Avoiding CTMs: What Every Agent Needs to Know to Stay Complaint-Free

When it comes to selling Medicare plans, a smooth enrollment experience doesn't just benefit the client—it protects your reputation and keeps you out of the dreaded CTM (Complaint Tracking Module) reports. This quick guide breaks down the most common drivers of complaints and how you can stay ahead of them.

🧠 Know Before You Show: Presenting Benefits the Right Way

Before diving into benefits, make sure you're speaking to the decision-maker. Then, focus on:

• Knowing your plans—inside and out.

• Clear communication—don’t gloss over any details.

• Full disclosure—highlight all benefits, especially the ones that generate the most confusion:

  • Spending account cards

  • Dental, vision, and hearing

  • Transportation services

These are often the root of customer complaints—so slow down and explain clearly.

✅ Confirm Decision-Making Authority

Always ask the beneficiary directly: "Do you make your own healthcare decisions?"
If a Power of Attorney (POA) or Legal Guardian is present, confirm their authority and let them know CMS may require proof later.

🕒 Educate on the Late Enrollment Penalty (LEP)

A Late Enrollment Penalty can sneak up on clients who go without creditable drug coverage for 63+ days. Let them know in advance:

• What it is

• When it applies

• How it impacts their costs long term

No surprises = fewer complaints.

🩺 C-SNP: Chronic Condition, Clear Communication

If you're enrolling someone in a Chronic Care Special Needs Plan (C-SNP), don’t skip the fine print:

• Explain eligibility clearly

• Let them know they need to get the Verification of Chronic Condition (VCC) form completed by their doctor

• Stress the deadline: no VCC by the end of month two = disenrollment

💵 The Part B Giveback: Set Realistic Expectations

The Part B Giveback is great—but only if it's explained well. Be sure your clients understand:

• It may take up to 3 months to show up

• Reimbursements are retroactive

• It’s typically applied to their Social Security check

• If they don’t pay Part B through Social Security, their monthly bill to Medicare is reduced

• Railroad retirees? It goes to their Railroad Retirement benefit

🗽 Working with Veterans? Do a Full Needs Analysis

For Veterans with TRICARE for Life or CHAMPVA, enrolling in a Medicare Advantage Plan requires extra clarity. Tell them:

• They must use providers in the plan’s network

• They’ll need to coordinate to get secondary coverage from TRICARE or CHAMPVA—or submit reimbursement forms

🪖 Honors Plans vs. VA/ChampVA Coverage

Honors plans can be appealing, but make sure your clients know:

• VA and Medicare Advantage don’t coordinate

• VA Healthcare only covers services by VA providers or pharmacies

• Non-VA prescriptions typically can’t be filled at VA pharmacies unless approved by a VA doctor

Final Thought: The Best Offense is a Great Defense

Avoiding CTMs is all about transparency, education, and taking the time to understand your client's situation. When you empower your clients with the right information, everyone wins.

PSM Agent Compliance Resources

PSM Medicare Agent Resources