When beginning a relationship with a potential Medicare client, it can be tempting to dive straight into selling. However, there are important steps to take before doing so, with the most crucial being obtaining permission to contact.
You cannot initiate a Medicare sale without explicit consent from the beneficiary. We’re here to guide you through the process of connecting with prospective clients while staying fully compliant with the regulations!
What Is Permission to Contact for Medicare Sales?
Permission to contact (PTC) is a safeguard designed to protect Medicare beneficiaries from unsolicited outreach by agents selling Medicare products. In the past, some agents used misleading tactics, pressuring beneficiaries into plans that benefitted the agent with commissions but didn’t necessarily meet the client’s needs—exactly what you want to avoid.
To stay compliant, the key rule is that the beneficiary must initiate the first direct contact. You cannot reach out to a Medicare beneficiary directly—whether by phone, text, or other digital means—without their explicit permission. This consent must also be properly documented.
Is Permission to Contact the Same as a Scope of Appointment?
While PTC and a Scope of Appointment (SOA) are related, they serve different purposes in the sales process. PTC is required before you can make any contact with a beneficiary. Once you have permission, you can then collect a Scope of Appointment, which allows you to have a more specific discussion—either in person or over the phone—about the Medicare products the beneficiary is interested in during a formal appointment.
When Is Permission to Contact Required?
Agents must obtain Permission to Contact (PTC) before initiating any conversation with potential Medicare clients, particularly those interested in Medicare Advantage or prescription drug plans. Even though Medicare Supplement plans are not regulated by CMS, they still fall under the guidelines of the Telephone Consumer Protection Act (TCPA). Additionally, since Medicare Supplement clients often need prescription drug coverage, it’s a best practice to secure PTC for all product types to avoid any bait-and-switch scenarios, such as selling a Medigap lead a Medicare Advantage plan, which would be non-compliant.
It’s also important to include the proper disclaimers on the PTC form. If Medicare Supplement products are part of the product scope, the disclaimer “This is a solicitation of insurance” must be clearly stated.
The only exception to CMS’s unsolicited contact rules is that agents are allowed to send unsolicited emails to potential enrollees, as long as the emails include an opt-out option and do not qualify as “marketing materials.” This means the content must not include details like plan premiums, co-pays, or benefit information, nor should it attempt to steer recipients toward a specific plan. In addition to following CMS marketing guidelines, these emails must comply with the CAN-SPAM Act requirements.
You do not need to obtain PTC for clients who are already in your current client records.
How to Obtain Permission to Contact
So, how can you initiate a conversation with a potential client when the beneficiary must be the one to start the contact? While agents are allowed to send unsolicited emails to market their services—as long as they meet specific requirements—having an actual conversation requires you to first collect Permission to Contact (PTC). Below, we outline some key guidelines for doing so effectively.
Guidelines for Obtaining Medicare Permission to Contact (PTC)
| CAN | CAN’T |
| · Send business reply cards (BRCs) to prospects.
· Reach out to a beneficiary after they request a call back. · Follow up with a beneficiary after they submit an online contact form. · Send emails with an opt-out option for future communications. |
· Send direct messages through social media platforms.
· Communicate via text message. · Engage in door-to-door outreach. · Obtain individual permission to contact (PTC) for each spouse separately. |
To attract potential clients and gather their Permission to Contact (PTC), we suggest promoting your services as an agent by forming affinity partnerships with local businesses, maintaining a professional website, and featuring your contact information in advertisements for your services, both through traditional and digital marketing channels.
When Does Medicare Permission to Contact Expire?
Once you receive a Permission to Contact (PTC) from a beneficiary, you have 12 months from the date of the beneficiary’s signature or their request for more information to reach out. After that, the PTC expires.
Staying Compliant When Working with Third-Party Providers
If you use a third-party lead provider to connect with beneficiaries, they must also follow compliance guidelines on your behalf, including:
- Disclosing any subcontracted relationships (like third-party lead-generation companies) used for marketing, lead generation, or enrollment to Essential Care and/or carriers.
- Reporting monthly to Essential Care and/or carriers any staff disciplinary actions related to beneficiary interactions.
- Informing beneficiaries during lead-generating activities that their information will be shared with a licensed insurance agent for future contact. This disclosure should be made:
- Verbally, if communicating via phone.
- In writing, if communicating via mail or paper materials.
- Electronically, if communicating through email, online chat, or other digital messaging platforms.
Final Thoughts
Every agent wants to jump in and start connecting with potential clients, but it’s essential to understand the necessary steps before those conversations can begin. Use our Medicare PTC guidelines to initiate the process and ensure compliance every step of the way!
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