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Medicare Advantage Enrollment Forms

Who is this for?

If you want to sign up for a Medicare Advantage plan, you can find the enrollment form here.

Did you find a Medicare Advantage plan that's right for you? Select whether your plan is an HMO or a PPO, then download the form and send it to the appropriate address.

What you'll need:

  • Your Medicare card
  • Your banking information and a voided check if you want to sign up to have payments taken out of your bank account

View 2018 forms

View 2017 forms


Things to remember:

  • If you’re signing up during open enrollment, you can send us your form anytime after Oct. 15. We need your form no later than Dec. 7.
  • You'll need to fill out a separate form for each person enrolling in the plan.
  • We'll bill you. So don't worry about sending your payment in with the form. Or you can sign up to have payments taken out of your bank account.