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Medicare has rules about what agents need to talk about with beneficiaries before signing someone up for a plan. Using a checklist helps agents stay organized and make sure they talk about everything important. Use the checklists below to help improve your appointments this AEP.

Before the Appointment:

You can’t treat insurance premiums as qualified medical expenses unless the premiums are for any of the following:

• Confirm Appointment: Make sure you know when and where the meeting is.

• Gather Information: Get the client’s name, contact info, and if they can get Medicare.

• Review Client Needs: Find out about their current healthcare, medicines, doctors, and budget.

• Prepare Materials: Bring brochures, plan summaries, and cost tools.

• Print Forms: Have “Scope of Appointment” and enrollment forms ready. The SOA should be done 48 hours before the meeting.

At the Appointment:

• Introduction & Disclosures:
  
  • Say who you are and give a business card.
  • Explain you are not with Medicare or the government.
  • Tell them plans are under contracts with CMS and renew yearly.
  • Briefly explain how you get paid.
• Medicare Overview:
  
  • Explain the four parts of Medicare (A, B, C, D) if needed.
  • Explain the difference between Original Medicare and Medicare Advantage.
• Needs Assessment:
  
  • Ask questions to understand their healthcare needs and budget.
  • Examples: “What do you like about your current plan?” “Any concerns?” “Worried about costs?”
• Plan Presentation:
  
  • Show plans that fit their needs with pros and cons.
  • Use simple language and don’t overload them with info.
  • Focus on benefits they care about (e.g., doctors, medicines, vision/dental).
  • Explain key features like network type, premiums, co-pays, deductibles.
  • Use summaries and cost tools for clarity.
    
• Address Concerns & Questions:
  
  • Give them time to ask questions and share concerns.
  • Answer honestly and don’t mislead.
    
• Enrollment Process (if applicable):
  
  • Only proceed if they are ready to enroll.
  • Review the plan details again and answer final questions.
  • Help fill out the enrollment form correctly.

After the Appointment:

• Thank the Client: Thank them for their time and say you’re available for more questions.
• Provide Resources: Give more plan info or contact details if needed.
• Follow Up: Schedule a follow-up call to make sure the plan is a good fit.

Additional Tips:

• Be Patient & Respectful: Medicare decisions are important. Be patient with their questions and concerns.
• Maintain Ethical Standards: Focus on their needs, not just selling a plan.
• Comply with Regulations: Make sure all materials and presentations are CMS-approved.

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There is a big difference between communication and marketing in Medicare. It’s all about what they want to do and what they say.

Communication:

You can’t treat insurance premiums as qualified medical expenses unless the premiums are for any of the following:

Communication:

• Gives facts about Medicare plans.

• Goal: To inform and educate.

• Does not try to make you choose a specific plan.

• Examples:
  
  • A brochure that explains different types of Medicare plans (like Advantage vs. Supplement) without naming any companies.
  • A letter telling you what services an agent can provide.
  • A reminder letter to set up an appointment.

Marketing:

• Tries to make you choose a specific Medicare plan.
  
  
• Goal: To persuade and promote a plan’s features and benefits.
  
  
• Includes details about costs (like premiums, deductibles, copays) and plan highlights.
  
  
• Examples:
  • A TV ad promoting a plan with $0 premiums.
  • A flyer comparing benefits of two different plans.
  • A sales agent talking about the advantages of a specific plan.

Marketing is a part of communication. All marketing is communication, but not all communication is marketing.

Also: 

• CMS has strict rules for Medicare marketing materials to make sure the information is fair and accurate.
• Marketing materials must be reviewed by CMS before use. Communication materials do not need approval.

Clear communication helps people make good decisions about their Medicare coverage.

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The Centers for Medicare & Medicaid Services (CMS) has rules for recording Medicare sales calls. Here are the main points:

• Calls to Record: The recording requirement applies to all sales and enrollment calls where specific plan benefits are discussed, and the goal is to enroll a customer in a Medicare plan. This includes both incoming and outgoing calls, as well as virtual meetings held using platforms like Zoom or FaceTime. 
• Record the Whole Call: Don’t stop recording in the middle. You need to record the entire call, including when you ask for permission to record and read the required disclaimer (on applicable calls).
• No Recording for In-Person Meetings: You don’t have to record face-to-face meetings for marketing and sales.
• Keep Recordings for 10 Years: Make sure your recording system is HIPAA compliant and can keep the recordings for at least ten years.
• Exceptions for Non-Enrollment Calls: Calls that don’t help people sign up, like questions about ID cards or general info, don’t need to be recorded.