Need someone else to call Medicare for you?

[sswa...@umich.edu]

Would you like for a family member or caregiver to call Medicare on your behalf?

Medicare can't give personal health information about you to anyone unless you give permission in writing first. To do this, fill out form CMS-10106:“Authorization to Disclose Personal Health Information.”

You can fill out and submit the form online simply by logging into yourMyMedicare.gov account and following these steps:

1. Navigate to the “My Account” tab.
2. Click “Authorized Representative.”
3. Click “Medicare Authorization to Disclose Personal Health Information form.”
4. Enter the requested information and click the “Continue” button.

Log In

Don’t have a MyMedicare account yet? Signing up is easy — just visit MyMedicare.gov to get started. Alternatively, you can print and mail form-10106 to us.

Sincerely,

The Medicare Team