Medicare Call Flow

Medicare Verifier

Step-by-step guided call flow. Each step shows what to say, what to collect, and tips for keeping the customer engaged.

Educational template — not approved marketing material. This flow is a training aid, not legal or compliance advice. Before using it on live calls, have the wording approved by your carrier, your organization, and your compliance team or counsel. Medicare Advantage benefits, costs, eligibility, availability, and enrollment rules vary by plan and location, and CMS marketing rules (including call recording and disclaimer requirements) change year to year — verify current requirements at cms.gov.

Step 1 of 9 11%

Step 1 of 9

Greeting & Interest Check

Say to Customer

"Hello, may I please speak with [CUSTOMER NAME]?"

(After confirmed) "Great! My name is [YOUR NAME], and I'm calling about additional benefits that some Medicare Advantage plans offer — things like dental coverage, an over-the-counter allowance, or transportation support. Benefits, costs, and availability vary by plan and by where you live, and a licensed agent would confirm what you actually qualify for. Do you have just two minutes?"

Speak slowly and warmly. Seniors respond best to a calm, confident tone — never rushed or scripted-sounding.

Never promise that extra benefits are free or guaranteed — they differ by plan, county, and eligibility, and some plans have premiums or cost sharing. Let the licensed agent state plan specifics.

If they ask "how did you get my number?" — answer truthfully based on the actual lead source. Under the TCPA, telemarketing calls made with an autodialer or prerecorded voice require the consumer's prior express written consent, and Do-Not-Call rules apply to live calls too — confirm your lead's consent record before dialing.

If your organization records calls, disclose it the way your compliance team requires (for example: "This call is recorded."). CMS requires TPMOs to record sales, marketing, and enrollment calls in their entirety and retain them for at least 10 years.

Customer Name (for your records)

Step 2 of 9

Medicare Part A & B Status

Ask

"To make sure I can help you, do you currently have Medicare Part A and Part B?"

If they say "I think so" — ask them to check their red, white, and blue Medicare card. Part A = Hospital, Part B = Medical.

If they only have Part A or only Part B, they may still qualify for some plans. Note it and continue.

Medicare A & B Status

Step 3 of 9

Age Verification

Ask

"And may I ask how old you are? I just want to make sure we find the right plan for your age group."

Standard Medicare eligibility begins at age 65. Under-65 qualifies if they have a qualifying disability (SSDI for 24+ months) or ESRD.

Record age accurately — it determines which eligibility rules apply, nothing more. Treat every caller the same regardless of age.

Customer Age

Step 4 of 9

Zip Code

Ask

"What's your zip code? I want to make sure there are plans available in your area — benefits do vary by location."

Zip code determines which Medicare Advantage plans are available. Urban areas typically have more options.

"Benefits vary by location" is a factual statement — plan availability genuinely differs by county. State it as information, never as a pressure tactic.

Zip Code

Step 5 of 9

Medicaid Status

Ask

"Do you also receive Medicaid — that's the state health assistance program for people with lower incomes? It goes by different names in different states: it might be called Medi-Cal, TennCare, or just your state's name."

Dual eligible (Medicare + Medicaid) customers may qualify for D-SNP plans, which coordinate the two programs and can include additional benefits. Record their answer accurately — the licensed agent must verify actual dual status and plan availability.

If unsure: "Do you get any help from the state paying for your Medicare premium or prescriptions?" — that's Medicaid/LIS/Extra Help.

Medicaid Status

Step 6 of 9

VA / TRICARE Status

Ask

"Are you a veteran, or the spouse of a veteran? And if so, do you currently use VA healthcare or have TRICARE coverage?"

Always thank veterans for their service. It builds immediate rapport and goodwill.

Veterans with TRICARE for Life plus Medicare already have broad coverage, and plan changes can affect how their coverage coordinates. Record their status accurately and leave any plan recommendation to the licensed agent.

VA / TRICARE Status

Step 7 of 9

Current Insurance Company

Ask

"What insurance company is your Medicare currently through? For example, is it Original Medicare, Humana, United Healthcare, Aetna, or someone else?"

Knowing their current carrier helps the specialist confirm if a switch would improve their benefits without losing their doctors.

If they say "Original Medicare" — record it neutrally. Original Medicare and Medicare Advantage each involve trade-offs (provider networks, cost sharing, referral rules, extra benefits), so never imply the customer made a wrong choice or lacks something they were supposed to have.

Current Insurance Company

Step 8 of 9

Living Situation

Ask

"Are you currently living at home independently, in an assisted living community, or in a nursing facility?"

Living situation affects which plan types and benefit packages are available. Nursing home residents may qualify for Institutional Special Needs Plans (I-SNPs).

Some customers have an authorized representative or power of attorney who must be part of any plan decision — note it if mentioned, and never steer around a representative.

Living Situation

Step 9 of 9

Summary & Warm Transfer

Warm Transfer Script

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Always get verbal permission before transferring the live call: "Is it okay if I connect you with a licensed Medicare agent right now?"

Permission to transfer a call is not permission to share or reuse the customer's data. Under CMS rules (42 CFR 422.2274(g)), a TPMO may share personal beneficiary data with another TPMO for marketing or enrollment only with the beneficiary's prior express written consent. CMS allows a verbal "yes" only for connecting the beneficiary to another TPMO during a live call — it does not authorize storing, selling, or re-contacting from that data later. Follow your organization's approved consent process.

Stay on briefly after connecting. A quick "I'm transferring [NAME] — they told me they have Medicare A&B and receive Medicaid" sets the licensed agent up. Pass along only what the customer told you.

If the customer hesitates: "The licensed agent will go over what's available in your area, and the decision is entirely yours — there's no obligation." Never promise that no enrollment will happen; a licensed agent can enroll them if they choose.

Medicare Verifier

Warm Transfer Script

Lead Summary

Quick Rebuttals