The Medicare agent dictionary — plain English.

10-Digit Long Code registration with The Campaign Registry — required to send A2P SMS in the US through carriers.

Former CMS requirement that 48 hours must pass between a signed Scope of Appointment and the personal marketing meeting. Permanently eliminated by the CY2027 Final Rule, effective June 1, 2026.

Annual Medicare training and compliance certification accepted by most MA/PDP carriers as a prerequisite to certify on their plans.

October 15 – December 7 each year. Beneficiaries can join, switch, or drop Medicare Advantage and Part D plans, with coverage starting January 1.

The carrier-mailed notice (delivered by Sep 30) describing next-year plan changes vs. current coverage.

Medicare-covered yearly preventive visit (no copay under Original Medicare) to develop a personalized prevention plan.

The agent's active in-force client and policy roster — the renewable asset that produces residual commission.

CMS requirement to record all MA/PDP marketing, sales, and enrollment calls in full and retain them. Retention period reduced from 10 years to 6 years under the CY2027 Final Rule (effective June 1, 2026).

Plan-year-specific training each carrier requires (often built on AHIP) to sell its MA/PDP plans.

The federal agency that administers Medicare, Medicaid, and CHIP and writes the rules every Medicare agent works under.

Commission reversal when a member disenrolls, dies, or is found ineligible inside the carrier's chargeback window.

MA plan designed for beneficiaries with specific qualifying chronic conditions (diabetes, CHF, COPD, etc.).

CMS rule that TPMO sales calls discuss only plans the agent represents, but disclose that other plans exist via the TPMO disclaimer.

Rules determining payment order when a beneficiary has multiple coverage sources (employer, VA, TRICARE, Medicaid).

Total marketing spend divided by number of new enrollments produced.

Historical Part D phase where members paid more after hitting initial coverage limits. Closed by IRA reforms in 2025+.

Prior drug coverage at least as good as standard Medicare Part D — protects against the LEP.

Software of record for leads, contacts, policies, tasks, and communications — the spine of an agency.

Beneficiaries enrolled in both Medicare and Medicaid. Dual Special Needs Plans (D-SNP) are MA plans tailored to them.

An event that provides objective Medicare information only — no plan-specific marketing, no SOAs, no enrollments.

Digital submission of an MA/PDP enrollment — instant carrier acknowledgement vs. paper apps.

Professional liability coverage that protects agents from claims of negligent advice or paperwork errors.

The full plan contract describing benefits, rules, and rights for members.

Upline organization that contracts agents/agencies with carriers, provides support, training, and sometimes leads or tech.

The list of prescription drugs covered by a Part D or MAPD plan, organized by tier with cost-sharing rules.

January 1 – March 31 each year for beneficiaries to enroll in Medicare Part A and/or B if they missed their IEP.

AI systems that produce new content (text, images, voice) from prompts — used for drafts, summaries, voicemails, and outreach.

Free Google listing that controls how your agency appears in Search and Maps, including reviews, hours, posts, and Q&A.

Specific situations in which Medigap carriers must sell a beneficiary a policy without underwriting.

MA plan questionnaire collecting health, social, and functional data used to coordinate care.

CMS risk-adjustment model that scores beneficiary health complexity to set plan payments.

A surcharge added to Part B and Part D premiums for higher-income beneficiaries, based on IRS tax data from two years prior.

The 7-month window around a beneficiary's 65th birthday month to enroll in Medicare Parts A, B, and a Part D or MA plan.

MA plan for beneficiaries living in or expected to live in an institutional setting for 90+ days.

Permanent surcharge added to Part B or Part D premiums for beneficiaries who delay enrollment without creditable coverage.

Expected total commission a Medicare client generates across renewals, net of chargebacks and servicing cost.

Federal program that lowers or eliminates Part D premiums, deductible, and copays for qualifying low-income beneficiaries.

A mid-tier upline between agent and carrier/FMO with authority to recruit and manage downline agents.

Any communication that promotes a specific MA/PDP plan — subject to CMS filing and TPMO disclaimer rules.

An event where plan benefits are discussed and SOAs/enrollments are permitted, subject to CMS notice and content rules.

The annual ceiling an MA enrollee will pay for in-network covered services. CMS sets an upper limit each year.

Medicare Part C — private plans approved by CMS that bundle Part A, Part B, and usually Part D plus extra benefits (dental, vision, OTC, fitness).

January 1 – March 31. Current MA enrollees may make one switch to another MA plan or back to Original Medicare with a PDP.

An MA plan that also includes Part D drug coverage in one membership.

Voluntary program letting Part D members spread annual drug costs into level monthly payments to the plan.

State-administered programs (QMB, SLMB, QI) that help low-income beneficiaries pay Part B premiums, deductibles, or cost share.

Standardized policies (Plans A, G, N, etc.) sold by private carriers that help pay Original Medicare out-of-pocket costs.

Part D program that provides eligible high-risk beneficiaries with pharmacist-led medication reviews.

The non-profit that handles electronic state license applications, renewals, and appointments across the US.

The unique NIPR-assigned ID number tied to every licensed insurance producer in the US.

CMS standards ensuring an MA plan has enough providers within reasonable time/distance for members.

An enrollment held by a carrier because of missing or invalid information.

Six-month window starting the first month a beneficiary is 65+ and enrolled in Part B, when Medigap is guaranteed issue.

Federal fee-for-service Medicare = Part A (hospital) + Part B (medical), administered directly by CMS.

Hospital insurance covering inpatient stays, skilled nursing, hospice, and limited home health.

Medical insurance covering outpatient care, doctor visits, preventive services, and durable medical equipment.

Medicare Advantage — the private-plan alternative bundling A, B, often D, plus extras.

Voluntary prescription drug coverage from private plans, available stand-alone or inside an MAPD.

Documented consent from a beneficiary allowing an agent to reach out about Medicare plan options, scoped and dated.

The pharmacies a Part D/MAPD plan contracts with, often split into preferred and standard tiers.

CMS form reviewed with the beneficiary before enrolling, confirming key plan features and beneficiary understanding.

Stand-alone Medicare Part D drug coverage paired with Original Medicare or an MA-only plan.

Carrier approval required before a covered service or drug is provided.

The process of getting a new agent licensed, contracted, AHIP-certified, and RTS with their carriers.

The contracted doctors, hospitals, and pharmacies a member can use at in-network cost share.

Tools (Sunfire, Connecture, Integrity MedicareCENTER, etc.) that compare MA/PDP plans and submit e-applications.

A member leaving a plan within roughly the first 90 days, often triggering 100% commission chargebacks.

Status indicating an agent has completed all carrier requirements (AHIP, carrier cert, contract, license, E&O) for a plan year.

Adjustments to communication or process for beneficiaries with disabilities or limited English proficiency.

CMS-required document capturing which Medicare product lines a beneficiary agrees to discuss with an agent, collected before the meeting.

Practices that help your website and Google Business Profile rank for searches like "Medicare agent near me."

The counties or ZIP codes where a plan is sold and where members must reside to enroll.

Windows outside AEP/OEP triggered by life events (move, loss of coverage, dual/LIS status, 5-star plan, etc.) that allow plan changes.

CMS quality scores (1–5 stars) for MA and Part D plans based on member experience, clinical outcomes, and complaints.

Free, state-based Medicare counseling for beneficiaries — referenced in the TPMO disclaimer.

Carrier document summarizing plan benefits, cost share, and network for a given MA/PDP plan year.

Non-medical MA benefits (transportation, OTC, healthy food, utility allowance) often limited to chronic-condition enrollees.

Any entity that markets MA/Part D on a plan's behalf — including independent agents, agencies, FMOs, and lead vendors.

The CMS-required disclosure stating you don't offer every plan available and directing the beneficiary to 1-800-MEDICARE, Medicare.gov, or their SHIP.

12-month window for first-time MA enrollees to drop the MA plan and return to Original Medicare + Medigap with GI rights.

The amount counted toward a Part D member's annual out-of-pocket cap, including LIS and manufacturer contributions.

Beneficiaries who stay on employer group coverage past 65 and delay Part B/D under a valid SEP.