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This guide is for training purposes only and should be used in conjunction with current CMS guidelines and carrier-specific compliance requirements. All agents must stay up-to-date with the latest Medicare regulations and compliance standards. The examples provided are for illustrative purposes and should be adapted according to specific situations and requirements.

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Opening and Closing the Call

Category: Compliant Medicare Sales Calls

Last Updated: March 12, 2025

CMS Reference:

• 42 CFR § 422.2274(b) (Agents must be licensed, trained, and identified)
• 42 CFR § 422.2274(c)(9)(i) (Agents must confirm that beneficiaries understand the product before enrolling)
• MMCM CH 2: 40.1.3 (Enrollment via Telephone – Requires recording and agreement to be recorded)
• MMCM CH 2: 40.2 (Processing the Enrollment Request – Requires agent details and tracking mechanisms)
• MMCM CH 2: 40.2.1 (Who May Complete an Enrollment Request – Only the beneficiary or legal representative can enroll)
• MMCM CH 2: 40.4.1 (Tracking enrollment and confirmation number prior to coverage start)
• 42 CFR § 422.111(h)(1) (Carrier must provide toll-free number with TTY service)

Overview

A Medicare sales call must follow a structured opening and closing process to ensure compliance with CMS regulations and provide a professional, informative, and consumer-friendly experience.

✅ The Opening of the Call Must Include:

✔ Agent identification, including licensing and agency name

✔ Beneficiary agreement to be recorded

✔ Verification that the caller is authorized to enroll