1. Download, print and complete form with signature:
Enrollment Application 2024
You can enroll in a Preferred Care Partners plan RIGHT NOW by doing the following:
Need Assistance Completing This Form?
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Phone
1-844-723-6470 (TTY -711) Toll-Free
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Fax
1-888-950-1170
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Office Hours
8 a.m. to 8 p.m. 7 days a week
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Phone
1-855-548-1564 (TTY -711) Toll-Free
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Fax
1-888-950-1170
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Office Hours
8 a.m. to 8 p.m. 7 days a week
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Phone
1-855-874-6282 (TTY -711) Toll-Free
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Fax
1-888-950-1169
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Office Hours
8 a.m. to 8 p.m. 7 days a week
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Or you can:
2. Enroll online by completing and submitting your enrollment form electronically!
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Website
Enroll online by completing and submitting your enrollment form electronically!
www.medicare.gov