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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.

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Medicare educational events are to teach people about Medicare, not to sell them a plan. Here's what you need to know:

Goal: Teach people about Medicare (Original Medicare, Advantage Plans, Part D) and how to sign up. No selling specific plans.

Talk about:

What Medicare is and what it covers.
Who can get Medicare.
When you can sign up.
Where to find more information.to record face-to-face meetings for marketing and sales.

Rules:

Teach, Don’t Sell: Don’t give out marketing materials or sign people up at the event.
Generic Information Only: You can give general Medicare brochures, business cards, and contact information for later appointments.
Answer Questions: Answer questions about Medicare options but don’t push any specific plans.
Public Place: Events must be in public places, not in homes or one-on-one.
Advertise As Learning: Tell people it’s an educational event.

Uncategorised

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