Getting Started: Securing Permission to Contact for Medicare Sales

Before engaging with a potential Medicare client, you must take the proper first step—obtaining permission to contact. While it may be tempting to dive straight into discussing plans, compliance regulations require you to get the beneficiary’s approval first.

A Medicare sale can’t officially begin without the client’s consent, and we’re here to guide you on how to connect with prospects while staying fully compliant with the rules!

Understanding Permission to Contact (PTC) for Medicare Sales

Permission to Contact (PTC) is a compliance requirement designed to protect Medicare beneficiaries from unsolicited outreach by agents selling Medicare products.

To stay compliant, the beneficiary must initiate direct contact first. Before you can communicate with them—whether by phone, email, or other digital channels—you must obtain their explicit permission. This consent must also be properly documented.

Is Permission to Contact the Same as a Scope of Appointment?

PTC and a Scope of Appointment (SOA) serve different purposes but work together in the sales process. PTC grants you the ability to reach out to a beneficiary, such as making a call or sending a text. Once you have PTC, you can then request an SOA, which authorizes a discussion—either in person or over the phone—about the specific Medicare products the beneficiary is interested in reviewing.

When Is Permission to Contact (PTC) Required?

Agents must obtain Permission to Contact (PTC) before initiating a conversation with any prospective Medicare client, especially when discussing Medicare Advantage or prescription drug plans.

While Medicare Supplement plans are not regulated by CMS, they are still subject to Telephone Consumer Protection Act (TCPA) guidelines. Additionally, since agents often need to address prescription drug coverage for clients with Medicare Supplement policies, it’s best practice to secure PTC for all product types. This helps ensure compliance and prevents bait-and-switch tactics, such as using a Med Supp lead to sell a Medicare Advantage plan, which is strictly prohibited.

PTC Form Requirements & Exceptions

  • PTC forms must include the appropriate disclaimers. If Medicare Supplement products are mentioned, the form must clearly state: “This is a solicitation of insurance.”
  • The only exception to CMS’s unsolicited contact rules is email outreach. Agents may send unsolicited emails to potential enrollees, but:
    • Emails must include an opt-out option.
    • The content cannot be classified as marketing material (i.e., it cannot include plan premiums, co-pays, benefits details, or attempt to steer the recipient toward a specific plan).
    • Emails must comply with CMS marketing rules and the CAN-SPAM Act.

You do not need to secure PTC for existing Medicare clients already in your active client records.

How to Obtain Permission to Contact (PTC)

Since Medicare rules require the beneficiary to initiate contact, how can you legally start a conversation with a potential client?

While agents are allowed to send unsolicited emails promoting their services—provided they comply with specific regulations—direct communication, such as phone calls or texts, requires explicit Permission to Contact (PTC).

Below are key guidelines on how to properly collect PTC and ensure compliance.

Medicare PTC Guidelines

Can Can’t
  • Send out business reply cards (BRCs)
  • Contact a beneficiary after they request a return call
  • Contact a beneficiary after they fill out an online contact form
  • Contact through email with opt-out option
  • Direct message through social media
  • Text message
  • Go door to door
  • Collect contact for spouse (PTC must be provided by each individual)

To attract potential clients and create opportunities to obtain Permission to Contact (PTC), consider promoting your services strategically. Some effective approaches include:

  • Building partnerships with local businesses and community organizations to increase visibility.
  • Maintaining a professional website where prospects can learn about your services and submit their contact consent.
  • Including your phone number in both traditional and digital advertisements, ensuring your outreach efforts reach a wider audience.

By leveraging these methods, you can naturally encourage prospects to initiate contact while staying compliant with Medicare regulations.

When Does Medicare Permission to Contact (PTC) Expire?

Once a beneficiary grants Permission to Contact (PTC), agents selling Medicare or prescription drug plans have 12 months from the date of the beneficiary’s signature or their request for more information to reach out before the permission expires.

Staying Compliant When Working with Third-Party Lead Providers

If you rely on third-party lead providers to connect with beneficiaries, they must adhere to strict compliance guidelines on your behalf. These include:

  • Disclosure of Third-Party Relationships

    • Notify Essential Care and/or carriers of any subcontracted partnerships used for marketing, lead generation, or enrollment.

  • Reporting Compliance Issues

    • Submit monthly reports to Essential Care and/or carriers detailing any staff disciplinary actions related to beneficiary interactions.

  • Proper Disclosure to Beneficiaries

    • Inform beneficiaries during lead-generation activities that their information will be shared with a licensed insurance agent for future contact:
      • Verbally when communicating by phone.
      • In writing when using mail or paper correspondence.
      • Electronically when reaching out via email, online chat, or digital messaging platforms.
    • Clearly disclose when transferring a beneficiary to a licensed insurance agent who can discuss enrollment options.

  • Restrictions on Data Sharing

    • Do not share beneficiary information with other Third-Party Marketing Organizations (TPMOs) unless the beneficiary has provided prior express written consent.
    • According to CMS, TPMOs include organizations that receive compensation for lead generation, marketing, sales, and enrollment activities within the chain of enrollment.
    • Beneficiaries must be given a clear and conspicuous disclosure listing every entity receiving their data, along with the option to approve or decline data sharing with each individual TPMO.

 

Stay Compliant & Start the Conversation the Right Way

Every agent is eager to connect with potential clients, but understanding compliance requirements is the first step. By following these Medicare PTC guidelines, you can build relationships with prospects while ensuring every interaction remains fully compliant!

Not affiliated with or endorsed by Medicare or any government agency.

 

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