How to Start a Medicare Call Center from Scratch in 2026

Step 1: Licensing and Certifications

Before you make a single call, you and your agents need to be properly licensed. Medicare sales are among the most heavily regulated in the insurance industry, and operating without proper credentials can result in fines, sanctions, and permanent exclusion from federal health care programs.

State insurance licenses: Every agent selling Medicare products must hold an active health insurance license in each state where they plan to sell. If you're operating a call center that takes calls from across the country, this means your agents may need licenses in 20, 30, or even all 50 states plus the District of Columbia. The licensing process varies by state—some require pre-licensing education (typically 20-40 hours), a proctored exam, and continuing education credits. Budget $200-$500 per state per agent for initial licensing, and plan for a 2-6 week timeline depending on the state.

AHIP certification: The America's Health Insurance Plans (AHIP) certification is effectively mandatory. While technically optional, virtually every major carrier requires agents to complete AHIP's Medicare training program before they can be appointed. The annual certification costs approximately $175 per agent and must be renewed before each AEP. Start this process no later than July to ensure all agents are certified before carrier contracting deadlines.

Carrier appointments: You'll need to be contracted with Medicare Advantage and Part D carriers to sell their products. The contracting process typically takes 2-4 weeks per carrier and involves background checks, E&O insurance verification, and completion of carrier-specific training modules. Most successful Medicare call centers are appointed with 5-15 carriers to offer broad plan selection.

Step 2: CMS Compliance Requirements

The Centers for Medicare & Medicaid Services (CMS) publishes the Medicare Communications and Marketing Guidelines (MCMG) annually, and every word in that document applies to your call center. Compliance isn't optional—it's existential. A single substantiated complaint can trigger a CMS audit, and systematic violations can result in civil monetary penalties of up to $119,561 per occurrence, suspension of marketing activities, or contract termination.

Here are the CMS requirements that directly impact call center operations:

• Scope of Appointment (SOA): You must obtain a signed SOA from every beneficiary at least 48 hours before a sales appointment during AEP. The SOA must specify which product types will be discussed—if the beneficiary asks about a product not on the SOA, you must end the conversation on that topic and obtain a new SOA for a separate appointment.
• Call recording: All marketing and sales calls must be recorded and retained for a minimum of 10 years. Your recording system must capture 100% of calls—missed recordings are treated as compliance violations during audits.
• Required disclaimers: Every call must include specific CMS-mandated disclaimers, including "We do not offer every plan available in your area" and "Medicare has neither reviewed nor endorsed this information."
• No cold calling: You cannot make unsolicited calls to Medicare beneficiaries. Every outbound call requires documented Permission to Contact (PTC) that was obtained in a compliant manner.
• No misleading statements: You cannot use scare tactics, make guarantees about benefits without knowing the beneficiary's specific eligibility, or imply that a plan is endorsed by Medicare or the government.

Step 3: Technology Stack Selection

Your technology stack is the backbone of your call center. The wrong tools will bottleneck your growth, frustrate your agents, and create compliance gaps. The right tools will multiply your agents' effectiveness and protect your business. Here's what you need:

Dialer system: This is your most critical investment. A Medicare call center needs a dialer purpose-built for insurance—not a generic contact center platform. Look for features including predictive/power/preview dialing modes, built-in compliance safeguards (TCPA, TSR, state-level calling restrictions), DNC list management, call recording with long-term archival, real-time supervisor monitoring (listen, whisper, barge), and disposition tracking. An insurance-specific dialer will have these features built in rather than bolted on.

CRM system: You need a CRM that tracks the entire beneficiary lifecycle—from lead to enrollment to retention. Your CRM should integrate with your dialer so agents never have to toggle between systems. Key features include lead source tracking, policy and enrollment tracking, follow-up task management, carrier portal integration, and commission tracking. A call center CRM designed for insurance will save you months of configuration compared to adapting Salesforce or HubSpot.

Phone system: Invest in a VoIP phone system with local presence dialing. Answer rates for calls from local area codes are 3-4x higher than toll-free or out-of-area numbers. You'll also need dedicated inbound numbers for marketing campaigns, a toll-free number for existing clients, and enough concurrent call capacity to handle peak AEP volumes.

Quality assurance tools: AI-powered call monitoring can review 100% of your calls for compliance and quality—something human QA teams can only do for 2-5% of calls. This is increasingly becoming a competitive necessity rather than a nice-to-have.

Step 4: Staffing and Training

Hiring the right agents and training them properly is where most new Medicare call centers succeed or fail. The ideal Medicare sales agent combines product knowledge, compliance awareness, empathy, and sales ability—a rare combination that you'll typically need to develop rather than find ready-made.

Hiring profile: Look for candidates with prior call center experience, ideally in insurance or financial services. Prior Medicare experience is a bonus but not a requirement—product knowledge can be trained, but communication skills and work ethic are harder to teach. Plan on hiring 20-30% more agents than you think you need to account for attrition during training.

Training program: A comprehensive Medicare agent training program should take 2-4 weeks and cover the following areas:

• Week 1: Medicare basics (Parts A, B, C, D), eligibility rules, enrollment periods, and beneficiary demographics
• Week 2: Product training on specific MA and Part D plans you're contracted to sell, plan comparisons, and carrier-specific enrollment procedures
• Week 3: CMS compliance training, call scripts and frameworks, objection handling, SOA procedures, and recording/disclosure requirements
• Week 4: Technology training (dialer, CRM, enrollment systems), live call observation, practice calls, and certification testing

Compensation structure: Most Medicare call centers use a base-plus-commission model. Base pay typically ranges from $15-$22/hour depending on the market and experience level. Commission structures vary widely but typically pay $100-$300 per Medicare Advantage enrollment and $50-$150 per Part D enrollment. During AEP, top-performing agents can earn $80,000-$120,000+ annualized when commissions are included.

Step 5: Lead Sources—Inbound vs. Outbound

Leads are the fuel that drives your call center. Without a reliable lead strategy, even the best agents and technology won't generate revenue. Understanding the lead landscape is critical to your cost structure and profitability.

Inbound leads: These come from beneficiaries who contact you—through your website, TV/radio ads, direct mail responses, or digital advertising. Inbound leads convert at 15-30% and are the highest-quality source, but they're expensive to generate ($50-$200+ per lead depending on the channel) and take time to build up. Most new call centers can't survive on inbound alone during their first year.

Outbound leads (with PTC): Purchased leads from vendors who have collected Permission to Contact from beneficiaries. These typically cost $15-$60 per lead and convert at 5-15%. Quality varies dramatically by vendor—always request sample leads and test small batches before committing to volume contracts.

Live transfer leads: Pre-screened beneficiaries transferred directly to your agents by a lead generation company. These are the most expensive ($30-$100 per transfer) but also the highest-converting outbound source (15-25%) because the beneficiary is already on the phone and has expressed interest. Excellent for AEP when speed matters.

Aged leads: Leads that are 30-90+ days old and have been worked by other agents. These cost $2-$10 per lead and convert at 1-5%. Low conversion rate, but the math can work if your cost-per-acquisition stays within target. Many successful call centers use aged leads to keep agents productive during off-peak periods.

Step 6: Building Your Compliance Program

A compliance program isn't a document that sits on a shelf—it's a living system that protects your business every day. CMS expects every organization selling Medicare products to maintain a comprehensive compliance program with the following elements:

• Written compliance policies and procedures covering all marketing and sales activities, call handling, SOA collection, recording retention, and complaint resolution
• Designated compliance officer who is responsible for monitoring compliance, investigating issues, and reporting to leadership
• Regular training on compliance topics for all agents and staff, documented with sign-off sheets
• Call monitoring program that reviews a statistically significant sample of calls for compliance violations
• Complaint tracking and resolution process with documented corrective actions
• Agent discipline and remediation procedures for compliance violations
• Annual compliance program audit to identify gaps and improvements

Step 7: Cost Breakdown—What It Actually Takes

One of the most common questions from aspiring call center owners is "How much does it cost?" The honest answer is that it depends on your scale, but here's a realistic breakdown for a 10-agent Medicare call center:

Startup costs (one-time):

• Office space build-out and furnishing: $10,000-$30,000 (or $0 if remote)
• Computer workstations (10): $8,000-$15,000
• Headsets and peripherals: $1,500-$3,000
• Licensing and certifications (10 agents, multi-state): $15,000-$30,000
• AHIP certifications (10 agents): $1,750
• Carrier contracting and training: $0 (time investment only)
• E&O insurance (annual): $5,000-$15,000
• Legal and compliance setup: $3,000-$10,000
• Total startup: $45,000-$105,000

Monthly operating costs:

• Agent payroll (10 agents, base only): $26,000-$38,000
• Dialer/phone system: $1,500-$4,000
• CRM software: $500-$2,000
• Lead costs: $10,000-$50,000 (highly variable)
• Office rent and utilities: $3,000-$8,000 (or $0 if remote)
• Telecom costs: $1,000-$3,000
• Supervision and management: $5,000-$10,000
• Total monthly: $47,000-$115,000

Plan for 3-6 months of operating capital before the business reaches profitability. During AEP, a well-run 10-agent call center can generate $200,000-$500,000+ in first-year commission revenue, with renewals providing recurring income in subsequent years.

Step 8: AEP and OEP Preparation

The Annual Enrollment Period (October 15 - December 7) is when 60-70% of your annual Medicare revenue will be generated. If you're not ready for AEP, you're not ready to run a Medicare call center. Preparation should begin at least 8-10 weeks before October 15.

• Technology stress testing: Run load tests on your dialer and phone system at 3-5x your normal call volume. Identify bottlenecks before they cost you revenue.
• Staffing surge: Hire and train seasonal agents 4-6 weeks before AEP. Plan for extended hours (8am-9pm) and weekend coverage.
• Lead pipeline: Secure lead vendor contracts and test delivery integrations well in advance. During AEP, you need leads flowing into the dialer in real time—a broken integration means lost revenue.
• Compliance refresher: Run a mandatory compliance training session for all agents. Review updated CMS guidelines, carrier-specific rules, and common violations from the previous year.
• Plan data updates: Load current-year plan data into your systems so agents can accurately compare benefits, premiums, and formularies.

The Open Enrollment Period (January 1 - March 31) is a secondary revenue opportunity where beneficiaries already in Medicare Advantage plans can switch to a different MA plan or return to Original Medicare. OEP call volumes are typically 30-50% of AEP, but conversion rates can be higher because you're dealing with beneficiaries who already understand their options and have a specific reason to make a change.

Step 9: Scaling Your Call Center

Once your call center is operational and generating consistent revenue, the question becomes how to scale profitably. Scaling a Medicare call center is not just about adding more agents—it's about building systems that maintain quality and compliance as you grow.

• Data-driven routing: As you add agents, implement skills-based and performance-based lead routing. Your best closers should get the highest-quality leads. Route by state expertise, product knowledge, and conversion rate.
• Automation: Automate repetitive tasks—appointment reminders, follow-up sequences, SOA delivery, and post-enrollment surveys. Every minute your agents spend on admin is a minute they're not selling.
• Remote agents: A remote or hybrid model dramatically reduces your per-agent overhead and gives you access to a national talent pool. Modern cloud-based dialers make remote agents operationally identical to on-site agents.
• Diversify lead sources: Don't rely on a single lead vendor. Build multiple channels—digital marketing, direct mail, community events, referral programs, and carrier-provided leads—to reduce risk and cost.
• Retention as revenue: Your existing book of business is a goldmine. Implementing a proactive retention program during AEP can retain 70-85% of your renewals while your competitors are trying to steal your clients.

Common Startup Mistakes to Avoid

Having helped hundreds of insurance call centers launch and grow, we've seen the same mistakes repeated. Here are the most costly ones to avoid:

• Underestimating compliance costs: Compliance isn't just a checkbox—it requires dedicated personnel, technology, training, and ongoing investment. Budget at least 10-15% of your operating costs for compliance.
• Choosing generic technology: A call center platform built for customer service or B2B sales lacks the compliance features, insurance integrations, and enrollment workflows that Medicare sales demand. You'll spend months trying to customize it and still have gaps.
• Skipping the compliance program: Operating without a formal compliance program is like driving without insurance—you feel fine until you don't. One CMS audit without a documented compliance program can shut you down.
• Insufficient training: Rushing agents through training to get them on the phones faster is a false economy. Poorly trained agents generate complaints, compliance violations, and chargebacks that cost far more than a few extra weeks of training.
• Ignoring agent retention: It costs $5,000-$10,000 to recruit, license, and train a new Medicare agent. If you're churning through agents because of poor management, inadequate tools, or below-market compensation, you're burning cash.
• No year-round strategy: Many new call centers prepare only for AEP and then scramble during the rest of the year. Build a year-round revenue plan that includes OEP, SEP opportunities, cross-selling (dental, vision, final expense), and retention activities.