In the world of Medicare, trust is everything. For agents, the rules around Permission to Contact (PTC) are essential for building trust and staying compliant with CMS guidelines. Whether you’re new to Medicare sales or an established agent, keeping up with PTC compliance means protecting your reputation and delivering a better experience for your clients.

In this article we’ll explain the importance of PTC, highlight the 2025 updates to CMS rules, and answer the most common questions around contacting Medicare beneficiaries. Let’s dive into what every licensed insurance agent needs to know.

What is Permission to Contact (PTC)?

Permission to Contact (PTC) is the consent agents need before reaching out to Medicare beneficiaries for marketing. It ensures beneficiaries are contacted only when they allow it, building trust and transparency.

PTC isn’t just a guideline—it’s a CMS requirement. Agents must receive and document this permission from each prospect and keep a record of each authorization.

Permission to Contact Guidelines

The Medicare Permission to Contact (PTC) outlines the specifics for compliant contact with beneficiaries. It defines:

• Who agents can contact: Only beneficiaries who have given explicit permission.
• What products can be discussed: Only the specific products, such as Medicare Advantage plans or prescription drug plans, that the beneficiary has authorized.
• How contact can be made: Only through the methods agreed upon by the beneficiary.
• When contact is appropriate: Within the timeframes and conditions set by CMS guidelines and within the scope of appointment (SOA).

These rules ensure that all outreach remains respectful, transparent, and compliant with CMS standards.

Contact Rules

Agents can only make unsolicited contact through the following methods:

Allowed Methods:

• Conventional Mail & Print Media: Includes direct mail and advertisements.
• Email: Must include an opt-out and the TPMO Disclaimer.
• Social Media Posts/Ads: Excluding text messaging and direct messaging on social platforms.

Prohibited Methods:

• Cold Calls and Robocalls: No unsolicited calls or voicemails.
• Door-to-Door Solicitation: Even with an address from a PTC form, agents cannot visit a residence without a scheduled appointment.
• Public Spaces: No approaching prospects in parking lots, lobbies, sidewalks, or stores.
• Unsolicited Social Media Messages: Direct messages are not allowed.

Allowed Contact with Permission:

Agents may contact potential and existing clients with permission as follows:

• Phone Call with Documented Permission: Allowed with documented “permission to contact” or Prior Express Written Consent (PEWC) if required.
• Client Referrals: Current clients can give agents’ contact info to friends or relatives, however referred individuals must initiate contact.
• Reach Out to Current Clients:
  • Discuss additional Medicare plans or plan benefits (e.g., MA-PD options for PDP clients).
  • Share general plan info like AEP dates, healthcare plan changes, or events.
  • Talk about other products the client has with the agent such as annuities or life insurance.
• Return Calls/Messages: Respond to client-initiated calls or messages.
• Leave Information for No-Shows: If a scheduled client misses an appointment you may leave relevant materials at the residence.
• Email Potential Clients: Allowed if emails include an opt-out option and follow CMS communication rules.

When Does Permission to Contact Expire?

For compliant outreach, Permission to Contact (PTC) forms, including Business Reply Cards (BRCs), are valid for 12 months from the date of the beneficiary’s signature or initial request for information. Once the 12-month period expires, agents must obtain new permission to continue contact with the individual.

NEW PTC Guideline For 2025:

• No Required Personal Details: CMS now prohibits requiring beneficiaries to provide personal information on a contact form—such as age, birth date, or health status—on lead forms like BRCs.
• Opt-Out Requirements: BRCs and email communications must provide a clear option for beneficiaries to opt out of further contact.
• Data Restrictions: Beneficiary data collected before October 1, 2024, cannot be transferred to or shared with another TPMO (including independent agents) after that date.
• Notification of Contact: Beneficiaries must be informed that by submitting a BRC, they are agreeing to be contacted by a licensed agent.

Contact Compliance for AEP Leads

After AEP, it’s crucial to adhere to PTC rules for post-enrollment contact. Here’s how to stay compliant:

PTC Verification Post-AEP

Ensure that Permission to Contact is still valid before re-engaging any beneficiary after AEP. If PTC has expired, refrain from outreach until a new PTC is in place​.

Timing your Follow-Up

For AEP leads, keep track of PTC expiration to ensure follow-ups are timely and compliant, especially in the months immediately following AEP.

Frequently Asked Questions

###

Editor’s Note: Originally published in March 2020. Content has been updated to reflect relevant and current information.