CMS Pub. 100-16, ch. mc86c17d, § 40.2.1

A Medicare beneficiary is generally the only person who may execute a valid cost plan

enrollment form. However, another individual would be the appropriate party to execute

an enrollment application if a court has designated him or her as the proper party to take

such actions on behalf of the beneficiary. The CMS will recognize State laws that

authorize persons to take such actions on behalf of a beneficiary. 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 the authority to act for the

beneficiary in this capacity.

If a Medicare beneficiary is unable to sign an enrollment form, or disenrollment request,

due to reasons such as physical limitations or illiteracy, state law would again govern

whether another individual may execute the form on behalf of the beneficiary. Usually, a

court-appointed guardian is authorized to act on the beneficiary’s behalf. If there is

uncertainty regarding whether another person may sign for a beneficiary, cost plan

organizations should check State laws regarding the authority of persons to sign for and

make health care treatment decisions for other persons.

Where cost plan organizations are aware that an individual has a representative payee

designated by the SSA to handle the individual’s finances, the cost plan should contact

the representative payee to determine his or her legal relationship to the beneficiary, and

to ascertain whether he or she is the appropriate person, under state law, to complete the

individual’s membership application.

When someone other than the beneficiary completes the application or submits the

disenrollment request, the plan must retain documentation showing how the

determination was made that another entity or person was legally authorized to enroll the

Medicare beneficiary.

If the cost plan receives an enrollment form that was signed more than 30 calendar days

prior to the organization’s receipt of the form, the plan is encouraged to contact the

individual to confirm intent to enroll prior to processing the enrollment, and to advise the

beneficiary of the upcoming effective date.