Need Help?

We're here to answer your questions.

Prescription Drug Plan Enrollment Forms

Who is this for?

If you want to sign up for a Medicare Part D prescription drug plan, you can find the enrollment form here.

 

What you'll need:

  • Your Medicare card
  • Your banking information and a voided check if you want to sign up for automatic payment withdrawal

Download and fill out the proper form for the year:

Mail to:

Prescription Blue PDP
P.O. Box 44828
Detroit, MI 48244-0828

 

Things to remember:

  • If you're enrolled in a Medicare Advantage plan, you shouldn't enroll in a prescription drug plan. If you do, you'll be dropped from your Medicare Advantage plan.