After UHC Contract Submitted:

✅ Complete 1-hour Call and Medicare situation training
✅ Watch 2 pre-recorded videos (script training + CRM walkthrough)
✅ Access to CRM and tech stack
✅ Assigned aged B-leads (veteran leads) to practice on
✅ Start calling immediately while AHIP and contracts process
✅ Any deals you find but aren't contracted for → We write it and pay you 40%

💰 Start earning in your first 2 weeks!

Complete During Your First 2-3 Weeks:

📖 AHIP Certification (reimbursed after first sale)
📖 Medicare 101 Training
📖 Product Training - UHC, Humana, Aetna, Cigna
📖 CRM Mastery - Learn the system inside and out
📖 Sales Scripts - Practice and refine

💡 You're learning while earning - not sitting idle waiting for contracts!

Requirements to Move to Exclusive Leads:

🎉 Once complete → Unlock exclusive leads: New Veterans, Webinar Leads, Fresh Inbound!

Lead Types Unlock Based on Enrollments & Revenue:


💪 The more you produce, the better your leads get!

After you're contracted with the 4 core carriers, you'll complete these:

• Devoted Health
• WellCare
• Mutual of Omaha (MOO)
• Other regional carriers

💡 These expand your options and will be completed progressively

Stage	Requirements	Lead Access
Phase 1 Getting Started	UHC submitted CRM access	B-Leads (Practice)
Phase 2 Training	AHIP + Medicare 101 Calling B-leads	B-Leads + Internal Referrals
Phase 3 Fully Contracted	4 carriers + AHIP 20+ calls (3+ min) Role play passed	Exclusive Fresh Leads!
Phase 4 Performance Tiers	20+ enrollments Consistent revenue	Premium Inbound + VIP Leads

"I'm happy with what I have"
→ "That's great! I'm actually calling to make sure you STAY happy with what you have. With all the changes for 2026, I just want to make sure your plan is still available and still the best fit for you."

"I need to think about it"
→ "I completely understand. That's exactly why I'd like to schedule just 15 minutes to go over your options - so you have all the information you need to make the best decision. Do mornings or afternoons work better for you?"

"How much does this cost?"
→ "Great question! Our services are completely free - we're paid by the insurance companies, not by you. You'll never get a bill from us. The only costs are the plan premiums, which I'll show you during our consultation."

"I don't want to switch plans"
→ "I'm not here to switch you - I'm here to make sure you don't miss any important dates and that you're in the best plan for YOUR situation. Sometimes that means staying exactly where you are, and that's perfectly fine."

"I'm too busy right now"
→ "I totally understand. That's why we keep it to just 15 minutes. And if you wait too long and miss your enrollment window, you could face lifetime penalties. When would be a better time - mornings or afternoons?"

"I already have someone helping me"
→ "That's wonderful! I'm glad you're getting help. Just to confirm - have they already reviewed the 2026 changes with you and confirmed your plan is still available? If not, I'd be happy to provide a second opinion at no cost."

"Can you just send me information?"
→ "I can definitely send you information, but Medicare rules can be confusing. The best way to make sure you get exactly what you need is to spend 15 minutes together on the phone. That way I can answer your specific questions. Do mornings or afternoons work better?"

Q: "What's the difference between Medicare Advantage and Medigap?"
A: "Great question! Medicare Advantage is an all-in-one plan that replaces Original Medicare and usually includes drug coverage. Medigap is a supplement that works alongside Original Medicare to help cover your out-of-pocket costs. Let me walk you through which might work better for your situation."

Q: "Will I lose my doctor?"
A: "That's one of the most important things we check! Every Medicare Advantage plan has a network of doctors, and we'll verify your doctors are in-network before recommending any plan. If keeping your current doctors is your priority, we'll make sure that happens."

Q: "When can I enroll?"
A: "It depends on your situation. If you're turning 65, you have a 7-month Initial Enrollment Period. If you're already on Medicare, the Annual Enrollment Period is October 15 - December 7. There are also Special Enrollment Periods if you have a qualifying event. Let me figure out which applies to you."

Q: "Do I have to pay for this consultation?"
A: "Absolutely not! Our services are 100% free. We're paid by the insurance companies, not by you. You'll never get a bill from us."

Q: "What if I don't like the plan you recommend?"
A: "No problem at all! There's zero obligation. My job is to show you all your options and help you make the best decision for YOUR situation. If you decide not to enroll, that's perfectly fine."

Q: "How long does this take?"
A: "The initial consultation takes about 15 minutes. If you decide to enroll, the application process takes another 15-20 minutes. We keep it quick and simple."

✅ Create a set weekly schedule that works for them
Top producers treat this like a JOB, not a hobby. They have set hours and stick to them.

✅ Dial new leads at least 2X per day in the first 5 days
Speed to lead matters. They hit fresh leads hard and fast within the first week.

✅ Don't overthink the process - dive in and fail fast
They understand that action beats perfection. Make the call, learn from it, improve, repeat.

✅ Use the script and don't deviate too much from the process
The script works. Top producers follow it until they master it, then they personalize.

✅ Show up to trainings
This is the most common trait we see in top producers. They're always learning, always improving.

✅ Communicate often with management to ask for coaching
They're not afraid to ask for help. They seek feedback and coaching proactively.

✅ Dial 75-150 dials per day OR 4 hours of talk time
High activity = high results. They understand this is a volume game until you build a book.

✅ Don't get paralysis by analysis
Top producers take action instead of overthinking. They learn by doing.

✅ Understand this is not going to happen overnight
They have realistic expectations. Success takes 60-90 days of consistent effort.

✅ Comfortable with rejection and don't take things personally
Rejection is just part of the game. They move on to the next call without dwelling on it.

✅ Have a long-term vision and short-term logical goals
They know where they want to be in a year, but focus on daily and weekly goals to get there.

✅ Don't give up
The #1 trait of top producers: persistence. They keep showing up even when it's hard.

✅ Do the boring stuff day in and day out
Dial leads, follow up on tasks, call appointments even when they don't show. The mundane work compounds over time.

✅ Set goals and do every activity necessary to reach their daily goals
They work backwards from their goals. "If I want X enrollments, I need Y appointments, which means Z dials."

✅ Have amazing work ethic and don't make excuses not to dial leads and show up
Bad weather? System down? Lead quality poor? Top producers find a way. They don't make excuses.

Top producers aren't special - they just do what everyone else won't.

They show up every day, follow the process, handle rejection without flinching, and refuse to quit.

The question isn't "Can I be a top producer?"
The question is "Will I do what top producers do?"

🏆 You have everything you need. Now go execute.

"Hello and thank you for calling, my name is [Agent Name], I am a Licensed Insurance Agent here at [Your Agency Name]. Please know our call will be recorded; is it ok if I continue?"

• IF NO: "It is only being recorded for training and required regulatory purposes, and to make sure I am helping you to the best of my ability. Are you sure you do not want to continue to review your Medicare options today?"
*End call if appropriate

"We do not offer every plan available in your area. Currently we represent [insert number of organizations] organizations which offer [insert number of plans] products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options."

Number of organizations & plans can be found in SunFire using client's zip code

"You are calling today to review your Medicare coverage options, is that correct?"

• IF YES: "Perfect, I am happy to help. To see if I can help you with your Medicare request, what is your zip code?"

• IF NO: "Well, I am a licensed insurance agent and since you have me on the phone already, what questions about your Medicare coverage can I answer for you? That's a good question, so I can better assist you, what is your zip code?"

• (client wants information on claims, billing, etc.) *Assist lead in getting pointed in the right direction, then "Well, I am a licensed insurance agent ready to help you review your current Medicare coverage today to see what may be available to you in 2025, but if [call in reason] is all you needed today, I hope you have a great rest of your day."
*End call

"I have your name as [Repeat Clients full name] and your zip code as: [repeat zip code]. Do you mind repeating that back to me? What county is that zip code located in?"

(Or if you don't have client's info) "What is your name and current zip code? What county is that?"

"Perfect, and do I have permission to call you back if we get disconnected during this plan review?"

"Do <I/Agency Name> have permission to contact you in the future about Plan information and your enrollment options? Your consent is voluntary, allowing <me/agency> to contact you via text messaging or auto dialing to discuss information about Medicare Insurance plans. You can change your preferences at any time without affecting your eligibility for Plan enrollment or benefits. Carrier data charges may apply."

Agent Note: If "YES", confirm consumer's phone number. If "NO", document client's response and follow DNC procedures.

"Amazing, and are you looking for yourself or someone else today Mr./Mrs. [name of beneficiary]?"

• IF LOOKING FOR SOMEONE ELSE: "Great! Glad you are getting this handled on their behalf. What is your relationship to the beneficiary? I can give you general information about the Medicare plans, but we'll need to bring them on the phone if they decide they want to enroll, ok?"

"Are you going to be responsible for making your own health care decisions today as well?"

• IF NO: "Ok, since you cannot make any Medicare related decisions today, I still want to ensure we are getting you that well needed review of your plan for 2025. Can we add the decision maker to the call? (Try to schedule a different time to discuss if they are not available)."

• IF YES: (Once they are added to the call) "Ok, may I have your name, and your relationship to the beneficiary? Are you the legal representative or someone who is legally authorized to act on behalf of the beneficiary under the applicable state law? And can you provide written documentation evidencing your authority if requested by CMS? For example, do you have a durable Power of Attorney, or a court appointed guardianship?"

• IF NO: "We will be shopping for Medicare plans and the plan you select could change your health insurance coverage. If you have someone who helps you make healthcare decisions, are you sure you would not like to add them on the line to help you decide what is best for you?"

"Now, what is your current coverage?"

• IF CLIENT KNOWS COVERAGE TYPE: "Great, so you have [repeat coverage back to them and state if it is a carrier you represent]."

• IF THE CLIENT DOESN'T KNOW COVERAGE TYPE: "No worries I can still help you with that!"

"I do believe reviewing everything available to you is important so we can find the plan to best suit your needs, but before we get started, I have a couple more statements I must read to you so hang tight while I collect these remaining questions."

Agent Note: for outbound calls, you must have a valid Permission to Contact or Business Reply Card already completed by the beneficiary, as well as a completed SOA, dated at least 48 hours prior to the outbound call/appointment.

"I work for [agency name], and in your area, we have a wide variety of plans such as [Medicare Advantage plans, Medicare Advantage Prescription Drug plans, Stand-alone Prescription Drug plans, Medicare Supplements Insurance Plans, Optional Supplemental Benefits (OSBs), Stand-Alone Vision, Stand-Alone Dental]." (Agent to list out all product types available). "Would you like to discuss all of these options or are you only interested in certain ones?" (Must wait for an affirmative response and proceed accordingly based on beneficiary's choice). "I can give you a brief overview of each of these plans, then you can decide which plan might be best for you based on your needs. Would that be ok?" (Agent to wait for response).

"This conversation has no effect on your current or future health coverage unless you enroll in a plan today. Talking to me does not obligate you to enroll or automatically enroll you in a plan." (An affirmative response is required).

Inform caller of available plans in the area (mention ALL that are available).

"Please be aware that you are not required to give any health-related information unless it will be used to determine your enrollment eligibility in the plan. If you choose not to provide the health information that is necessary to determine enrollment eligibility, then you may not be able to enroll."

"Remember like I mentioned earlier, I am licensed and appointed with the top Medicare carriers in your area. That means I will do a DEEP DIVE into your coverage options today to ensure we are maximizing your benefits. One thing about Medicare advantage plans is that they change each year. Meaning their copays, out of pocket costs, and even the additional benefits can change. It is extremely important to make sure you shop and compare your coverage each year."

"So, to get started do you mind sharing your permanent home address, Medicare Number & DOB."

Agent Note: If caller does not want to provide this information, you must move forward without it.

(ONLY READ IF IN AEP) "Since this is the Medicare Advantage and prescription Drug Plan Annual Enrollment Period, you are automatically qualified to enroll in a plan!"

"Do you give me permission to use this information on SunFire to look up your current situation and provide the best recommendations based on other available plans in your area?"

• IF YES: (Move on to needs analysis)

• IF NO: "This information will not be shared outside of SunFire and will only grant me access to what may be available to you this upcoming enrollment year. But if you do not wish to continue, we do not have to conduct your review today."

*Determine beneficiaries' current coverage with SunFire*

"Are you on any other coverage currently such as an Employer, Individual Major Medical, Employer Group Medicare plan, retirement benefits for healthcare, VA benefits or Tricare for Life/CHAMPVA?"

Agent Note: VA Healthcare benefits are different from Tricare for Life and ChampVA.

• IF NO: Continue to next qualifier section

• IF YES: Agent must explain how current coverage may be affected.

• IF EMPLOYER OR UNION: "Enrolling in a Medicare Advantage Plan may impact your ability to keep your Employer or Union health coverage. If you are unsure of how it may be affected, you can review the communications your employer or union sends you, visit their website, or contact the office listed in their communications. If there isn't any information on whom to contact, <your/their> benefits administrator or the office that answers questions about <your/their> coverage can help."

• "Do you wish to continue with the enrollment application?"

• IF YES: Continue
• IF NO: Close call

• IF INDIVIDUAL: ask if they will be ending that coverage to prevent duplication of coverage.

• IF VA: "VA Healthcare and Medicare Advantage are separate. VA Healthcare cannot bill Medicare Advantage and Medicare Advantage cannot bill the VA. You cannot leverage both VA coverage and an MA plan on any given service/claim. You will either use the VA for VA covered services and prescriptions or the MA plan for civilian doctors and hospitals. Having a Medicare Advantage plan will not disrupt VA healthcare services. An MA plan may be helpful to consider for those with VA as it would allow access to additional civilian providers within the MA plan network."

• IF TRICARE FOR LIFE OR CHAMPVA: "Benefits with Tricare for Life or ChampVA are generally more comprehensive than most other types of coverage available but enrolling in a Medicare plan may affect your Tricare or ChampVA. For example, claims will pay differently & require coordination by the beneficiary and provider, Tricare/ChampVA will become the secondary insurance if an MA/MAPD plan is selected, you will be limited to the network of providers on the MA/MAPD plan, and the MA/MAPD plan cannot only be utilized for additional benefits like dental or hearing. Therefore, while they can enroll in an MA/MAPD plan, it's not recommended."

"Do you still wish to proceed with this call to learn about MA/MAPD options?"

• IF NO: *End the call

"Now that we have determined your Medicare coverage, are you also on Medicaid or LIS?"

• IF YES: (Make note to offer a review of D-SNP plans later)

*Refer to Supplement Guide (pages 8-11) for overview of election periods beneficiary is eligible for*

"When it comes to Medicare Advantage, many plans come with dental, vision, hearing, over the counter, and transportation benefits. But what separates these plans are the amount of each benefit you receive and the copays and out of pocket costs."

"Which of those benefits do you feel are most important to you?" (Client states benefit)

"Ok great! I will make sure to find a plan that gives you the most (benefit they chose.)"

"Are there any carriers you would like me to look at specifically, or that you would like me to avoid? Sounds good, I will make sure to find a plan with / without [stated carrier]"

"Do you give me permission to discuss your drugs and doctors today?"

• IF YES: "Are there any Medications we need to make sure that are covered in this plan?"

• IF YES: Great go ahead and grab your medication list and I will add them.
• Important Instructions: properly identify drug, name, correct form, size, dosage, and frequency.

• IF NO: "Not a problem. But before we continue, I would like you to know that not all prescriptions are covered by all plans and cost may differ between plans as well. So, if you change your mind and would like me to look something up let me know."

"Is there a pharmacy you would like to make sure is in Network?"

Agent Note: Explain they will need to pick a new pharmacy if their current pharmacy is not in the plan's network.

"Do you have a primary doctor and any specialists that you would like to make sure are in network?"

• IF YES: "Who are your doctors?"

• IF NO: If a client has no PCP and you are looking at HMOs, offer to find one close to home.

"Do you have any other health care needs, such as needing durable medical equipment, physical therapy?"

"Now [Client Name] I am going to do my best to ensure that the doctors are covered but as we talked about earlier, we will focus on getting you all the benefits you may be eligible for today."

"So, what I am going to do now is put you on a brief hold while I sort through [Number of plans in the area] so that we can find a plan that may cover your doctors, prescriptions, and gives you the additional benefits you may be eligible for." (Put client on Hold)

If Special Needs Plan(s) are available in the caller's area, before discussing, state:

"In your area we do offer <Chronic Care and/or Dual Eligible> Special Needs Plan(s). These are plans specifically designed for anyone who:"

• (If Chronic Care SNP is available:) "has been diagnosed with <list conditions of available CC SNPs such as, Diabetes, Cardiovascular Disease, etc.>. Would you like to hear more about this plan?"

• (If Dual Eligible SNP is available:) "has both Medicare and Medicaid. Would you like to hear more about this plan?"

• (If Chronic Care SNP is available:)) "has been diagnosed with <list conditions of available CC SNPs such as, Diabetes, Cardiovascular Disease, etc.>. Would you like to hear more about this plan?"

• (If Dual Eligible SNP is available:) "has both Medicare and Medicaid. Would you like to hear more about this plan?"

DURING AEP: if discussing a plan that will NOT be renewing for the upcoming plan year for a beneficiary with IEP/ICEP or SEP for current plan year, state {verbatim}: "[Carrier name, plan type, contract/PBP number] will not be available in this area effective January. You may choose to enroll in the plan, but the coverage will automatically end on December 31. You are entitled to enroll into a new Medicare Advantage or Prescription Drug plan between October 15th and the end of February. However, if you want the new plan to be effective January 1st, your completed application must be submitted and received by December 31st. If you do not enroll into a Medicare Advantage or Prescription Drug plan by December 31st, you will be disenrolled from your current plan and only have Original Medicare as of January 1st."

"Based on the information you have given me we have found a plan in your area that may cover your doctors, medications, and additional benefits." (Plan name, plan number, and cost)

(Go over the plan SOB requirement, medication cost breakdown, and doctors.) Required SOB portion:

• Plan Premium
• Part B Premium Reduction (If Applicable)
• Medical/Part B Deductible (If Applicable)
• Maximum Out of Pocket (MOOP) (If Applicable) (In and Out of Network)
• Acute Inpatient Hospital Care
• Inpatient Hospitalization (State the COPAY and PER DAY amounts) (In and Out of Network)
• Outpatient Hospital Care (In and Out of Network)
• PCP Copays (In and OON)
• Specialist Copays including Mental Health Services (In and Out of Network)
• ER, Urgent care Copays-State the amounts (In and Out of Network)
• Preventative Care (In and Out of Network)
• Coverage outside of the United States
• Key Additional benefits of interest to prospect (examples but not limited to Lab, SNF, PT, Rehabilitation and Value-Added Dental, Vison, OTC, Hearing, Transportation, Fitness, Podiatry) (FOR DVH, EXPLAIN THAT THIS IS NOT A DVH RIDER, BUT A FULL PLAN)

IF special supplemental benefits for the chronically ill (SSBCI) benefits are mentioned, state:

"The benefits mentioned are Special Supplemental Benefits for the Chronically Ill (SSBCI). You may qualify for SSBCI if you have a high risk for hospitalization and require intensive care coordination to manage chronic conditions such as Chronic Kidney Diseases, Chronic Lung Disorders, Cardiovascular Disorders, Chronic Heart Failure, or Diabetes. For a full list of chronic conditions or to learn more about other eligibility requirements needed to qualify for SSBCI benefits, please refer to Chapter 4 in the plan's Evidence of Coverage".

IF Value-Based Insurance Design (VBID) benefits are mentioned, state Member Allowance disclaimer:

"Members may receive a monthly or quarterly allowance in the form of a benefits prepaid card to pay for a wide range of approved [groceries] [and] [utilities]. Unused amounts will expire at the end of the month or quarter".

IF VBID Transportation benefits are mentioned, state:

"Transportation services are issued as one-way trips and provided on an annual basis. Benefits vary by plan."

NOTE: If stating the number of rides, be sure to include "one-way" in the language to meet form/frequency/amount requirements. Include how to request information in an alternative language or format, and on a standing basis.

"Do you have any outstanding questions or want to dive into any of these benefits in more detail?"

• IF YES: answer questions and/or provide the plan details as requested and then continue.

Agent Note: The prompt to provide other plan details may be indirect, such as a member telling you they need oxygen or transportation. If additional benefits are reviewed, all limitations should be reviewed as well, such as allowances and frequencies on services for dental, vision, and hearing.

"All right, [Client Name], based off the information I gathered, we verified that all your prescriptions are covered by this plan."

(Must discuss cost & accurately identify drugs. Discuss Information regarding cost sharing differences relative to the pharmacy's status as preferred or non-preferred, mail-order, Long-Term Care (LTC) or home infusion, and 30- or 90-days' supply.)

Explain quantity limits, step therapy, prior authorization (If applicable to prescriptions)

"[Client Name], we were also able to find you a plan that offered: (At this point list the additional benefit provided)."

• (If applicable list the benefits that apply): $ Dental, $ Vision, $ Hearing, $ Lower Maximum OOP, $ Med cost, Copays, $ over the counter, etc.
• AGENT NOTE: Use the actual dollar amount to help paint the picture. (Real numbers)

"We were able to verify that [list the name of doctors that are in network for the plan]."

• (If doctor/doctors not in network) "Not all your doctors are in network for this plan, but I was able to find [List Doctor Name/Specialties being replace] who are in network with this plan. This will allow you to maximize your benefit, which is great!"

"Are there any other preferred facilities that need to be in network?"

• IF APPLICABLE: Explain HMO you must stay within network for the plan to pay EXCEPT for emergent and Urgent OR if it is PPO allows you to see any doctors you want however if you go out of network you may experience some additional cost sharing.

Explain physician referral is required or not required.

"Now [Client name] since we have found a plan that fits your needs go ahead and grab your Medicare card and we can move forward to the last stage of the process. Please be aware that enrolling in this Medicare Advantage plan will replace the current <clarify existing coverage type> coverage that you have today. Once approved by Medicare, your new <clarify new plan coverage type> plan coverage will begin on <effective date>. Would you like to proceed with the enrollment in the selected plan?"

• IF NO: probe to answer any additional questions or if the beneficiary is not ready to enroll, end the call.

If not interested in telephonic enrollment, state: "There are other options available for you to enroll." List available options.

"It will take me just a few minutes to start the enrollment process and I may have some additional questions for you."

*Complete agent portion of enrollment application.

The PECL that must be reviewed with the prospective enrollee prior to the completion of the enrollment references information on the following:

• (i) The EOC
• (ii) Provider directory
• (iii) Pharmacy directory
• (iv) Formulary
• (v) Premiums/copayments/coinsurance
• (vi) Emergency/urgent coverage
• (vii) Plan-type rules
• (viii) Effect on current coverage
• Right to cancel the enrollment as well as specific date through which cancellation may occur
• How to file a complaint

"Just confirming before we sign the application, you understand how the plan works, and you are ready to enroll?"

• Must address additional questions and get confirmation they are ready to enroll.

Once agent portion is completed: "[Client Name], I have the enrollment application completed and ready for your signature."

Agent must read all disclaimers and questions on SunFire application MULTIPLAN_001_SUNFIRE_ENROLLMENT001_2025_M

"Would you prefer to receive the signature link via email or via text on your smart phone? Great, I have that on the way to you now. Your personal security code to complete the signature is [XXXXX]."

MOVE TO SUNFIRE ENROLLMENT SCRIPTING
MULTIPLAN_001_SUNFIRE_ONEFLENROL001_2025_M

• Is this call taking place during AEP <10/15 through 12/7>?

• If during AEP, probe to determine if eligible for other election periods (IEP/ICEP or SEP) and if so, determine if the beneficiary desires an effective date earlier than January 1:

• If yes, determine the election period to which the beneficiary qualifies.
• If no, continue with the call.

• If NOT during AEP, state: "Since we are currently outside the Medicare Advantage & Prescription Drug Plan Annual Enrollment Period, which run from October 15th to December 7th and the Open Enrollment Period from January 1st to March 31st each year, you will need to have a Special Election Period (SEP) in order to qualify for a Medicare Advantage or Prescription Drug Plan. There are several election periods for which you may qualify, based on your circumstances. I want to ask a few questions to determine if you are eligible to enroll today, ok?" (Refer to Medicare Managed Care Manual Chapter 2 - Medicare Advantage Enrollment and Disenrollment, Section 30.4 - Special Election Period (SEP))

• Does the caller qualify for an election period now? Ask the following questions until you receive a "Yes" response. Once you receive a "Yes", educate the caller about the relevant SEP, for example if SEP MOV, advise you have one month before and two months after to complete your enrollment. Then continue.

• "Are you new to Medicare?" (ICEP-Initial Coverage Election Period)
• "Are you enrolled in a Medicare Advantage plan and want to make a change during the Medicare Advantage Open Enrollment Period (MA OEP)?"
• "Have you recently moved outside of your plan's service area, or have you moved, and this plan is a new option? If yes, what was the date?"
• "Have you recently been released from incarceration? If yes, what was the date?"
• "Have you recently returned to the United States after living permanently outside of the United States? If yes, what was the date?"
• "Have you recently obtained lawful presence status in the United States? If yes, what date did you obtain this status?"
• "Have you recently had a change in your Medicaid (new to Medicaid, had a change in level of Medicaid assistance, or lost Medicaid)? If yes, what date was this change?"
• "Have you recently had a change in your Extra Help paying for Medicare prescription drug coverage (newly received Extra Help, had a change in the level of Extra Help, or lost Extra Help)? If yes, what date was this change?"
• "Do you have both Medicare and Medicaid or is your state helping to pay for Medicare premiums or do you get Extra Help paying for your Medicare prescription drug coverage, but you haven't had a change?"
• "Are you moving into, live in, or recently moved out of a Long Term Care Facility (example, nursing home)? If yes, as of what date?"
• "Have you recently left a Program of All-Inclusive Care for the Elderly (PACE)? If yes, when did you leave?"
• "Have you recently involuntarily lost creditable prescription drug coverage (as good as Medicare's)? If yes, what was the date?"
• "Are you losing or leaving coverage you had from an employer or union? If yes, what was the date?"
• "Do you belong to a pharmacy assistance program provided by your state?"
• "Were you enrolled in a plan by Medicare (or your state) and you want to choose a different plan? If yes, what date did your enrollment in that plan start on?"
• "Is your plan ending its contract with Medicare or is Medicare ending its contract with your plan?"
• "I was affected by an emergency or major disaster (as declared by the Federal Emergency Management Agency (FEMA) or by a Federal, state or local government entity. One of the other statements here applied to me, but I was unable to make my enrollment request because of the disaster."
• "I'm in a plan that's had a star rating of less than 3 stars for the last 3 years. I want to join a plan with a star rating of 3 stars or higher."
• "I'm in a plan that was recently taken over by the state because of financial issues. I want to switch to another plan."
• "Were you enrolled in a Special Needs Plan but have lost the Special Needs qualification requirement to be in that plan? If yes, when?"
• "If none of these statements applies to you, is there another reason you believe you may be eligible to enroll?"

• If SEP is determined, state: "Based on the information you've provided, it appears you do qualify for an election period to enroll now." Continue with the call.

• If SEP is not determined, state: "I'm sorry but at this time it does not appear that you qualify for a special election period to enroll in a plan now. The Annual Enrollment Period is from October 15 through December 7 when you can change plans. Please feel free to contact us once the Annual Enrollment Period begins." Go to the 'Closing the Call'.

• Required Privacy disclaimer: "Please be aware that you are not required to give any health-related information unless it will be used to determine your enrollment eligibility in the plan. If you choose not to provide the health information that is necessary to determine enrollment eligibility, then you may not be able to enroll."

✓ You must have Medicare Part A and Part B

✓ If you have a Medicare Advantage Plan, you can't buy and don't need a Medigap policy

✓ It's illegal for anyone to sell you a Medigap policy if you have a Medicare Advantage Plan — unless your Medicare Advantage Plan coverage is ending

✓ You pay the private insurance company a monthly premium for your Medigap policy — in addition to the monthly Part B premium you pay to Medicare

✓ A Medigap policy only covers one person — if you and your spouse both want Medigap coverage, you'll each have to buy separate policies

✓ Any standardized Medigap policy is guaranteed renewable — even if you have health problems. This means the insurance company can't cancel your policy as long as you pay the premium

The best time to buy a Medigap policy is during your Medigap Open Enrollment Period. This period lasts for 6 months and begins on the first day of the month in which you're 65 or older AND enrolled in Part B. (Some states have additional open enrollment periods.)

During this period, an insurance company:

• Can't use medical underwriting — they can't refuse to sell you any Medigap policy it offers
• Can't charge you more for a Medigap policy because of your health problems
• Can't make you wait for coverage to start

After this period, your option to buy a Medigap policy may be limited and it may cost more.

Medigap Plans Sold in Most States

This chart shows the benefits included in each standardized Medigap plan. Every company must make Plan A available if they offer Medigap. Some plans may not be available in your state. Note: ✓ = the plan covers 100% of this benefit. 50%, 75% = the plan covers that percentage of this benefit.

PLAN G — Most Comprehensive Coverage

Best for: People who want the most comprehensive coverage and predictable out-of-pocket costs.

Covers: Everything except the Part B deductible ($240 in 2026). Once you pay this deductible, you have virtually no out-of-pocket costs for Medicare-covered services.

Average Monthly Premium: $150-$250 depending on age and location

PLAN N — Lower Premium Alternative

Best for: People who want comprehensive coverage but are willing to pay small copays for doctor visits.

Covers: Most expenses except the Part B deductible, plus small copays (up to $20 for doctor visits, up to $50 for ER visits).

Average Monthly Premium: $120-$200 depending on age and location

HIGH-DEDUCTIBLE PLAN G

Best for: Healthy individuals who want lower monthly premiums and can afford a higher deductible.

Covers: Same as Plan G, but you must first pay a deductible of $2,870 (2026 amount) for Medicare-covered costs before the policy pays anything.

Average Monthly Premium: $50-$100 depending on age and location

Medigap policies generally don't cover:

• Long-term care (like care in a nursing home)
• Vision care (eyeglasses)
• Dental care
• Hearing aids
• Private-duty nursing
• Prescription drugs — If you want drug coverage, you'll need to join a Medicare Part D plan

✓ Emphasize the Medigap Open Enrollment Period

This is the BEST time for clients to buy Medigap — no health questions, guaranteed acceptance, no waiting period.

✓ Explain Premium Pricing Methods

Medigap premiums can be priced 3 ways: Community-rated (same price for everyone), Issue-age-rated (based on age when you buy), or Attained-age-rated (increases as you get older).

✓ Compare Plan G vs High-Deductible Plan G

For healthier clients, HD Plan G can save $1,200-$1,800 annually in premiums. Break-even analysis: if they spend less than $2,870 on Medicare services, HD Plan G saves money.

✓ Discuss the Part B Excess Charge Protection

Only Plans F and G cover Part B excess charges (when doctors charge more than Medicare-approved amount). Important for clients in states where excess charges are common.

✓ Household Discounts

Many insurers offer discounts when spouses both have Medigap policies with the same company.