AI for Medicare Lead Qualification.

Medicare is one of the most seasonal verticals in pay-per-call. During AEP (October 15 - December 7), call volume surges. The rest of the year, it drops by 60% or more.

That seasonality creates a staffing nightmare. You either hire for peak and pay for idle seats most of the year, or hire lean and miss volume during AEP. Neither option is profitable.

Beyond staffing, the qualification challenge is real. Medicare calls attract confused seniors, people under 65 who don't qualify, callers from ZIP codes your carriers don't cover, and people who just want to ask a question about their existing plan — not switch.

At $50-162 per qualified transfer, unqualified calls hitting your licensed agents waste serious money. And CMS compliance adds another layer — your agents can't say the wrong thing, which means you need experienced (expensive) people on the phone.

Medicare Advantage payments in 2025 are 20% higher per person than traditional Medicare, adding $84 billion in federal spending. The market is growing, the volume is there — the challenge is filtering it efficiently.

Medicare marketing has CMS-specific rules on top of TCPA:

• CMS marketing guidelines restrict what can be said during enrollment conversations. The AI never discusses specific plan benefits, premiums, formularies, or coverage details. It screens for eligibility and transfers to a licensed agent.
• Scope of Appointment (SOA) requirements may apply before discussing specific plans. The AI can collect SOA consent as part of the screening flow if your compliance team requires it.
• No plan recommendations. The AI asks what the caller is looking for (Advantage, Supplement, Part D) but never recommends a specific plan or carrier. That's the licensed agent's job.
• Call recording and disclosure. Dual-channel recording on every call. AI disclosure within 30 seconds per FCC rules.
• Enrollment period verification. The AI confirms the caller has a qualifying reason to enroll or switch, preventing out-of-window transfers that can't result in enrollment.