Fill out CMS-10106 (1-800-MEDICARE Authorization) online
Form CMS-10106 authorizes 1-800-MEDICARE to share a Medicare beneficiary's personal health information with a designated person or organization. It is required when a beneficiary wants someone else, such as a family member, caregiver, or attorney, to access their Medicare claims and health records on their behalf.
How to fill out CMS-10106 (1-800-MEDICARE Authorization)
Enter your Medicare information
Provide your full name, date of birth, and Medicare Beneficiary Identifier (MBI) number as shown on your Medicare card.
Designate your authorized representative
Enter the name, address, phone number, and relationship of the person or organization you are authorizing to receive your Medicare information.
Specify the scope of authorization
Indicate what types of information the authorized person can access and whether the authorization covers all information or specific types of claims and records.
Sign and date the form
Sign and date the authorization. If someone is signing on behalf of the beneficiary, they must provide documentation of their legal authority to do so.
About CMS-10106 (1-800-MEDICARE Authorization)
Who needs this form
Medicare beneficiaries who want to authorize a third party (family member, caregiver, attorney, or representative) to access their personal health information through 1-800-MEDICARE.
Where to submit
Submit online via Medicare.gov, mail to the address on the form, or fax. You can also call 1-800-MEDICARE (1-800-633-4227) for assistance with submission.
Source and content freshness
- Filing deadlines may shift for weekends and holidays. Verify due dates with official instructions.
Common mistakes to avoid
- Forgetting to include the Medicare Beneficiary Identifier (MBI) number
- Not specifying which information the authorized person can access
- Leaving the authorization end date blank when a limited period is intended
- Not signing and dating the form
Got any questions?
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How long does the authorization last?
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