Medicare Sales Script

For the record my name is (Agent Full Name) and I am a licensed insurance agent, appointed to help you find the
most suitable plan options for your needs.

Before I continue I need to let you know that this call may be recorded and monitored.

Could you confirm the spelling of your full name and the best contact number to reach you?

Also, just to confirm, are you calling for YOURSELF or SOMEONE ELSE?

If for YOURSELF:
Are you legally authorized to make your own healthcare decisions?

If for SOMEONE ELSE:

Do you have legal authority under the state in which the beneficiary resides to make
healthcare decisions for that person and can provide documentation of that authority
upon request by CMS?

If Yes:
What is that authority?

If No:
I'd be more than happy to give you general information about their plan options.
If we find something that you think they would find suitable, we'll need to review
plan information and complete the enrollment with them present.

Ok, great. So we can find the right product / plan for you, we'll go through 3 simple steps:

1. First, I'll ask you a few quick questions to see what you qualify for.
2. Then, I'll ask you some questions to understand your specific needs.
3. Finally, we'll put it all together to help you pinpoint the most suitable option for you
and help you enroll.

Are you ready to get started?

Great! May I have your zip code and county?

Are (you/they) enrolled into Medicare Parts A & B? (If no, end call.)

Ok, if you choose to enroll in a plan I will need your A and B effective dates during the application process, but for
now I’m going to ask you a few questions so I can give you further details, such as co-pays, deductibles, and drug
costs for plans in your area. These figures may change based upon your specific information, including not being
eligible for some plans that I may discuss.

To help us narrow down plan options, do you mind telling me what kind of coverage you currently have?
If Caller has a plan but did not mention the carrier's name:
Which insurance company is that with?

And, why are you looking to make a change?

Responding to an ad or commercial: If outside of AEP, check for SEP from the list below if not already established

1. Involuntary loss of coverage: Beneficiary qualifies for one-time SEP AND Medigap GI (A,B,C,F,K,L Only) if
within 60 days
2. Moved out of plan service area: Beneficiary qualifies for one-time SEP AND Medigap GI (A,B,C,F,K,L Only) if
within 60 days
3. Other qualifying event [click link below for more guidance]: Beneficiary qualifies for one-time SEP if within
60 days: https://www.medicare.gov/pubs/pdf/11219-Understanding-Medicare-Part-C-D.pdf
4. I enrolled in MA and changed my mind; I now want Medigap: Beneficiary qualifies for Medigap Trial Right
(GI for all plans) if within first year of Medicare
5. I had Medigap then switched to MA; I now want to go back to Medigap: Refer beneficiary to original
Medigap carrier for Trial Right to re-enroll in same plan as GI
6. None of the above: Check service area for 5-Star Plan or C-SNP availability and eligibility, for possible one-
time SEP
7. No qualifying event during AEP: Proceed to find a plan with 01/01/2020 effective date
8. No qualifying event outside of AEP: Proceed with MEDIGAP

You are not required to give any health-related information; unless the information is needed to determine your
eligibility to enroll in a plan. However, I do need to ask you the following two questions to see if you are eligible to
enroll in a plan.

Do you have End Stage Renal Disease, also known as ESRD or permanent kidney failure?

If No: Continue to line 170

If Yes: Did you previously have ESRD, but have since had a successful kidney transplant?

If Yes: Continue to line 170

If No and eligible for Medigap OE or GI: Proceed as Medigap or ESRD C-SNP if available.

If No and NOT eligible for Medigap OE or GI: Check service area for ESRD C-SNP; if none, refer to 1-800-
MEDICARE

Do you reside in a nursing home or long-term care facility?

If Yes and Medigap OE or GI eligible: Proceed as Medigap ONLY

If Yes and NOT eligible for Medigap OE or GI: Refer to 1-800-MEDICARE

Do you receive any government assistance like Extra Help or Medicaid?

If Yes: Beneficiary may qualify for SEP.

 If recently lost Extra Help or Medicaid: Beneficiary qualifies for one-time SEP if within 60 days (LIS annual
redetermination SEP from Jan 1 to Mar 31)

If NO: Continue to line 190

In your area, we have a wide variety of plans. I’d like to outline each of these, and then we can decide which plan
might be suitable for you based on your needs. So, typically, I discuss coverage options for your

Health, prescriptions, dental, vision, and other health related products.

Is it ok to discuss all of these today?

If No: Which of these would you like to discuss today?

NOTE TO AGENT: Restate selected options to confirm understanding, then proceed with plan options only for which
the beneficiary has provided confirmation and consent. Ask if you can discuss benefits that are in the plan that cost
no additional money!

you have two possible paths if you're looking for a private Medicare plan. One is called Medicare Advantage and the other is called a Med
u familiar with the differences between these options?
Caller knows what plan type they're interested in:
Which of these options did you have in mind? What do you like about it?

Caller doesn’t knw what plan type they’re interested in:

No problem. I'm here to help. Both plan options include benefits for hospital and medical expenses. Now I'd like
to share with you how the two are different, including how they work with prescription coverage. Then, you can
decide which one you prefer.

DRUG SCREENER call WITH RX LISTED:

As far as your drug coverage goes, it's important to make sure the plans in your area include any medications you'd
like covered. Are there any medications you'd like me to look up?

I see a list of medications associated with your profile. Do I have permission to verify that these are correct?

If YES: Thank you. Please let me know if any need to be edited, added, or removed.

If NO: No problem. We'll move on, but please keep in mind that our suggestions are based on the accuracy of the
information that we have.

If Yes: Sure! Please provide the name, dosage, and quantity of any medications you'd like me to look up. If No:
Click the button below for the appropriate plan type.

Are there any doctors that must be in the network for you to feel comfortable enrolling in the plan?
 If Yes: Which providers would you like me to look up?
If No: In that case, once you decide on an option, we can find a doctor near you within the plan's
etwork. You can always change your Primary Care Physician later if you decide, or if you find out that a doctor
you like already accepts your plan.

Alright, now is there anything else that we have not spoken about?
And with everything we have discussed, what is of most importance to you?
Alright, so you said you’d like <restate/summarize previous answer”, is that right?

1.) USING YOUR QUOTING TOOLS, FIND THE MOST SUITABLE PLAN FOR THE CALLER.
2.) OPEN THE PLAN'S SUMMARY OF BENEFITS TO PREPARE FOR THE BENEFITS
PRESENTATION.
3.) MAKE NOTE OF THE PLAN'S CUSTOMER SERVICE PHONE NUMBER AND WEBSITE.
4.) MAKE NOTE OF YOUR TOP 2 OR 3 REASONS FOR THE PLAN SELECTION.

Thanks for all that information. I've researched (##) plans in your area, from (Carrier 1, 2,3) and more, with monthly
premiums as high as <highest plan premium>, but we were able to find a plan for only $<plan premium>. The plan is
through <carrier name>, and here are a few reasons why I think this might fit your needs:

(List the top 2 or 3 reasons the plan is a suitable fit. THIS IS NOT A BENEFITS PRESENTATION)

Would you like to hear more about this plan?

If No: What would you like to see different?

If yes: Before we go any further, here are some things you should know about this plan. The plan's name is <Plan
Name>. You don't need to write this down now, but it also has a unique Plan Number to identify it. It is <Plan
Number>.

While HealthMarkets licensed sales agents may not represent all plans in your service area, we offer many plan
options from multiple insurance companies. For a complete listing of plans available in your service area, you may
contact 1-800-MEDICARE (TTY: 877-486-2048), 24 hours a day/seven (7) days a week, or
consult www.medicare.gov.

Before making an enrollment decision, it is important that you fully understand the plan's benefits and rules.
If you have any questions, let me know and I will be happy to address them with you.

If you choose to enroll, you will receive an Evidence of Coverage in the mail, among other plan documents.
The Evidence of Coverage will give you a detailed look at everything the plan covers, as well as any exclusions or
limitations, so it's important to look at this when you get it.

Review the full list of benefits found in the Evidence of Coverage (EOC), especially for those services for which you
routinely see a doctor. Visit [INSERT PLAN WEBSITE] or call [insert plan phone number] to view a copy of the EOC.
Benefits, premiums and/or copayments/co-insurance may change on January 1, [INSERT FOLLOWING YEAR].
(Example: If you are discussing a 2020 plan, you should say, "January 1, 2021," etc.)

FOR MA/MAPD
NOTE TO AGENT: Please read ONLY the applicable Plan Type Disclosure from the list below.
C-SNIP: This plan is a chronic condition special needs plan (C-SNP). Your ability to enroll will be based on
verification that you have a qualifying specific severe or disabling chronic condition.

D-SNP: This plan is a dual eligible special needs plan (D-SNP). Your ability to enroll will be based on verification that
you are entitled to both Medicare and
medical assistance from a state plan under Medicaid. [D-SNPs may provide additional information if they impose
restrictions to specific
Medicaid eligibility category(ies)]

I-SNP: This plan is an institutional special needs plan (I-SNP). Your ability to enroll will be based on verification that
you, for 90 days or longer,
have had or are expected to need the level of services provided in a long-term care (LTC) skilled nursing facility (SNF),
a LTC nursing facility (NF),
a SNF/NF, an intermediate care facility for individuals with intellectual disabilities (ICF/IDD), or an inpatient
psychiatric facility.

I-SNPS ACCEPTING MEMBER PRIOR TO HAVING AT LEAST 90 DAYS OF INSTITUTIONAL

LEVEL OF CARE: This plan is an institutional special needs plan (I-SNP). Your ability to enroll will be based on
verification that your condition makes
it likely that either the length of stay or the need for an institutional level of care would be at least 90 days.

MSA’s
Plans combine a high deductible Medicare Advantage Plan and a trust or custodial savings account (as defined
and/or approved by the IRS).
The plan deposits money from Medicare into the account. You can use this money to pay for your health care costs,
but only Medicare-covered expenses count toward your deductible. The amount deposited is usually less than your
deductible amount, so you generally have to pay money out of pocket before your coverage begins.

Medicare MSA Plans do not cover prescription drugs. If you join a Medicare MSA Plan, you can also
join any separate Medicare Prescription Drug Plan. There are additional restrictions to join an MSA plan, and
enrollment is for a full calendar year unless you meet certain exceptions. Those who disenroll during the calendar
year will owe a portion of the account deposit back to the plan. Contact the plan at [insert customer service and TTY]
for additional information.

NOTE TO AGENT: Please read ONLY the applicable Network Disclosure from the list below. For
HOM-POS read BOTH HMO and POS disclosures.
HMO: This plan is an HMO. That means both Medicare and the plan will ONLY pay for services you receive through
providers in the plan's network. So, you will have to pay the FULL COST for any treatment you get from a provider
that is NOT in the plan's network, unless it's an urgent care or emergency situation, or if you need renal dialysis. Also,
referrals are required from your Primary Care Physician before seeing any network Specialists.

POS/PPO: This plan is a PPO (or POS). That means both Medicare and the plan will pay for providers who are NOT
in the plan's network, although you might have to pay a higher out-of-network rate for their services, unless it's an
urgent care or emergency situation, or if you need renal dialysis. It's important to call ahead if you decide to see an
out-of-network provider since they're not required to see you unless it's an emergency. To save you some time, I'll
cover the plan's costs for different services at the in-network rate. Please let me know if you'd like to hear the out-
of-network rate for any of these items.

PFFS Non-Network: This is a Private Fee-for-Service or PFFS plan. A Private Fee-for-Service plan is NOT a
Medicare Supplement plan. Providers who do not contract with the plan are not required to see you, except in an
emergency.

PFFS – Full and Partial Networks: This is a Private Fee-for-Service or PFFS plan. A Private Fee-for-Service plan is
NOT a Medicare Supplement plan. Providers who do not contract with the plan are not required to see you except in
an emergency. With the exception of emergencies and urgent care situations, it may cost more for covered services
received outside the network.

REVIEW MEDICAL BENEFITS FROM THE SUMMARY OF BENEFITS

Medical Deductible [ONLY READ If the plan has a deductible]

Some covered services may require you to meet a deductible every calendar year before the plan will pay its share of
the cost. If your deductible applies, it is $<#>.

Maximum Out Of Pocket (MOOP)

This plan has a built-in safety net to protect you financially, called a Maximum Out of Pocket (MOOP). You can think
of this as your worst-case scenario during any calendar year for covered medical and hospital services. If your out-
of-pocket spending for these items ever reaches $<#>, the plan will pay 100% of any other of these expenses you
incur the rest of the year for covered services.
NOTE: does not apply to Part D

Doctor Office Visits (PCP) The copay for each visit to a network Primary Care Physician is $<#>.
Specialist Office Visit The copay for each visit to a network Specialist is $<#>.
READ THIS FOR HMO PLANS: Except in emergency or urgent situations, we do not cover services by out-
of-network providers (doctors who are not listed in the provider directory).

READ THIS FOR HMO-POS PLANS: Our plan allows you to see providers outside of our network (non-contracted
providers). However, while we will pay for certain covered services provided by a non-contracted provider, the
provider must agree to treat you. Except in an emergency or in urgent situations, non-contracted providers may deny
care. In addition, you will pay a higher co-pay for services received by non-contracted providers.

READ THIS FOR PPO, PFFS AND OTHER PLANS THAT OFFER OUT TO NETWORK COVERAGE: Our plan allows you to see
providers outside of our network (non-contracted providers). However, while we will pay for certain covered services
provided by a non-contracted provider, the provider must agree to treat you. Except in an emergency or in urgent
situations, non-contracted providers may deny care. In addition, you will pay a higher co-pay for services received by
non-contracted providers.

READ THIS DISCLOSURE FOR ALL PLANS: Review the provider directory (or ask your doctor) to make sure the
doctors you see now are in the network. If they are not listed, it means you will likely have to select a new doctor.

Inpatient Hospital Care : This plan covers an unlimited number of days per hospital stay. If you're ever admitted to a
network hospital for an inpatient stay, you will pay $<#> per day for the first <#> days, then your plan pays for the
rest of that stay.

Other Covered Services Now I'm going to list some other services this plan covers. Please be sure to call your plan
ahead of time, since prior-authorization may be required.

NOTE: YOU DO NOT HAVE TO READ THE COPAYS FOR THE BENEFITS LISTED BELOW.

Some of these covered expenses include:

• Routine Diagnostics and Lab work

• Durable Medical Equipment (DME), such as wheelchairs, crutches, oxygen, and diabetic supplies
• Skilled Nursing Facility (SNF)
• Home Health Care
• Outpatient Mental Health Care

MAPD PLANS
You must use network pharmacies, except under non-routine circumstances. Quantity limitations, copayments, and
restrictions may apply.

Review the pharmacy directory to make sure the pharmacy you use for any prescription medicines is in the network.
If the pharmacy is not listed, you will likely have to select a new pharmacy for your prescriptions.

DISCLOSE ALL DRUG RESTRICTIONS LISTED IN THE "DRUG

OVERVIEW" SECTION OF
QUOTECONNECT FOR ANY RX MENTIONED BY THE CALLER

IF PRIOR AUTHORIZATION APPLIES TO A SPECIFIC MEDICATION: [INSERT RX NAME/S] will require prior authorization
by the plan before it will pay for the costs. This means you will have to call ahead to ensure your plan will cover this
medication.

IF STEP THERAPY APPLIES TO A SPECIFIC MEDICATION: [INSERT RX NAME/S] will require step therapy by the plan
before it will pay for the costs. This means the plan may require you to try other, less expensive drug options used to
treat the same medical condition before it will cover this medication.

REVIEW PART D BENEFITS FROM THE SUMMARY OF BENEFITS

• Part D Deductible (also called the Pharmacy Deductible.)
• All Drug Tiers and Costs for ALL categories (i.e. Preferred, Standard, Mail Order, etc.)
• Coverage Gap
• Catastrophic Coverage

MAPD’s
Star Rating This plan's OVERALL Star Rating is <#> stars out of five stars. Medicare evaluates plans based on a 5-star
rating system. Star Ratings are calculated each year and may change from one year to the next.
Monthly Premium Your monthly plan premium for all of these benefits is $<#>.
NOTE: Agents must never refer to $0 premium as “free”

Annual Premium That comes to $<#> per year.

NOTE: Multiply monthly premium x 12.

In addition to your monthly plan premium, you must continue to pay your Medicare Part B premium. This
premium is normally taken out of your Social Security check each month.

Do you think this plan meets your needs? Do you have any questions about the plan?

Great, so as a reminder, this is the <Plan Name> and <Plan Number>. The next step is enrollment; are you ready to
enroll in this plan today?

If No:

What part of this plan doesn't work for you?

What would you like to see different?

If needed go back to Plan Search and select a new plan.

If I can't right now / I don't have time:

May we give you a call back next week?

If Yes: What is a good day and time?

If No: Would you like to schedule a call back?
(Agent: Schedule a "callback" in Five9)

If Yes:

Okay, I'd like to give you a few pointers to make the enrollment process smoother:

• To comply with legal requirements, I may have to repeat some basic questions I've already asked you--such as your
name, Medicare information, etc
• You'll want to keep your Medicare ID information handy since you'll need it to apply.

• I will also have to read all questions and disclaimers exactly as they appear on the screen, although I'm happy to
explain any of these as needed.

• You will need to provide a clear YES or NO response if asked; otherwise, I may be required to repeat the question.

AGENT PRE-ENROLLMENT CHECKLIST

• Are you on an inbound line? (required for MA/MAPD/PDP)

• Did you review the required benefits and disclosures about the plan and answer all the beneficiary's questions?

• Did you identify (or assign) a valid, in-network PCP with a valid PCP ID? (required for ALL plans, except PFFS and
Medigap)

GO TO ENROLLMENT WEBSITES FOR CHOSEN CARRIER