Medicare Outsourcing: FCC 26-16 and 2026 CMS Rules

Written and operationally reviewed by Miki Furman, Founder and CEO, on August 18, 2026.

The earlier version of this guide incorrectly described an FCC offshore-call-center proposal as a September 2024 final ruling. The official record shows something different: FCC 26-16 was adopted March 26 and released March 27, 2026 as a Notice of Proposed Rulemaking. Comments closed June 2 and reply comments June 29, 2026 after an FCC extension order. As of this August 18 update, the cited record is still a proposal, not a final rule.

What Did FCC 26-16 Change for Medicare Outsourcing?

FCC 26-16 did not create a current Medicare offshore-disclosure obligation. It is a March 2026 notice of proposed rulemaking. The proposals initially target specified communications providers and their affiliates, while the FCC asks whether some requirements should extend to other services and calls covered by parts of the TCPA.

The proposal's initial scope covers telecommunications, commercial mobile radio, interconnected VoIP, cable television, and direct broadcast satellite providers or their affiliates, including consumer communications about internet access that they provide. The FCC asks separately whether it has authority to extend some or all proposals to other providers or to calls covered by sections 227(c) and 227(d) of the Communications Act.

Among the ideas on which the FCC sought comment were:

• disclosing at the beginning of a call that it is handled outside the United States;
• transferring a consumer to a US-based representative on request;
• limits on the share of customer-service calls handled at foreign call centers;
• English-proficiency, training, reporting, and data-security standards; and
• keeping specified sensitive-data transactions in the United States.

Those are proposals, not requirements that this guide can treat as current law. A Medicare organization may still face existing TCPA, CMS, HIPAA, state insurance, recording-consent, contract, and privacy duties. FCC 26-16 should be monitored as a possible future change, not used as the legal basis for a current disclosure script.

What CMS Rules Apply to Outsourced Medicare Calls in 2026?

Under 42 CFR 422.2274, agents and brokers representing Medicare Advantage organizations must be licensed and appointed when state law requires, complete annual training and testing with at least an 85% score, and document Scope of Appointment before personal marketing appointments. TPMO rules also govern call recording, lead disclosures, plan oversight, and beneficiary-data sharing.

Licensing, appointment, training, and Scope of Appointment

The regulation defines representation broadly: it includes selling Medicare products, outreach to existing or potential beneficiaries, and answering or potentially answering their questions. Agents and brokers who represent an MA organization must be licensed and appointed where applicable state law requires it, complete annual training and testing, score at least 85%, and secure and document Scope of Appointment before a personal marketing appointment. CMS publishes separate 2026 training and testing guidelines; the federal rule does not require one named commercial training vendor.

TPMO oversight and call recording

When a Medicare Advantage plan works with a third-party marketing organization, the plan must oversee that TPMO and require disclosure of subcontracted marketing, lead-generation, and enrollment relationships. Marketing and sales calls must be recorded in their entirety and retained for at least six years: audio for the first three years, then audio or a complete and accurate transcript for years four through six.

Lead disclosures and beneficiary-data sharing

A TPMO conducting lead generation must disclose when beneficiary information will be provided to a licensed agent for future contact and when a beneficiary is being transferred to an agent who can enroll them. Since October 1, 2024, personal beneficiary data collected for marketing or enrollment may be shared with another TPMO only after prior express written consent that names each receiving entity and lets the beneficiary accept or reject each one.

Does Caribbean Nearshore Avoid Offshore Rules?

No. A call center in Jamaica, Trinidad, Belize, Saint Lucia, Guyana, or Colombia is outside the United States. Time-zone overlap and language capability may improve operations, but they do not create domestic legal status or an exemption from CMS, HIPAA, TCPA, state, contract, or data-access requirements.

Nearshore can still be an operationally useful delivery model. Caribbean teams overlap US Eastern and Central business hours, can support real-time supervision during AEP and OEP, and offer English-first or bilingual staffing depending on the country. Those factors belong in the service and cost analysis, not in a claim that the geography changes the legal classification.

For a buyer comparing locations, evaluate the actual control environment: which data fields foreign agents can see, where recordings are stored, whether subcontractors are disclosed, how scripts are versioned, who can override a transfer, and how the plan audits the vendor. Our Medicare call center outsourcing model is designed around client-approved administrative and routing scope, with plan-specific marketing, recommendations, and enrollment kept behind the licensed boundary the client establishes.

How Should a Medicare Buyer Scope an Outsourced Team?

Start with the activity, not the job title or vendor location. Classify every script step as administrative service, communication, marketing, representation, sales, or enrollment; identify the data exposed; then assign licensing, training, recording, consent, and oversight controls. Transfer the call before an unlicensed agent crosses into plan-specific advice, recommendation, or enrollment.

Administrative work to evaluate for outsourcing

• inbound administrative member-service intake and routing;
• appointment scheduling and callback coordination;
• identity, contact, and case-reference collection within approved system permissions;
• status updates read directly from a plan-approved system or script; and
• warm transfer to the appropriately licensed or authorized team.

That list is not a legal safe harbor. CMS defines representation broadly, and state rules differ. A script that begins as scheduling can become marketing when an agent answers plan questions, steers a beneficiary, or gathers information to recommend a product. The plan and its counsel should approve the exact workflow before the BPO handles live calls.

2026 buyer checklist

1. Map every task. Mark the exact point where administrative service becomes representation, marketing, sales, or enrollment.
2. Verify people controls. Confirm state license and appointment requirements plus annual CMS training and testing for each regulated role.
3. Approve scripts and transfers. Version-control scripts and make the escalation boundary visible in the desktop workflow.
4. Record the required calls. Confirm the six-year TPMO retention design, including audio for years one through three.
5. Control lead disclosures and consent. Test the licensed-agent transfer disclosure and entity-by-entity written consent before TPMO data sharing.
6. Limit beneficiary data. Give each role only the fields it needs and document where recordings, transcripts, and audit logs reside.
7. Audit subcontractors. Require the vendor to disclose every downstream marketing, lead-generation, and enrollment relationship.
8. Monitor FCC 26-16. Track the docket for a final order, but do not represent the proposal as current law.

Call Force Global is not an insurance agency and does not provide plan recommendations or enrollment. We scope non-licensed administrative and routing work only after the client approves the task list, script, system permissions, recording controls, and transfer boundary. Use the CFG outsourcing calculator after that boundary is defined, and use our nearshore call center company comparison to build a wider diligence list.

Sources

1. Federal Communications Commission, FCC 26-16, Notice of Proposed Rulemaking, adopted March 26 and released March 27, 2026.
2. Federal Communications Commission, DA 26-510, order extending comments to June 2 and reply comments to June 29, 2026.
3. 42 CFR 422.2274, current agent, broker, and other third-party requirements for Medicare Advantage organizations.
4. CMS Contract Year 2026 Agent and Broker Training and Testing Guidelines.

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