A question posed by an attorney on ElderLawAnswers' members-only Listserv has raised questions about the Center for Medicare and Medicaid Service's (CMS) policy on agents making Medicare Part D decisions for an incapacitated individual. The member wondered if CMS had issued any directives requiring specific language in a power of attorney to allow the agent to make decisions and deal with a beneficiary's pharmaceutical requirements.
According to the CMS's PDP (Prescription Drug Plan) Guidance handbook, CMS will recognize state laws that authorize persons to effect a Part D enrollment or disenrollment request for Medicare beneficiaries. According to the guidance, persons authorized under state law may be court-appointed legal guardians or persons having durable power of attorney for health care decisions, provided they have authority to act for the beneficiary in this capacity.
It is not clear what type of language is specifically necessary to give an agent the authority to make these types of decisions, but the agent should have the authority under state law to enroll the beneficiary in a private health insurance plan. The agent must also be prepared to present any proof of that authority to the insurer. Representative payee status, as designated by the Social Security Administration, is not necessarily sufficient to enroll or disenroll a Medicare beneficiary from a drug plan.
In May, CMS announced that nursing home staff are permitted to educate Medicare beneficiaries about Part D and assist them in enrolling. Under old rules, staff could not help residents. For details, click here.
Click here to read the CMS's PDP Guidance.
For more information on helping with Medicare prescription drug coverage decisions, click here.
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