parents’ health information and communicate with their healthcare providers on their behalf.
- Where to Get It: Available from your parents’ healthcare provider or insurance company.
2. Medicare Authorization to Disclose Personal Health Information (CMS Form 10106)
- Purpose: Grants permission to access your parents’ Medicare information and speak to Medicare on their behalf.
- Where to Get It: Download from the Medicare website (www.medicare.gov).
3. Appointment of Representative Form (CMS Form 1696)
- Purpose: Allows you to act as a representative for your parents in matters related to Medicare claims and appeals.
- Where to Get It: Available on the Medicare website or through the Social Security Administration.
4. Durable Power of Attorney for Health Care
- Purpose: Authorizes you to make healthcare decisions on your parents’ behalf if they are unable to do so.
- Where to Get It: Obtain from a lawyer or legal service, or find a template online. Must be notarized and comply with state laws.
5. Advance Healthcare Directive (Living Will)
- Purpose: Specifies your parents’ preferences for medical treatment in situations where they are unable to communicate their wishes.
- Where to Get It: Available from healthcare providers, legal advisors, or online legal form providers. Must be notarized.
6. Medicare Initial Enrollment Questionnaire (IEQ)
- Purpose: Used to gather information about your parents’ health coverage to coordinate benefits with other insurance plans.
- Where to Get It: Typically sent by Medicare after enrolling, or can be completed online through the Medicare website.
7. Request for Employment Information (CMS Form L564)
- Purpose: Verifies employment information to enroll in Medicare Part B during a Special Enrollment Period.
- Where to Get It: Download from the Medicare website or obtain from the Social Security Administration.
8. Social Security Benefits Application (Form SSA-1)
- Purpose: Required to apply for Social Security benefits and Medicare if your parents are not automatically enrolled.
- Where to Get It: Available on the Social Security Administration website (www.ssa.gov).
9. Medicare Supplement Insurance (Medigap) Application
- Purpose: Enrolls your parents in a Medigap policy to cover additional costs not covered by Original Medicare.
- Where to Get It: Obtain from the insurance company offering the Medigap plan.
10. Medicare Advantage Plan Enrollment Form
- Purpose: Used to enroll in a Medicare Advantage Plan (Part C).
- Where to Get It: Available from the Medicare Advantage Plan provider or through the Medicare Plan Finder tool on the Medicare website.
11. Medicare Part D Prescription Drug Plan Enrollment Form
- Purpose: Enrolls your parents in a Medicare Part D plan for prescription drug coverage.
- Where to Get It: Obtain from the chosen Part D plan provider or through the Medicare website.
By completing and submitting these forms, you can effectively assist your parents with their Medicare planning. For further assistance and to get answers to your specific questions, feel free to email us at info@medicareformyparents.com. We’re here to help!
