Who Can Make Medicare Decisions on Your Behalf?

Understanding all the rules of Medicare and navigating all of the different plan options and choices can be a daunting task. As we age, it's common for a decline in mental cognition, and the older we get, the more this stands true. Whether it's unexpected medical issues or a general feeling of overwhelm, you may want to have someone support you in your most important healthcare insurance decisions.

Although there are some rules and guidelines to follow, Medicare recognizes these factors and does allow authorized individuals to make decisions for Medicare beneficiaries. In this article, we'll highlight what this looks like and what steps to take if you or someone you care about needs assistance making Medicare decisions.

Why You Might Need Someone to Help With Medicare Decisions

There are many factors why you may want or need support from a friend or family member, from cognitive decline to illness or general confusion over complex plans.

• Cognitive decline or medical conditions
• Legal or physical inability to act on your own behalf
• Help navigating complex Medicare choices
• Peace of mind for family members

Source: Medicare.gov/coverage/advance-care-planning

Who Can Legally Make Medicare Decisions for You?

There is a difference between getting input from a friend or loved one on your Medicare decisions and legally electing someone to make Medicare decisions for you. Below, we'll cover several different terms and designations you may hear of and what they really mean, so you can decide what's most suitable for your personal situation.

Authorized Representative

An authorized representative is an individual who can assist you in selecting coverage, enrolling in Medicare, and managing your benefits. This person can talk to Medicare on your behalf, take care of paperwork, and help you make well-informed decisions during the enrollment process. Your authorized representative might be a family member, friend, caregiver, or anyone else you trust.

Get the form here.

Power of Attorney (POA)

A power of attorney or POA is a formal document that designates a legally authorized individual to make decisions on your behalf. There are different types of POAs, including medical POA, which specifically grants authority over healthcare decisions, and general POA, which covers broader financial or legal matters.

Make sure that if you appoint someone as a Power of Attorney, you are giving the proper authority, as a general POA will not be able to make Medicare coverage decisions and elections on your behalf. While you can complete a POA without a legal aid, working with a lawyer can help ensure your document meets state laws and includes all necessary permissions you intend to make.

When it comes to Medicare, a medical POA can allow someone to manage Medicare benefits and make healthcare decisions. However, some people may mistakenly believe a POA allows them to make all decisions regarding a person's Medicare coverage, when in fact, there are specific rules and limitations that apply. Completing documentation to be a medical POA as well as an Authorized Representative will ensure that you have the legal authority to make healthcare decisions on behalf of someone who is unable to do so themselves.

Related: Helping a Parent with Medicare Coverage

Legal Guardianship or Conservatorship

A legal guardian can act on behalf of a minor or incapacitated adult for Medicare-related matters, including enrollment, plan selection, and managing claims and paperwork. This is typically done when the individual is unable to make these decisions for themselves. Guardianship is often court-ordered, or an individual can be appointed as an authorized representative through a Power of Attorney (POA) or other legal documents.

HIPAA Authorization

HIPAA authorization gives someone the ability to access your personal health records and information. This can be used to inform a family member of your personal medical records, although it does not give them the ability to make any decisions. This is often used in combination with one of the above types of authorization.

Common Mistakes to Avoid

As you can see, there are a lot of specifics to understand, and actions needed to ensure that you have made the right elections and even legal paperwork. There are some important mistakes that are commonly made when it comes to assuming who can make Medicare decisions on your behalf.

• Assuming a spouse can automatically act on your behalf.

One major oversight is the assumption that a spouse can automatically step in as your decision-maker. While a spouse often plays an important role in your healthcare choices, you still need clear legal documentation to confirm this authority. Without proper paperwork, you may experience confusion or delays when critical decisions need to be made.

• Not having documents ready in an emergency.

Failing to prepare essential documents for emergencies can lead to unnecessary stress during challenging times. Life is full of uncertainties, and having a plan in place can alleviate some of that pressure. Taking the time to outline your preferences and appoint the right individuals to make decisions for you ensures that your wishes are respected when it matters most.

• Another mistake is confusing access to information with decision-making rights.

Just because someone can access your medical records does not mean they have the authority to make choices regarding your care. Clarifying these distinctions ahead of time can prevent misunderstandings and ensure that the people you trust are able to act on your behalf.

By being aware of these common pitfalls and taking proactive steps to address them, you can navigate your Medicare decisions with greater confidence and clarity.

Planning Ahead Gives You More Control

If you have started to notice signs that your cognitive abilities may be on a decline or if a loved one has already expressed concerns, it's a good time to consider appointing someone to help with your Medicare decisions. Although it might not be easy to, you don't need to feel like you are no longer in control; it's about your protection and best interest, not loss of independence. Embrace the support available to you as a means to empower yourself, not as a limitation.

Medicare Guidance To Help You Along the Way

Need more help understanding the options for Medicare coverage and who can support in insurance decisions? At Twin City Underwriters, we've been helping Medicare beneficiaries and their families for over 50 years. We are focused on making Medicare easy to understand and helping you feel confident in your healthcare decisions.

Contact us today for answers and guidance.

Navigating the complexities of Medicare can be a daunting task, but understanding these details and taking the right actions can help ensure that your choices are well-informed and that the necessary legal paperwork is completed.

Choosing a Medicare plan can be difficult. Twin City Underwriters helps Medicare recipients in Minnesota, Wisconsin, North Dakota, South Dakota, Iowa and Florida find the Medicare plan that meets their unique needs. Schedule a one-on-one meeting with one of our Medicare insurance brokers to get your questions answered!

Do you need help with Medicare, insurance and health plans? Explore your options with Allina Health Aetna, BlueCross BlueShield of Minnesota, Medica, UCare, United HealthCare and more. We work with you to find the best plan for your needs and budget. Contact us today to get started.