Every Medicare relationship begins with a first step — but before you can discuss plans or start selling, you must have the beneficiary’s permission to contact.
No Medicare sale can move forward without that initial approval. Don’t worry — we’ll walk you through exactly how to reach out to prospects compliantly while building meaningful connections the right way.
What Is Permission to Contact (PTC) in Medicare Sales?
Permission to Contact (PTC) is designed to protect Medicare beneficiaries from receiving unsolicited outreach from agents promoting Medicare plans.
To stay compliant, the beneficiary must initiate the first contact — you cannot call, text, or message them until they have given explicit, documented permission for you to do so. This ensures that all communication begins with the beneficiary’s consent and in accordance with CMS rules.
How Does Permission to Contact Differ from a Scope of Appointment (SOA)?
While PTC and SOA are related, they serve different purposes in the sales process — and both are required for compliance.
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PTC grants you the right to reach out to the beneficiary, allowing you to make initial contact.
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SOA outlines which Medicare products you’re authorized to discuss once an appointment is scheduled.
In short: you need PTC to make contact, and once that’s secured, you can obtain an SOA to conduct a compliant discussion about plan options.
When Is Permission to Contact (PTC) Required?
Agents must obtain Permission to Contact (PTC) before initiating any communication with a prospective Medicare client, especially when discussing Medicare Advantage or Prescription Drug Plans (PDPs).
While Medicare Supplement (Medigap) policies are not regulated by CMS marketing rules, they are still subject to the Telephone Consumer Protection Act (TCPA). Since conversations about Medigap plans often lead to discussions about prescription drug coverage, it’s best practice to secure permission for all product types from the start. This helps prevent bait-and-switch situations, such as presenting a Medigap lead and then pivoting to a Medicare Advantage plan — which is non-compliant.
PTC Form Requirements
Your PTC form must include proper CMS-compliant disclaimers. If the form covers Medicare Supplement products, it must clearly state:
“This is a solicitation of insurance.”
Exceptions for Unsolicited Contact
Under CMS guidelines, agents may send unsolicited mail or email to potential beneficiaries to market their services, but with strict limitations:
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The email must include an opt-out option.
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The content cannot qualify as marketing material — meaning it cannot include plan premiums, copay details, or benefits information, nor attempt to steer a beneficiary toward a specific plan.
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Emails must also comply with the CAN-SPAM Act requirements.
Existing Clients
You do not need new PTC for current clients already in your records, as they have an existing relationship with you.
How to Obtain Permission to Contact (PTC)
You might be wondering — if the beneficiary must initiate contact, how can you begin a conversation with a potential client?
Agents are allowed to send unsolicited emails to market their services, provided those emails meet CMS and federal compliance requirements. However, before you can speak directly with a beneficiary about Medicare plans, you must first collect documented Permission to Contact (PTC).
Here are a few key guidelines to help you do it correctly.
PTC Guidelines for Medicare
To attract potential clients and create opportunities to collect PTC, consider promoting your services through multiple trusted channels. Partner with local community organizations or businesses, maintain a professional business website, and include your contact information on advertisements for your services — both in traditional media and digital marketing platforms.
These efforts help prospects discover you organically and provide a compliant way for them to initiate contact and grant permission for follow-up communication.
When Does Medicare Permission to Contact (PTC) Expire?
Once a beneficiary grants Permission to Contact (PTC), an agent selling Medicare Advantage or Prescription Drug Plans has up to 12 months — starting from either the beneficiary’s signature date or the date they requested more information — to contact them. After this period, the PTC expires and must be renewed before any further outreach.
Staying Compliant When Working with Third-Party Lead Providers
If you work with a third-party marketing organization (TPMO) or lead generation company, you are still responsible for ensuring full compliance with CMS regulations. These partners must follow the same rules that apply to you.
To remain compliant:
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Disclose Relationships
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Report to Essential Care and/or the carriers any subcontracted relationships, including third-party vendors used for marketing, lead generation, or enrollment activities.
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Report Disciplinary Actions
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Submit a monthly report to Essential Care and/or the carriers detailing any staff disciplinary actions related to beneficiary interactions.
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Inform Beneficiaries During Lead Generation
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Clearly disclose to beneficiaries that their information will be shared with a licensed insurance agent for follow-up contact.
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Verbally, when speaking over the phone
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In writing, when using mail or printed communication
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Electronically, when communicating via email, chat, or other digital platforms
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Disclose Transfers
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When transferring a beneficiary to a licensed agent, clearly inform them that they are being connected with someone who can assist with plan enrollment.
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Protect Beneficiary Data
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Do not share personal beneficiary information with other TPMOs unless the beneficiary provides prior express written consent.
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CMS Definition of a TPMO
A Third-Party Marketing Organization (TPMO) is defined by CMS as “an organization compensated to perform lead generation, marketing, sales, and enrollment-related functions as part of the chain of enrollment.”
To share beneficiary data or contact information, TPMOs must obtain express written consent through a clear and conspicuous disclosure that:
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Lists each entity receiving the data, and
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Allows the beneficiary to opt in or out of sharing their information with each specific TPMO.
Every agent is eager to connect with new clients — but before starting any conversations, it’s essential to understand the compliance steps that must come first.
Follow our Medicare Permission to Contact (PTC) guidelines to lay the proper foundation and ensure you stay fully compliant from the very first interaction onward!
Not affiliated with or endorsed by Medicare or any government agency.
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