Enroll Now

• MedicareBlue PPO (Regional PPO) Enrollment Form
• MedicareBlue Rx (PDP) Enrollment Form
• When to Enroll

MedicareBlue Rx (PDP)

A few quick tips before enrolling...

• Please read this important information.
• Make sure you meet the eligibility requirements.
• You must complete each section before moving to the next one.
• Your enrollment will not be saved until you click the Enroll Now button at the end of the application. If you click Exit Enrollment at any time (before clicking Enroll Now) and come back later, you will need to start over.
• If you have problems enrolling online you can also:
• Print and mail in the MedicareBlue Rx (PDP) paper enrollment form (PDF) PDF instructions or
• Enroll by phone by calling 1-866-434-2037, 8 a.m. to 8 p.m., daily, Central and Mountain Time. TTY users should call 1-866-456-1550.
• If anyone helps you fill out your application, that individual must electronically sign the enrollment form and indicate his or her relationship to you.
• No premium payment is required at the time you join. If you complete a paper application, make a copy of your signed application for your records.

After You Apply

MedicareBlue Rx (PDP) will send you an acknowledgement letter confirming your enrollment, an ID card and a Welcome Kit with the plan’s Evidence of Coverage that provides a full description of MedicareBlue Rx (PDP) benefits.

Note: Do not disenroll from any Medicare supplement plan, or Medigap or Medicare Select plan until you receive approval from MedicareBlue Rx (PDP).