When a Medicare client has a power of attorney (POA), insurance agents need to determine who is actually authorized to make healthcare and enrollment decisions before proceeding with an enrollment request.
For Medicare Advantage (MA) and Medicare Part D enrollment, the Centers for Medicare & Medicaid Services (CMS) recognizes authorized representatives according to applicable state law. Depending on the circumstances, that may include someone with durable power of attorney for healthcare decisions, a court-appointed legal guardian, or another person legally authorized to make healthcare decisions.
For agents, the practical takeaway is straightforward: do not assume that being a spouse, adult child, caregiver, financial representative, or Social Security representative payee automatically gives someone authority to enroll a Medicare beneficiary.
Here is what Medicare agents should know and how to handle these situations.
A power of attorney is a legal arrangement that gives one person authority to act for another person within the scope established by the document and applicable state law.
That last part matters.
Not every POA grants the same authority. A document dealing with financial matters, for example, should not automatically be treated as authority to make healthcare or Medicare enrollment decisions.
For Medicare Advantage and Part D enrollment, CMS uses the broader term authorized representative for someone legally permitted to act on the beneficiary's behalf.
Under CMS's Contract Year 2027 Medicare Advantage and Part D Enrollment and Disenrollment Guidance, authorized representatives recognized under state law may include:
The person must have the authority to act for the beneficiary in that capacity.
Agent takeaway: Focus on the person's legal authority for the Medicare decision at hand rather than simply asking whether someone “has POA.”
Potentially, yes.
CMS permits Medicare Advantage and Part D enrollment or disenrollment requests to be completed by an eligible beneficiary or an authorized representative acting under applicable state law.
Under CMS's 2027 guidance, when someone other than the beneficiary completes an enrollment or disenrollment request, the representative must:
The plan must retain the representative's attestation as part of the enrollment or disenrollment record.
Agents should remember that the underlying authority depends on applicable law and the circumstances—not simply on the person's relationship to the beneficiary.
CMS maintains its current Medicare Advantage enrollment and disenrollment guidance online. Agents should consult current guidance because requirements and operational instructions can change.
When another person says they make healthcare decisions for the beneficiary, slow the enrollment workflow down enough to establish who is authorized to act.
A practical process includes the following steps.
Ask whether the beneficiary makes their own healthcare decisions.
If the beneficiary does, having a family member or caregiver present does not necessarily make that person the beneficiary's legal representative.
If another person is responsible for the decisions, determine what role that person has.
Agents incorporating this question into a telephone sales process may also want to review PSM's Voice Scope of Appointment guide, which addresses decision-maker and POA situations as part of the Medicare sales workflow.
The individual might be:
These roles are not interchangeable.
Rather than deciding based on someone's title or family relationship, agents should determine what authority the individual claims to have for the specific Medicare action being taken.
Carrier and enrollment-platform procedures can differ.
Agents should follow the applicable plan's current enrollment instructions for handling an authorized representative, including required attestations, signatures, relationship information, and contact information.
Do not create an informal workaround when an enrollment system does not clearly accommodate the situation.
PSM-contracted agents can also review PSM's Medicare Agent Resources for Medicare sales, enrollment, training, and compliance resources.
Maintain appropriate records of who participated, the representative's stated relationship and authority, and the enrollment process followed.
Agents should also follow applicable CMS, carrier, agency, privacy, call-recording, Scope of Appointment, and record-retention requirements.
For agents looking to standardize their call process, PSM's compliant Medicare sales scripts include decision-maker and power-of-attorney protocols within the Medicare sales workflow.
Insurance agents should not try to provide legal interpretations of questionable POA documents or resolve complicated state-law questions themselves.
If it is unclear whether someone can legally act for the beneficiary, pause the enrollment and seek guidance through the appropriate carrier, compliance, or legal channel.
Agents should not assume that every Medicare enrollment involving an authorized representative requires them personally to collect and retain a copy of the POA document.
CMS's Contract Year 2027 Medicare Advantage and Part D enrollment guidance describes an attestation process when an authorized representative completes an enrollment or disenrollment request. The representative must attest to their authority under state law, indicate their relationship to the beneficiary through the applicable enrollment mechanism, and provide contact information.
However, state law, carrier procedures, the enrollment method, or the circumstances of the transaction may create additional requirements.
The better operational approach is to follow the current carrier and enrollment-platform instructions rather than creating a blanket rule for every POA situation.
No. Agents should not treat CMS-1696 as a universal Medicare power-of-attorney form.
CMS Form 1696, Appointment of Representative, is used to appoint a representative to act on someone's behalf for certain Medicare matters. CMS describes the form as applying to a claim, appeal, grievance, or request.
For example, CMS explains that a Part D enrollee may use the Appointment of Representative form, or a conforming written equivalent, to appoint someone to file a grievance, request a coverage determination, or request an appeal on the enrollee's behalf.
That is different from assuming the form establishes broad legal authority to make healthcare decisions or execute every type of Medicare enrollment transaction.
Agent takeaway: Identify the Medicare action being performed first. Then determine what authority, documentation, or form applies to that particular action.
No.
A representative payee is designated by the Social Security Administration to manage another person's Social Security or Supplemental Security Income payments. That role alone does not establish authority to complete a Medicare Advantage or Part D enrollment.
CMS's 2027 enrollment guidance says that when a plan knows an individual has a Social Security Administration representative payee, the plan should determine the person's legal relationship to the beneficiary and whether that individual is authorized under state law to execute the enrollment or disenrollment request.
This is an important distinction for agents: authority to manage someone's finances does not automatically establish authority to make Medicare enrollment decisions.
A family member can play an important role without necessarily having legal authority to act for the beneficiary.
An adult child or caregiver might help a beneficiary:
But helping a beneficiary is different from having legal authority to make an enrollment decision for that person.
Agents should not assume that a spouse, son, daughter, caregiver, or other relative can sign or complete an enrollment request solely because that person regularly assists the beneficiary.
When another person intends to act on the beneficiary's behalf, determine whether that individual is an authorized representative for the action being taken.
These terms can sound similar, but they should not be treated as interchangeable.
| Term | General Meaning | What Agents Should Consider |
|---|---|---|
| Power of attorney | Legal authority granted through a POA document | Determine whether the authority covers the healthcare decision involved |
| Authorized representative | Someone legally authorized to act for a beneficiary under applicable law | May execute an MA or Part D enrollment or disenrollment when appropriately authorized |
| Court-appointed guardian | Person granted authority through a court order | Authority depends on the court order and applicable law |
| Appointed representative | Representative appointed for certain Medicare claims, appeals, grievances, or requests | CMS-1696 may apply, but it should not be treated as a universal enrollment POA |
| Representative payee | Person designated to manage Social Security or SSI payments | Representative-payee status alone does not establish Medicare enrollment authority |
The safest habit is to identify the specific Medicare action being taken before determining which type of representative authority applies.
Being someone's spouse, adult child, sibling, or caregiver does not by itself establish authority to make every Medicare decision for that person.
POA documents can grant different types and scopes of authority, and applicable state law matters. Agents should avoid interpreting unfamiliar legal documents beyond their role.
An Appointment of Representative used for a Medicare claim, appeal, grievance, or request should not automatically be treated as legal authority to enroll someone in a Medicare Advantage or Part D plan.
CMS distinguishes representative-payee status from the authority necessary to execute an MA or Part D enrollment or disenrollment request.
When an agent cannot establish that the person acting for the beneficiary has the appropriate authority, the better approach is to use the applicable carrier or compliance escalation process rather than guessing.
Before completing an MA or Part D enrollment involving another decision-maker, ask:
Building these questions into your standard Medicare sales workflow can help agents handle unusual situations more consistently.
A person legally authorized to act for a Medicare beneficiary under applicable state law may be able to execute a Medicare Advantage enrollment or disenrollment request on the beneficiary's behalf. The scope of the representative's authority and applicable enrollment requirements still need to be satisfied.
CMS's Contract Year 2027 Medicare Advantage and Part D enrollment guidance identifies people with durable power of attorney for healthcare decisions as an example of individuals who may qualify as authorized representatives under state law, provided they have authority to act for the beneficiary in that capacity.
Caregiver status alone should not be assumed to provide enrollment authority. The relevant question is whether that caregiver is legally authorized under applicable state law to act for the beneficiary for the transaction involved.
Agents should avoid making legal determinations outside their role. When the validity or scope of someone's authority is uncertain, follow the applicable carrier or compliance escalation process and seek legal guidance when appropriate.
CMS-1696 is an Appointment of Representative form used for matters such as claims, appeals, grievances, or requests. Agents should not assume it is the form required to establish authority for an MA or Part D enrollment. Follow current CMS guidance and the applicable plan's enrollment procedures.
Power-of-attorney situations may not occur during every Medicare appointment, but agents should know how to respond before one surfaces in the middle of an enrollment.
Build a repeatable process for identifying decision-makers, documenting representative information, following carrier procedures, and escalating questionable situations. Pair that process with current Medicare enrollment guidance and your agency's compliance procedures.
Independent agents looking to strengthen their Medicare operation can explore PSM Brokerage's Medicare products and resources for insurance agents and Medicare Agent Resources for product, training, enrollment, and agent-support resources.
Educational information only. This article is not legal advice. Power-of-attorney and representative authority can depend on state law, the specific legal document, the transaction involved, carrier procedures, and current CMS requirements. Agents should verify applicable requirements with CMS, the carrier, their compliance resources, and legal counsel when appropriate.
Last regulatory review: September 21, 2026.