Selling Medicare plans face-to-face can be very effective, but it requires the right approach to ensure a successful client interaction. Unlike online or phone-based sales, in person meetings allow agents to build trust, address concerns directly, and provide a more personalized experience. Our tips for in person Medicare sales will help agents formulate a sales strategy and expand their book of business.
Do your research
Before meeting a potential client, take the time to understand their specific needs. Having clients fill out a well designed fact finder can provide a roadmap for agents to identify client needs and preferences. Being prepared demonstrates professionalism and allows you to provide relevant options.
Ask questions to help determine the best coverage options
- What are the preferred doctors and hospitals?
- Do they take any prescription medications?
- What is the monthly budget for healthcare expenses?
- Do they travel frequently or spend part of the year in another state?
This goes back to the fact finder suggestion. These insights help tailor recommendations to the unique needs of each individual.
Create a professional first impression
First impressions matter. Dress appropriately, arrive on time, and maintain a friendly yet professional demeanor. Be aware of the client’s needs and preferences and follow all CMS guidelines. Bring all necessary materials, such as brochures, plan comparisons, and enrollment forms, to ensure a smooth meeting.
Form a personal connection
Medicare decisions can be overwhelming for clients. Establish rapport by engaging in friendly conversation and showing genuine interest in their concerns. Building trust makes it more likely they will rely on your guidance and even recommend you to their friends or family.
Learn how to maintain your book of business
Educate rather than sell
Instead of trying to push a specific plan, focus on educating the client about their coverage options. Explain the differences between plan types (Medicare Advantage, Supplement plans, and Part D) in understandable terms. Do not use industry jargon that may confuse clients.
Do not pressure clients to enroll in a plan. Be transparent with all plan benefits and costs. Let prospects consider all information and enroll if they are comfortable. If they choose not to enroll, respect their decision and let them know you are available if they need assistance in the future.
What you need to know before a Medicare sale – Watch a quick YouTube video
Use visual aids and examples
Many clients understand information better when it is presented visually or in a practical context. When possible, use plan comparison charts, benefit breakdowns, and real-life scenarios to illustrate coverage differences and potential costs.
Address concerns
It is very common for clients to have concerns about cost, coverage limitations, or provider networks. Be prepared to address objections with clear explanations of plan benefits, potential cost savings, and alternative options.
Follow all CMS and carrier guidelines
Always adhere to CMS (Centers for Medicare & Medicaid Services) and carrier regulations when discussing plans. Avoid misleading statements, ensure proper documentation, and provide all required disclosures to maintain ethical and legal compliance. This helps protect both the client and the agent in the event questions arise later.
Learn about the Medicare Scope of appointment
Follow Up
A simple follow-up call or email reinforces your commitment to client satisfaction. Check in to see if they have additional questions or need further clarification before making a decision. Agents should also follow up after the enrollment to be sure clients know they are available if any concerns arise later. This helps reinforce the relationship and the client’s confidence in choosing an agent.
Continue learning
Because Medicare plans and regulations change every year, it is important to stay updated on plan details, industry news, and new regulations. This helps you provide the best service to your clients.
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In-person Medicare sales provide agents with the opportunity to build meaningful relationships and offer personalized guidance. By focusing on trust, education, and professionalism, agents can build their book and become valued members of the community.
Are you interested in joining the Crowe team – click here for online contract
Understanding rapid disenrollments and their impact on agents
If you are in Medicare sales, you may hear the term rapid disenrollment. Newer agents may wonder; what are Medicare rapid disenrollments. We explain a little about this term and how it affects agents below.
Although you may have done your best, not every enrollee remains satisfied with their plan choice. When a beneficiary quickly disenrolls from a Medicare Advantage plan, this is known as a rapid disenrollment. While this can be frustrating for the beneficiary, it also has significant repercussions for agents who sell these plans.
What is a rapid disenrollment
A rapid disenrollment occurs when a beneficiary leaves their Medicare Advantage plan within the first three months of enrollment. This happens for a variety of reasons, including dissatisfaction with provider networks, unexpected costs, confusion about benefits, or an agent not properly explaining the plan’s details.
Rapid disenrollments can take place during the Medicare Advantage Open Enrollment Period (January 1 – March 31) or via ann SEP (Special Enrollment Period) if the beneficiary has a qualifying life event.
Why rapid disenrollments matter
For agents, rapid disenrollments can have significant financial and professional consequences:
- Chargebacks – When a beneficiary disenrolls early, agents often face a chargeback, meaning they must repay some or all of their earned commission from that sale. This can significantly impact an agent’s earnings, particularly if multiple rapid disenrollments occur.
- Compliance scrutiny – High disenrollment rates may trigger compliance audits by CMS (Centers for Medicare & Medicaid Services) or plan sponsors. If an agent is found to have misrepresented a plan or failed to properly educate the enrollee, they could face penalties or even be barred from selling Medicare plans.
- Reputation damage – If beneficiaries frequently disenroll from an agent’s recommended plans, it can damage the agent’s reputation in the industry. Clients may leave negative reviews or hesitate to trust the agent in the future.
Join the team at Crowe – fill out an online contract
Reduce rapid disenrollments
- Conduct thorough needs assessments – Before enrolling a client in a Medicare plan, agents should take the time to understand the client’s healthcare needs, budget, and provider preferences. Making sure the plan chosen aligns with these factors reduces the likelihood of disenrollment.
- Explain all costs and coverage – Unexpected costs, such as high copayments or out-of-network charges, often lead to disenrollment. Agents should clearly explain all costs associated with a plan so beneficiaries can make informed decisions.
- Follow Up with Clients – A simple follow-up call after enrollment can address any concerns early and prevent clients from making hasty disenrollment decisions. Providing ongoing support builds trust and reduces confusion.
- Stay Educated on Plan Changes – Medicare plans change annually. Agents who stay updated on plan benefits, provider networks, and formulary adjustments can better guide their clients toward the most suitable options.
- Ensure CMS Compliance – Agents should always follow CMS marketing guidelines to avoid misleading beneficiaries. This includes proper documentation and full disclosure of plan details.
Watch a quick video on the FCC one to one consent rule
Although disenrollment can sometimes be unavoidable, agents who are well educated, transparent, and ethical can reduce its occurrence. By following the rules and understanding clients’ needs, they can protect their commissions, maintain a good professional reputation, and, most importantly, ensure beneficiaries receive the best possible coverage for their needs.
Medicare Part D is prescription drug coverage and is essential for anyone enrolled in Medicare. Understanding when to enroll in Medicare Part D is extremely important for both beneficiaries and agents. Medicare beneficiaries not enrolled on time will be without coverage resulting in a life-long penalty.
Initial Enrollment Period (IEP)
The IEP ( Initial Enrollment Period) is the first opportunity beneficiaries have to enroll in a Medicare plan. If the beneficiary enrolls in Medicare at this time, they should make sure to include Part D coverage. During the IEP, beneficiaries can choose either a stand alone Part D plan or a Medicare Advantage Plan with drug coverage MAPD plan.
The IEP is a 7 month window when a beneficiary turning 65 can enroll in Medicare. It starts three months before the beneficiary’s 65th birthday month and ends three months after their 65th birthday month.
Those eligible for Medicare due to a disability have an IEP. The IEP starts three months before their eligibility date and ends three months after the 25th month of receiving disability benefits.
Annual Enrollment Period (AEP)
The Annual Enrollment Period (AEP), also called Open Enrollment, takes place from October 15 until December 7 each year. During this time, beneficiaries can enroll in a Part D (PDP) plan if they did not enroll during their IEP. For those already enrolled in a PDP plan, this is an opportunity to look at current coverage and change to a plan that provides better coverage. Plan enrollees can switch from one Part D plan to another or enroll in an MAPD plan.
Please note: changes made during AEP take effect on January 1st of the following year.
Special Enrollment Periods (SEPs)
SEPs provide an opportunity to make changes to Medicare coverage. This includes Medicare Part D outside the standard enrollment periods when the following circumstances occur:
- They move their place of residence and it is outside the service area of their current plan. When this happens, the enrollee is eligible for an SEP.
- If the beneficiary is eligible for Extra Help, they can change their Part D coverage once during each of the first 3 quarters of the calendar year.
- When there is loss of creditable prescription coverage (not due to non-payment), they have 63 days to enroll in a new PDP plan. Most commonly, this happens when a beneficiary comes off employer sponsored coverage.
- In the event a plan leaves the current service area, beneficiaries have 63 days to move to a new PDP plan.
Medicare Advantage Open Enrollment Period (MA OEP)
This enrollment period is only available to those currently enrolled in a Medicare Advantage plan. It runs from Jan 1 through March 31 each year. During this time, plan enrollees have an opportunity to change their current MA/MAPD plan. The MA OEP allows beneficiaries to change from one Medicare Advantage plan to another Medicare Advantage plan either with or without Part D coverage. They can also disenroll from a Medicare Advantage plan and go back to Original Medicare with the option to enroll in a stand alone Part D plan and a Medicare Supplement.
Watch a quick YouTube video on OEP best practices
Important: beneficiaries must have a guaranteed issue election or pass underwriting to enroll in a Medicare Supplement plan.
Late Enrollment Penalty (LEP)
Those who enroll in Part D coverage when first eligible can avoid late enrollment penalties. The LEP applies to Medicare beneficiaries who go without creditable prescription drug coverage for a period of 63 consecutive days or more once their IEP ends.
CMS calculates the penalty based on how long the beneficiary went without coverage. Once they have that figure, they add it to the monthly Part D premiums for life. This applies even when the enrollee has a $0 MAPD plan. Although those who receive Extra Help do not have to pay the penalty.
It is important to understand Medicare Part D enrollment periods and rules to avoid penalties and ensure beneficiaries have the coverage they need.
At some point, some individuals with prescription coverage may find their prescription drug copay higher than expected. This could mean, the drugs are on a higher tier and therefore the copay is more. Higher tiered drugs are more expensive than lower tiered drugs. Although this can make out-of-pocket expenses significantly greater than expected, beneficiaries can request a tier exception. This may help lower the copay for the medication. In this post, we discuss how to request a tier exception.
What is a tier exception
A tier exception is a formal request individuals send to their insurance provider asking them to cover a drug at a lower cost tier. Typically, each insurance plan has a formulary (list of covered drugs) where they categorize medications into different tiers. Generic drugs are in the lowest-cost tiers and specialty or brand-name drugs in the highest-cost tiers. Individuals who have medication on a high-cost tier and cannot afford their copay can request an exception to lower their costs.
Review the formulary
Individuals should check their insurance provider’s formulary, which is the list of covered medications and their respective tiers. This cost for drugs on each tier is available in the plan’s evidence of coverage. Enrollees can also request a plan formulary from the plan provider or review it on the plan’s website. If the drug is on a high-cost tier, check and see if there are lower-tier alternatives that might work. If that is not an option, a tier exception may provide a way to afford the necessary medication.
Learn about Medicare Part D 2025
Obtain a supporting statement from the doctor
The enrollee’s insurance company will require a supporting statement from the prescribing doctor explaining why lower-tier alternatives are not suitable for the individual. The doctor must specify that:
- The lower-tier medications have been ineffective or would cause adverse effects.
- The requested drug is necessary to treat the specific condition.
Submit a formal request to the insurance carrier
Contact the insurance company to obtain the tier exception request form. The doctor’s office may be able to do this for the patient. Complete the form, attach the supporting statement, and submit it through the insurance company’s designated method (fax, email, mail, or online portal).
Wait for a decision
In the majority of cases, insurance carriers have 72 hours to make a decision on a standard request. If the situation is urgent and the medication is needed immediately, request an expedited review, which requires a response within 24 hours.
If the request is approved
The drug will be covered at a lower cost sharing amount that applies to the new drug tier. In most cases, the approval will last until the end of the calendar year. Beneficiaries may request the drug tier be honored the following year. In the event the carrier does not allow the exception the following year, the plan enrollee can start the process over again or use the Medicare AEP to find a plan that covers the drug at a lower rate.
If the request is denied
If the tier exception request is denied, beneficiaries have the right to appeal the decision. Each plan will provide instructions on how to appeal, which often includes submitting additional medical documentation. If the appeal is still denied, the beneficiary can escalate it to an independent review entity.
Watch a quick YouTube video on Medicare enrollment periods
Requesting a tier exception can help make prescription medications more affordable, but it may require careful documentation and persistence. Those facing high medication costs must work closely with their doctors and insurance carrier to improve their chances of approval.
When navigating health insurance, you come across terms like coinsurance and copays both of which determine how much you pay for medical services. While some people use these terms interchangeably, they have distinct meanings and impact out-of-pocket healthcare costs differently. Understanding the differences between copays and coinsurance can help beneficiaries have a better understanding of how their coverage works.
What is a Copay
A Copay (copayment) is a fixed amount plan enrollees pay for a specific healthcare service. Copays are typically required at the time of service and apply to things like primary care or specialist visits, urgent care visits, and prescription medications.
How Copays Work
- If a health plan has a $30 copay for primary care visits, plan enrollees pay $30 each time they see their doctor, regardless of the total cost of the visit.
- When a plan specifies a $50 copay for a specialist visit, enrollees pay that amount, while the insurance covers the rest of the cost for the visit itself. Please keep in mind; some medical services include additional charges.
- Copays for prescriptions vary based on tiers (generic vs. brand-name drugs). Copays for prescriptions may vary greatly based on the drug.
What is Coinsurance
Coinsurance is a percentage of the cost for medical services, equipment or prescriptions that enrollees are responsible for after they meet the deductible. Unlike copays, which are fixed amounts, coinsurance is a percentage of the total bill.
How Coinsurance Works
- If the plan enrollee has a coinsurance of 20% and receives medical services that cost $1,000, their cost is $200. Their insurance covers the remaining $800, once they meet their annual deductible amount.
Differences Between Copays and Coinsurance
| Feature | Copay | Coinsurance |
|---|---|---|
| Payment Type | Fixed amount | Percentage of total cost |
| When It Applies | At the time of service | After meeting the deductible |
| Predictability | Predictable | Can vary depending on service cost |
| Common Examples | Doctor’s visits, prescriptions, ER visits | Hospital stays, surgeries, specialized procedures |
Which is Better: Copay or Coinsurance
Neither is inherently better. Each affects overall healthcare costs in different ways. Plans with higher copays may have lower monthly premiums, making them ideal for those who prefer predictable costs. In contrast, plans with coinsurance may have lower copays. This can result in higher out-of-pocket costs for major medical procedures.
Choosing a Plan
Those who visit doctors frequently may prefer a plan with lower copays to help save some money. It is important to consider any known major medical expenses and focus on a plan that provides a lower coinsurance amount and a manageable deductible. It is also important to be aware of the maximum out-of-pocket limit, which caps the amount enrollees pay each year before approved medical expenses are covered at 100%.
Online quoting and enrollment tools help show plan costs side by side to make choosing a plan easier. Medicare agents; click the links below to see how to run a quote on Sunfire and Connecture, our free agent quoting sites.
Agents see how easy it is to use Sunfire for a quote and an enrollment
Take a look at how to use Connecture for quoting and enrollments
Understanding how copays and coinsurance work helps individuals estimate medical expenses and choose a plan that aligns with their healthcare needs and budget. Carefully comparing these costs can help avoid unexpected bills and make the best health coverage choice for each individual
When you discuss Medicare prescription coverage with clients, understanding prescription drug tiers is imperative. Medicare Part D or Medicare Advantage plans place each drug into a specific tier. These tiers impact how much enrollees pay out of pocket for prescriptions. When clients know the tiers their medications are on, they can make informed choices and potentially save money.
What are prescription drug tiers
Prescription drug tiers are cost levels assigned to different medications within a plan’s formulary (the list of drugs each plan covers). Generally, lower-tier drugs cost less, while higher-tier drugs have higher copays or coinsurance.
Prescription drug tiers
Most Medicare Part D and Medicare Advantage drug plans use a 5-tier system, but some may vary slightly. Here’s a general breakdown:
Tier 1 – Preferred Generic Drugs
- Least expensive tier
- Includes common, low-cost generic drugs
- Lowest copay
Tier 2 – Non-Preferred Generic Drugs
- Slightly more expensive than Tier 1 drugs
- Includes common, low-cost generic drugs
- Higher copay than Tier 1
Tier 3 – Preferred Brand -Name Drugs
- Brand-name drugs that the insurance company has negotiated lower prices for
- Higher copay or coinsurance than generic drugs
Tier 4 – Non-Preferred Brand-Name Drugs
- Higher-cost brand-name drugs
- May require prior authorization or step therapy
- Higher copay or coinsurance than lower tiers
Tier 5 – Specialty Drugs
- Highest cost medications, often for complex or chronic conditions
- Typically require prior authorization
- Coinsurance instead of a set copay. In other words, beneficiaries pay a percentage of the drug cost.
In some cases, the necessary drug is not on the plan’s formulary. In that case, the beneficiary needs to request a formulary exception.
Use drug tiers to your advantage
Check the plan formulary – Every Medicare Part D or Medicare Advantage drug plan has a unique formulary. Look up medications to see which tier they fall into to see which plan is the best option.
Consider generic alternatives – Beneficiaries should ask their doctor or pharmacist if a Tier 1 or Tier 2 generic is available instead of a higher-tier brand-name drug.
Use preferred pharmacies – Many plans offer lower prices when beneficiaries fill prescriptions at “preferred” network pharmacies.
Look into tier exceptions – If a prescribed drug is in a high-cost tier, beneficiaries can request a tier exception from their plan, which may reduce their cost.
Compare plans during open enrollment – Each year, Medicare beneficiaries can review and switch plans during the Annual Enrollment Period (AEP) from October 15 to December 7 to find a plan that better suits their prescription needs.
Prescription drug tiers can significantly impact medication costs, but understanding how they work allows beneficiaries to make cost-effective choices. Always review the plan’s formulary, consider generics, and explore savings options like tier exceptions or different pharmacies. A licensed Medicare agent can help navigate drug coverage costs and plan options.
A fact finder for Medicare clients helps agents gather the information they need to provide their prospective clients personalized coverage options. Understanding a client’s healthcare needs, financial situation, and preferences is essential to find the best plan options.
A well designed fact finder provides insight for other products your client may need in the future. Keeping the fact finder in your client’s file allows you to use it for future reference.
What is a fact finder
A fact finder is a questionnaire or checklist agents use to collect important client information before making plan recommendations. It helps ensure the client receives a plan that aligns with their healthcare needs, prescription drug requirements, and budget. Many agents design their own fact finders based on their product offerings. We have included some sample fact finders below:
Download an example of a fact finder
CMS Medicare fact finder sheet for T-65 individuals.
Personal Life & DI Insurance fact finder
Why use a fact finder
Personalized Recommendations: Understanding the client’s medical history, prescriptions, and preferred providers allows agents to suggest plans that fit the client’s needs and minimize out-of-pocket costs.
Compliance and Documentation: A properly documented fact finder can help demonstrate that the agent followed CMS regulations and provided unbiased recommendations.
Client Trust and Retention: Gathering detailed information shows professionalism, making clients feel valued and confident in their choices.
Efficiency in the Sales Process: A fact finder streamlines the appointment, making the plan selection process smoother.
Components of a fact finder
To create a comprehensive Medicare fact finder, agents should include the following:
Client demographics
- Full Name
- Date of Birth
- Address
- Phone Number & Email
- Medicare Beneficiary Identifier (MBI)
Current Medicare coverage
- Does the client have Original Medicare (Part A & B)?
- What type of coverage do they currently have a Medicare Advantage or Medicare Supplement plan?
- Do they have a standalone Part D plan?
- Any employer or retiree coverage?
- Do they qualify for Medicaid or a Medicare Savings Program?
Healthcare needs
- List of current doctors and specialists
- Preferred hospitals and pharmacies
- Frequency of doctor visits
- Any planned surgeries or treatments
- Any chronic conditions (diabetes, heart disease, etc.)
Prescription drug information
- Current medications, including name, dosage, and frequency
- Preferred pharmacy (retail or mail-order)
- Any high-cost prescriptions requiring special coverage
Click here for an example of a Part D fact finder
Financial considerations
- Monthly budget for healthcare costs
- Concerns about out-of-pocket expenses
- Eligibility for Extra Help (Low-Income Subsidy) or state assistance programs
Additional benefits and preferences
- Interest in dental, vision, or hearing coverage
- Need for transportation, OTC or fitness benefits
- Preference for HMOs vs. PPOs
Decision-making preferences
- Is the client the primary decision-maker?
- Do they have a power of attorney or family member assisting with decisions?
- Preferred method of communication (phone, email, in-person)
Using the fact finder
After you introduce yourself to a new client and they feel comfortable speaking with you, you can complete a basic needs analysis. Take notes about their current plan; what they like and what they would change if possible. Find out what is most important to them and when they need the coverage.
- Keep it Conversational: Don’t make it feel like an interrogation. Use open-ended questions to gather insights.
- Explain the Purpose: Let clients know that this information helps tailor their plan selection.
- Ensure Accuracy: Confirm key details like medications and provider networks to prevent surprises later.
- Document Thoroughly: Keep a copy for future reference.
Do you need a Scope – click here
Ready to join a team that supports their agents- click here for online contract
A Medicare fact finder is an indispensable tool for agents, helping ensure clients receive the coverage best suited to their needs. By using a structured fact finder, agents can enhance efficiency, improve compliance, and build stronger relationships with their clients.
It is a good idea to repeat/review their biggest concerns and make sure you are clear on exactly what they are looking for in a health care plan. Make sure they understand you are there to show them their best options, but the decision is theirs.
Unfortunately, chargebacks are sometimes a part of Medicare sales. However if you follow the advice below, you can get some tips to help teach you how to avoid commission chargebacks.
What are chargebacks
When we refer to Medicare sales, an agent receives a chargeback if the client terminates the plan you enroll them in early. When this happens, a portion of an agent’s commission for the sale is lost. This occurs if a client either cancels their plan or passes away. When this happens, the agent must pay back a portion of any advanced commission payments they received.
In many instances agents choose to receive commission advances. In other words, the carrier pays several months of commissions on the sale of a policy up front, before the client makes their premium payments. Most agents like this because they do not have to wait to get the payment. Although, this can cause potential problems if the client cancels their policy. In that case, the agent incurs a debt to the insurance carrier.
Watch a YouTube video on how Medicare commissions pay
It is important to note: each insurance carrier has its own payment schedule and rule for chargebacks.
Don’t be surprised by chargebacks
Because most of us do not own a crystal ball; clients pass away or change their mind on their coverage choice, agents must prepare for a few chargebacks each year. It is helpful to set money aside to take care of any debt you may incur.
Pay your chargebacks
This is obvious. If you have a bill, you need to pay it. Agents who do not pay their debts may end up with a Vector hit against them. Insurance companies use this service to report unpaid debts. This will damage the agent’s credit score and can affect their ability to offer products with some carriers.
In certain situations, there are carriers who will not contract brokers with a Vector hit until the debt is paid.
Agents can pay some chargebacks directly out of their commissions if the insurance company owes them enough money to pay it. If there is not enough commission due to pay the debt, some carriers allow the agent to set up a payment plan to clear the debit.
AEP Enrollments
In some cases, enrollments that take place during AEP, are paid to agents in halves, The first half in January and the other half in February.
When the client either moves or drops their Medicare Advantage plan during the OEP, the agent receives a chargeback. That is a good reason to make sure that you are available to your clients and they do not seek another agent to answer their questions. Another agent could talk your client into a plan change during the MA OEP ending in a chargeback for you.
Find out about the 2025 Medicare commissions
Medicare Supplement chargebacks
Medicare Supplement chargebacks are much less common than MA chargebacks. In many cases, carriers pay Medicare Supplement commissions as earned. This means when the client pays their monthly premium the agent receives their commission. Sometimes agents receive commission advances anywhere from 3-12 months ahead. Because many carriers charge a small fee for advances, most agents decide to receive payments as earned. However when agents receive a chargeback for these plans, it is nominal.
Stay in touch with your clients
It is extremely important for agents to stay in contact with their clients. Agents who build a good relationship with their clients have a much lower chance of losing them to another agent. This ensures they will call you if they are considering a plan change. It is always a good idea to check in and make sure clients are happy with their coverage so you can solve any issues that come up of change their plan if necessary.
Get some tips to maintain your book of business
Some times you can’t predict losing a client due to death or other unforeseen circumstances. The best option is to make sure clients know you are available even when they are unhappy. Remember to be ready for a few chargebacks.
Watch a few Medicare agent training videos on our YouTube channel
If you are a Medicare agent offering Medicare plans this year, you need a scope of appointment for 2025 to stay compliant.
Medicare agents must follow strict compliance guidelines when marketing and selling Medicare Advantage (MA) and Medicare Part D prescription drug plans. One of the most important requirements is the Scope of Appointment (SOA) form. Understanding the SOA rules and proper collection methods is crucial to avoid compliance violations and ensure a smooth enrollment process.
What is a Medicare Scope of Appointment (SOA)
A scope of appointment is a required document that outlines the specific Medicare plans and products a beneficiary agrees to discuss with an agent. The CMS enforces this rule to prevent high-pressure sales tactics and ensure transparency in Medicare plan discussions.
Watch a quick YouTube video on SOAs
Key SOA Rules Agents Must Follow
- SOA Must Be Completed Before the Appointment
- Beneficiaries must sign the SOA at least 48 hours before the scheduled appointment unless the meeting occurs during a walk-in appointment or within the last four days of an enrollment period.
- One SOA per individual
- If the agent meets with more than one individual at a time (spouses or friends may attend a meeting together) each participant must complete a separate scope.
- SOA Must List Only Approved Topics
- The SOA form must clearly state which Medicare-related products will be discussed.
- Agents cannot discuss other plans or services not listed on the form without obtaining a new SOA.
- Agents must retain the SOA for 10 Years
- Agents must keep copies of completed SOAs for 10 years, even if no enrollment occurs.
- No Additional Product Discussions Without a New SOA
- If a beneficiary inquires about a product that is not listed on the SOA, the agent must obtain a new signed form before discussing it.
- No Unsolicited Contact
- Agents cannot call or visit potential clients uninvited to obtain an SOA. The beneficiary must initiate contact first.
SOA other lines of business
The scope also allows Medicare prospects to check off other lines of business they would like to discuss. In addition to supplements, most scopes have a section for vision, dental, hearing and hospital indemnity based products. These products are considered health products and can be reviewed/sold during the appointment.
Ways to collect SOAs
There are multiple compliant ways to obtain a Scope of Appointment form, ensuring flexibility for both agents and beneficiaries.
Paper SOA Forms
- Many agents still use traditional paper SOAs. Beneficiaries sign a printed form and return it via fax, email, mail, or in person.
- This method is reliable but may slow down the enrollment process if mail is the preferred method.
Electronic SOA (E-Signature)
- Many Medicare enrollment platforms allow agents to collect SOAs electronically.
- Beneficiaries can sign via email, a website portal, or a tablet during in-person meetings.
- This method is fast, efficient, and easy to store for compliance purposes.
Find out about Sunfire and Connecture; our online enrollment portals
Telephonic SOA (Recorded Call)
- CMS allows SOAs to be collected via recorded phone calls, as long as they meet CMS requirements.
- Many call centers and agents use CMS-approved systems to record SOAs for compliance.
- Beneficiaries must clearly agree to the scope verbally, and agents must store the recording for 10 years.
Learn about call recording compliance
Text Message (SMS) SOA
- Some Medicare enrollment tools now offer SOA collection via text message links.
- Beneficiaries receive a secure link to review and sign the SOA digitally on their phone.
- This method is growing in popularity due to its convenience.
In-Person SOA Collection
- When meeting face-to-face, agents can have the beneficiary sign a paper or electronic SOA before discussing any plans.
- Walk-in meetings are an exception to the 48-hour rule, but agents must still collect an SOA before starting the discussion.
Ready to join the team at Crowe; click here for online contract
Avoiding common SOA mistakes
- Failing to get the SOA 48 hours in advance (except for walk-ins or last-minute AEP enrollments).
- Discussing unlisted products without obtaining a new SOA.
- Not storing SOAs properly for the required 10 years.
- Using outdated or non-compliant SOA forms that do not meet CMS guidelines.
The Scope of Appointment requirement is a key part of Medicare sales compliance. It protects both clients and agents as it states exactly what you agreed to speak about. Agents must ensure they collect and retain SOAs properly to avoid penalties and maintain ethical sales practices. By leveraging modern technology like e-signatures, telephonic SOAs, and text-based approvals, agents can streamline the process while staying fully compliant with CMS rules.
Click here if you need a generic scope of appointment form
Spanish scope of appointment form – click here
Life is unpredictable, and a sudden diagnosis of a critical illness can bring both emotional and financial stress. The value of critical illness insurance is the financial protection it provides by offering a lump sum payout if an individual is diagnosed with a covered condition. This lets them focus on recovery rather than worrying about medical bills and lost income. Here’s why investing in critical illness insurance is a smart decision.
What is critical illness insurance
Critical illness insurance is a policy that pays a tax-free lump sum upon the diagnosis of a severe health condition such as cancer, heart attack, stroke, or organ failure. Unlike traditional health insurance, which covers only medical expenses, this policy provides funds beneficiaries can use for various needs, including:
- Medical treatments not covered by health insurance
- Travel for medical care
- Mortgage or rent payments
- Household bills and daily living expenses
Benefits of critical illness insurance
- Financial Security During Recovery
A serious illness can impact the ability to work, leading to lost income. The payout from critical illness insurance can help replace lost wages and maintain your standard of living. - Coverage for Non-Medical Expenses
Although health insurance covers hospital and medical bills, it doesn’t pay for things like home modifications, transportation to treatments, or additional caregiving needs. Critical illness insurance fills this gap. - Protection from Rising Healthcare Costs
The cost of treating serious diseases continues to rise. Even with health insurance, high deductibles, copays, and out-of-network charges can be overwhelming. A critical illness policy ensures additional financial resources to cover these costs. - Peace of Mind
Knowing that you have financial support in the event of a major illness allows you to focus on recovery rather than stressing about expenses. This provides stability and reassurance to the patient and their loved ones.
Learn about Mutual of Omaha Critical Illness insurance – watch a detailed video
Critical illness insurance is beneficial for
Individuals with a family history of one or more critical illnesses should consider adding this coverage. Those who are self-employed or do not have employer-provided coverage may want to enroll in a plan. In some cases, the individual has coverage with a high-deductible and needs help with out of pocket expenses.
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Anyone who wants to protect their savings from financial strain due to a major illness. Critical illness insurance serves as an important financial safety net, helping families navigate the challenges of a serious diagnosis.
By investing in this coverage, enrollees can ensure financial stability and peace of mind during difficult times. A licensed insurance agent can help review your current insurance portfolio to determine if critical illness insurance is a the right option for you.
If you’re a Medicare beneficiary with higher income, you may be subject to the Income-Related Monthly Adjustment Amount (IRMAA) for your Medicare Part B and Part D premiums. However, if your income has recently decreased due to qualifying life events, you may be eligible to appeal the IRMAA determination. Here’s what you need to know about how to appeal an IRMAA.
What is an IRMAA
The Medicare Income-Related Monthly Adjustment Amount (IRMAA) is an extra charge added to Medicare Part B and Part D premiums if the beneficiary’s income exceeds certain thresholds. The Social Security Administration (SSA) determines IRMAAs based on the tax return from two years prior. In other words, a 2025 IRMAA is based on 2023 income.
IRMAA brackets 2025
When you can appeal an IRMAA
Medicare beneficiaries may appeal an IRMAA redetermination if they experience a significant life-changing event that cause a reduction in income. Qualifying events include:
- Marriage, divorce, or annulment
- Death of a spouse
- Retirement or reduction of working hours
- Loss of a pension or settlement of an employers pension plan
- Loss of income-producing property due to a disaster or other circumstance
Any of these situations may cause a decrease in income. This provides grounds for an appeal.
How to File an IRMAA Appeal
To file an appeal, beneficiaries must complete Form SSA-44, Medicare Income-Related Monthly Adjustment Amount – Life-Changing Event. Here’s how to do it:
- Download the Form – Obtain Form SSA-44 from the Social Security website or by at the local Social Security office.
- Complete the Form – Provide details about the life-changing event, including supporting documentation (such as a marriage certificate, employer statements, or tax returns).
- Submit the Form – Either mail or deliver the completed form and supporting documents to the local Social Security office.
- Await a Decision – SSA will review the request and notify the beneficiary of the outcome. If they deny the appeal, the beneficiary may request a further review.
To Sum it up
If your income changes due to a qualifying event, don’t hesitate to appeal an IRMAA determination. Many beneficiaries successfully lower their Medicare premiums through this process. Be sure to gather all necessary documentation and submit the appeal as soon as possible to avoid overpaying.
For more details, visit the official Social Security Administration website or contact your local SSA office.
Medicare Supplement (Medigap) insurance is one of many great products for Medicare agents to offer their clients. They continue to provide a good source of income to agents with their stable commission structure and renewal income. The Medicare Supplement commissions 2025 remain the same as they have been in prior years. We will explain what to expect regarding payment of these commissions below.
How Medicare Supplement Commissions Work
Medigap commissions are structured differently than Medicare Advantage (MA) or Part D plans. Instead of receiving a one-time upfront payment, Medigap agents typically earn level commissions over multiple years. Here’s an overview of the commission structure:
- Initial Year Commission – Agents earn a commission based on a percentage of the first-year premium, typically between 20 and 22%.
- Renewal Commissions – In most cases, Medigap policies pay renewal commissions for a period of 6 years.
- Varying Payouts by State – Some states and carriers impose limits on commission percentages, affecting how much agents can earn.
How Agents Receive Medicare Supplement Commissions
Agents typically receive their commissions through one of the following methods:
Direct Deposit – Most carriers pay commissions electronically on a monthly or biweekly basis.
Advanced Commissions – Some insurers offer advance payments of commissions (e.g., 9 or 12 months upfront) based on projected renewals.
As-Earned Commissions – Commissions are paid out as the policyholder pays their premium.
General Payment Structure
A typical Medigap commission structure follows this breakdown:
First-Year Commission: about 21% – 22% of the annual premium
Renewal Commission (Years 2-6): percentage rates vary by area and carrier.
Payment Frequency: Monthly, biweekly, or advanced lump sums based on carrier agreements
Learn more about commission payment structures
Factors That Influence Commission Rates
Several factors determine how much an agent earns from selling a Medigap policy. These factors include; carrier-specific rates; each carrier sets its own commission structure (unlike PDP & MA/MAPD plans). Each state has its own regulations; some have specific commission caps (CA & FL). In other instances, commission rates are based on age of enrollee and plan type.
Medicare Supplement vs. Medicare Advantage Commissions
Medicare Supplement commissions are generally lower in the first year compared to Medicare Advantage, but the long-term renewal structure and coverage type make them more sustainable. Medigap policies also tend to have lower attrition rates, meaning agents can build a long-term residual income.
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Example using 22% commission and 12-month advance:
For agents selling Medicare Supplement plans, commissions remain a steady and reliable income source. While initial-year payouts may be lower than Medicare Advantage, the ongoing renewal structure provides financial stability.
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Please note: These payment amounts vary by carrier and product. Not all carriers pay 22% for enrollments. This amount varies quite a bit. Be sure you check each carrier’s rate in the specific area you plan to market the plans in.