A practical guide for agents and agencies looking to build trust and ensure compliance
Selling Medicare plans can be an excellent growth opportunity for health insurance agents and agencies. This federal program offers valuable options for millions of beneficiaries—especially seniors—and represents a steady source of commission income. However, it’s also a highly regulated, competitive market filled with specific rules that, if overlooked, can lead to costly mistakes: loss of clients, legal penalties, or even license revocation.
In this article, we’ll review the most common mistakes agents make when selling Medicare and how you can avoid them with simple, responsible, and effective strategies.
1. ❌ Not fully understanding the different types of Medicare plans
One of the most frequent mistakes is not mastering the differences between the parts and types of coverage. Many agents confuse the terms or present them unclearly to clients, leading to poor plan selections.
✔️ How to avoid it:
- Thoroughly study Parts A, B, C, and D of Medicare.
- Understand the differences between Original Medicare and Medicare Advantage, as well as Medigap supplemental plans.
- Stay up to date on annual CMS changes.
- Prepare easy-to-read visual guides to explain it to clients.
An informed agent builds trust and avoids confusion that can lead to cancellations.
2. ❌ Failing to verify client eligibility
Assuming all seniors over 65 qualify for Medicare without checking their status can result in incorrect proposals, delays, or lost opportunities.
✔️ How to avoid it:
- Before presenting any plan, confirm whether the client:
- Meets the age or qualifying disability criteria.
- Lives within the plan’s service area.
- Is enrolled in Parts A and B (if required).
- Use tools like MediConnect or CMS platforms to verify this information.
Pre-screening helps you provide accurate recommendations from the start.
3. ❌ Promising coverage or benefits not included in the plan
Some agents, either from enthusiasm or error, promise coverage the plan doesn’t include. This can lead to client complaints or even license loss.
✔️ How to avoid it:
- Always review the plan’s official Summary of Benefits (SB) before making any claims.
- Avoid vague phrases like “everything’s covered” or “you can use it anywhere” unless you’ve confirmed it.
- Use accurate language and clearly explain limits and copays.
Transparency and accuracy prevent disappointment and protect your career.
4. ❌ Failing to document client consent properly
A common compliance error is neglecting to use the Scope of Appointment (SOA) form before discussing Medicare plans. This is a direct CMS violation.
✔️ How to avoid it:
- Always use the SOA form—either written or electronic—at least 48 hours before the appointment (except in certain exceptions).
- Store the form for the required time (up to 10 years).
- Use digital tools to manage SOAs more efficiently and securely.
Proper documentation protects both you and your clients from regulatory issues.
5. ❌ Not explaining the real costs of the plan
Many clients believe Medicare is free or that the plan won’t have additional costs because the agent wasn’t clear.
✔️ How to avoid it:
- Be sure to break down:
- Monthly premiums (if applicable).
- Annual deductibles.
- Copayments and coinsurance.
- Out-of-pocket maximums.
- Provide real-world examples based on their medical history.
Helping clients visualize their annual spending improves satisfaction and retention.
6. ❌ Misunderstanding enrollment periods
Failing to understand—or explain—the Medicare enrollment periods can cause clients to miss important deadlines or try to change plans outside of eligible windows.
✔️ How to avoid it:
- Know these key enrollment periods:
- IEP: Initial Enrollment Period (7 months around age 65).
- AEP: Annual Enrollment Period (October 15 to December 7).
- SEP: Special Enrollment Periods (for relocation, loss of coverage, etc.).
- OEP: Open Enrollment Period (January 1 to March 31).
- Alert clients ahead of time and help them plan.
Missing enrollment opportunities due to poor guidance can cost you a client’s trust.
7. ❌ Not following up after enrollment
Many agents close the sale and forget about the client, leading to cancellations caused by confusion, lack of support, or improper plan use.
✔️ How to avoid it:
- Provide a welcome kit with clear instructions.
- Follow up 15 and 30 days after enrollment to answer any questions.
- Create monthly communications with tips, updates, and added benefits.
Ongoing support shows professionalism and improves long-term loyalty.
8. ❌ Not staying up to date through training
Medicare regulations change frequently. What was true last year may not apply this year.
✔️ How to avoid it:
- Attend annual CMS-approved training sessions (AHIP or equivalents).
- Stay informed on carrier updates and policy changes.
- Participate in webinars, workshops, or agent groups.
Being up to date gives you a competitive edge and protects your practice.
9. ❌ Offering the same plan to everyone
Recommending the same plan to all clients without evaluating their medical needs, lifestyle, or financial situation can result in poor experiences or cancellations.
✔️ How to avoid it:
- Conduct personalized assessments:
- Does the client have preferred doctors or clinics?
- Are they on specific medications?
- Do they need vision, hearing, or transportation support?
- Do they qualify for state assistance programs or Medicaid?
- Use tools like Medicare.gov Plan Finder to compare real options.
Tailored advice positions you as a trusted advisor, not just a seller.
10. ❌ Ignoring legal and ethical compliance
Some agents downplay compliance and focus only on commissions, exposing themselves to penalties or contract terminations.
✔️ How to avoid it:
- Review the Medicare Marketing Guidelines (MMG) annually.
- Avoid prohibited practices like cold calling, excessive gifting, or pressure selling.
- Only use CMS-approved marketing materials.
Ethical behavior protects your business and enhances client trust.
Real-life examples: Lessons from other agents
Case 1: High cancellation rates due to lack of follow-up
An agency in California had a 45% cancellation rate within the first 90 days of AEP. After analysis, it was clear agents provided no post-enrollment support. Once they implemented a 30-day follow-up protocol, cancellations dropped to 15%.
Case 2: Agent sanctioned for missing SOA documentation
An agent in Florida lost contracts with three carriers after a CMS audit revealed repeated SOA form violations. The mistake cost him thousands in lost commissions and suspended his license.
The Medicare market presents a valuable opportunity for agents and agencies—but it also demands professionalism, ethics, and ongoing education. Avoiding the mistakes listed here not only protects your license but also builds lasting client relationships and a solid reputation in the field.
Support your clients with clarity, honesty, and follow-through, and they won’t just stay with you—they’ll refer others too.
