Managing a parent's medical bills as a caregiver

Helping a parent with medical bills can feel like a second job. The envelopes pile up, the phone calls take hours, and someone always asks whether you're allowed to be on the line. You're not alone in this, and there's a clear way through it.

This guide covers your rights, how to get permission to talk to providers and Medicare, and how to keep the paperwork under control. It's part of our guide to how to read a medical bill.

Are you responsible for your parent's medical bills?

Generally, no. The Consumer Financial Protection Bureau (CFPB) says plainly that you aren't responsible for someone else's debt. Your parent's bills are paid from your parent's income and savings.

There are a few exceptions. You could owe if you co-signed for the care or agreed in writing to pay it yourself.

A small number of states have laws that can make a spouse responsible for some health care costs. That can matter if your other parent is still living. Some states also have older laws, called filial responsibility laws, that can make adult children pay for a parent's care. The National Conference of State Legislatures says they're rarely used.

Debt collectors aren't allowed to suggest you're responsible for a debt if you're not. If you're unsure where you stand, a legal aid office or elder law attorney can tell you how your state's rules apply.

Step 1: Talk with your parent first

Before you call anyone, sit down with your parent. Ask what help they want and who they're comfortable with you talking to. Some parents want you to handle everything. Others only want help reading the mail.

Make a list of every provider and plan that sends them bills or notices. That includes doctors, hospitals, labs, pharmacies, Medicare, and any other plan they have. You'll need permission from each one.

Step 2: Get permission to talk to providers and plans

Federal privacy rules allow doctors, hospitals, and health plans to talk with a family member who helps with a patient's care or bills. They can share what's relevant to your part. If your parent is there and able to decide, the provider can ask them, or go ahead if they don't object.

Providers may share, but they don't have to. That's why calls can go better with a form on file.

• Ask each office for its permission form. Many call it a release or an authorization. Have your parent sign it and keep a copy.
• Call your parent's plans. Ask member services what they need before they can talk with you.
• Make a 3-way call. If a form isn't on file yet, call with your parent on the line. They can say it's OK to talk with you.

If your parent can't make decisions, a provider may still share what's relevant to your role. The provider uses professional judgment about what's in your parent's best interest.

Step 3: Set up permission with Medicare

Medicare has its own rule. 1-800-MEDICARE can only share your parent's information with you if your parent gives permission. They can do that on the phone while you're both on the call. For ongoing help, they need to sign a form.

The form is called "Authorization to Disclose Personal Health Information" (Form CMS-10106). Here's how it works:

• Online is fastest. Your parent can fill it out in their Medicare.gov account. Medicare says you can then call right away.
• Mail takes longer. Your parent can print, sign, and mail the form. Medicare says you'll usually wait a few weeks before you can call.
• Your parent chooses what to share. They can share any information, or only certain types, like claims or premium payments.
• Your parent chooses how long. They can choose no end date, or set start and end dates.
• Your parent can cancel it. They can take back permission in writing at any time.

If you have legal authority to act for your parent, you can sign the form as their personal representative. Attach a copy of the paperwork, like a power of attorney.

The Medicare form covers 1-800-MEDICARE. If your parent has a Medicare Advantage plan, a drug plan, or a supplement, ask each plan for its own form.

If you need to file a Medicare appeal for your parent, there's a separate form. It's called "Appointment of Representative" (Form CMS-1696). Once you and your parent both sign it, it can be used for new appeals for 1 year.

Step 4: Understand power of attorney

A power of attorney is a legal paper that lets someone act for another person. There are different kinds, and the names and rules vary by state. This is general information, not legal advice.

Under federal privacy rules, someone with a health care power of attorney that's in effect is treated like the patient for related health information. A financial power of attorney alone doesn't give you those privacy rights. You can still help with bills under the family rule in Step 2.

These papers are easiest to set up while your parent can still make their own choices. An elder law attorney or legal aid office can help.

Step 5: Gather and organize the paperwork

Most of the work is matching papers. Set up a folder or binder for each provider, with a section for each visit. Keep 3 things together:

An MSN isn't a bill. Medicare mails one every 6 months if your parent had any services. You can also sign up for electronic notices, with an email for any month with a processed claim.

Keep a call log in the same binder. Write down the date, the person's name, and what they said every time you call.

Step 6: Check each bill before you pay

Before paying any bill, find the MSN or EOB for the same date and provider. The amount due usually shouldn't be more than what the MSN or EOB says your parent may owe.

Our guide on how to read a Medicare Summary Notice shows where each number is. For plans that send EOBs, see EOB vs. medical bill.

Say Linda helps her father, who has Original Medicare and no other coverage. A bill arrives from his heart doctor. These numbers are fictional.

On the MSN	Amount
Amount Provider Charged	$480
Medicare-Approved Amount	$300
Amount Medicare Paid	$240
Maximum You May Be Billed	$60

On the bill	Amount
Total charges	$480
Medicare payment	−$240
Adjustment	−$120
Amount due	$120

The bill asks for $120, but the MSN says the most he owes is $60. The gap is $60.

The adjustment should be $180 ($480 − $300). The bill shows only $120, so $60 is missing.

Linda's father already gave Medicare and the office written permission. So Linda calls the billing office alone. She asks them to apply the full adjustment and send a corrected bill for $60. She also asks them to hold the account while they fix it.

If a bill asks for more than the MSN or EOB, see why a medical bill is higher than your EOB. A bill for a routine visit may also include a hospital charge. Our guide to the facility fee on a medical bill explains why.

If your parent is in a Qualified Medicare Beneficiary (QMB) program, Medicare providers aren't allowed to bill them for Medicare-covered costs. That includes deductibles, coinsurance, and copays.

Step 7: Pay from your parent's money, and read before you sign

When a bill is correct, pay it from your parent's accounts, not yours. Keeping the money separate helps show the debt is theirs.

Be careful with anything you're asked to sign. The CFPB warns caregivers to watch for terms like "responsible party" and "joint and several liability." Ask what a term means before you sign. If you sign for your parent, ask whether you're signing as their representative or agreeing to pay yourself.

If your parent is moving into a nursing home

Federal rules protect you here. A nursing home that takes Medicare or Medicaid can't require someone else to promise to pay as a condition of admission. It can't make that a condition of a faster admission or of staying, either.

The nursing home can ask you to sign if you have legal access to your parent's income or savings. But that only means you agree to pay from your parent's funds. It doesn't make you personally liable.

If a nursing home or collector says you owe from your own money, the CFPB suggests these steps. Contact your state's nursing home survey agency or attorney general, or your local long-term care ombudsman. If you're sued, contact a lawyer right away.

Step 8: Look for financial help

If your parent can't afford a bill, there may be help. Here's where to look:

• Medicare Savings Programs. Your parent's state runs these programs. They help pay Medicare premiums and, for some people, deductibles, coinsurance, and copays. Apply through the state Medicaid office.
• Medicaid. If your parent's income and savings are limited, they may qualify.
• Hospital financial assistance. Many hospitals reduce or forgive bills for people with lower incomes. See hospital charity care. Our financial assistance request letter helps you apply.
• A payment plan. Many providers will spread a bill over time. See medical bill payment plans and our payment plan request letter.

For every option, in order, see what to do if you can't afford medical bills.

If this doesn't work

Sometimes a provider still won't talk with you, or a bill stays wrong after you call. Here's what to try:

• Ask for a supervisor or the privacy office. Explain that your parent gave permission, and offer to send the signed form again.
• Put it in writing. Send a letter that explains the error and asks for a corrected bill. Our medical bill dispute letter gives you the words.
• Appeal if Medicare denied it. The MSN explains how to appeal, and the last page has the address. File by the date shown on the MSN.
• Respond to a collection notice. If a bill goes to collections, ask the collector to verify it. Our debt validation letter can help. See your rights when a medical bill is in collections.

When to get help

You don't have to do all of this alone. It's worth getting help when:

• You can't get permission set up, or a provider won't talk with you.
• A bill is in collections, or someone says you owe from your own money.
• A nursing home asks you to sign something you don't understand.
• You're managing several providers and running out of time.

Your parent's State Health Insurance Assistance Program (SHIP) offers free, one-on-one Medicare counseling. Find yours at shiphelp.org or call 1-877-839-2675. You can also call 1-800-MEDICARE (1-800-633-4227).

A nonprofit such as Patient Advocate Foundation may help with billing problems. A medical bill advocate can take on the calls for you. For power of attorney or a lawsuit, talk with an elder law attorney or your local legal aid office.