---
title: Medicare authorization form CMS-10106 | Plan Before You Die
url: https://planbeforeyoudie.app/medicare-form
source: Plan Before You Die
---

# Let Medicare talk with your family

Medicare won't discuss your claims with your family until you give written permission. Form CMS-10106 does that. Medicare estimates it takes about 15 minutes, and you can send it from your Medicare.gov account.
- 5 steps
- Official sources
- Checked October 14, 2026

**Open enrollment runs October 15 to December 7.** If your family helps you look at plan changes, this form lets 1-800-MEDICARE talk with them about your plan enrollment too.
### Choose who Medicare can talk to

Name up to two people or organizations on the front of the form, with their mailing addresses. To add more, list them on the back.
### Choose what they can hear

Pick "any information," or pick only some: Medicare eligibility, claims, health and drug plan enrollment, or premium payments.
### Choose how long it lasts

Share indefinitely, or only between a start date and an end date. The form notes that your state may have its own limits. For the reason, you can write "At my request."
### Send it

Medicare says the fastest way is online, from your secure Medicare.gov account. You can also mail the signed form to:

1-800-MEDICARE Written Authorization Dept.
PO Box 1270
Lawrence, KS 66044
### Tell the people you named

They call 1-800-MEDICARE (1-800-633-4227), or TTY 1-877-486-2048. You can cancel at any time by writing to the same address.

## Good to know

### Can my family call before the form is on file?

Only if you're on the call and give permission. Medicare needs your permission in writing before it shares anything with someone else.

### I have a Medicare Advantage or drug plan. Is this enough?

This form covers 1-800-MEDICARE. Ask your plan whether it needs its own permission form, and send that too.

### Can someone sign it for me?

A personal representative can sign. They attach paperwork that shows they can act for you, like a power of attorney.

### Do you help choose a Medicare plan?

No. For free, unbiased help choosing a plan, call your State Health Insurance Assistance Program (SHIP). Medicare.gov lists each state's program.

### Helping your mom or dad with this?

They fill out and sign the form, or send it from their own Medicare.gov account. Don't sign in to their account as them.

## What we checked

| Fact | Source | Checked |
|---|---|---|
| Medicare needs written permission before it shares your information with someone else | [Form CMS-10106 (03/2026)](https://www.cms.gov/cms10106-authorization-disclose-personal-health-information) | Oct 14, 2026 |
| Two names on the front, more on the back | [Form CMS-10106 (03/2026)](https://www.cms.gov/cms10106-authorization-disclose-personal-health-information) | Oct 14, 2026 |
| Send online from Medicare.gov, or mail to PO Box 1270, Lawrence, KS 66044 | [Form CMS-10106 (03/2026)](https://www.cms.gov/cms10106-authorization-disclose-personal-health-information) | Oct 14, 2026 |
| About 15 minutes to fill out | [Form CMS-10106, OMB 0938-0930](https://www.cms.gov/cms10106-authorization-disclose-personal-health-information) | Oct 14, 2026 |
| Open enrollment is October 15 to December 7 | [Medicare.gov](https://www.medicare.gov/health-drug-plans/open-enrollment) | Oct 14, 2026 |
| SHIPs give free help choosing a plan | [Medicare.gov](https://www.medicare.gov/talk-to-someone) | Oct 14, 2026 |

This guide is general information, not legal advice. Plan Before You Die isn't connected with Medicare or the U.S. government. Something wrong here? Tell us.