Providence Medicare Advantage Plan enrollment forms & documents




Enrollment information

Please visit our how to enroll page and read the enrollment instructions(PDF) before completing enrollment forms.


Once you have completed your enrollment form, fax it to 503-574-8653 or mail to:


Providence Medicare Advantage Plans

P.O. Box 5548
Portland, OR 97228-5548


You will receive a notice in the mail acknowledging receipt of your enrollment request.


Individuals must have both Part A and Part B to enroll.




Reference documents




Resources for enrollment

Enrollment forms

Do you need some extra assistance?

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Webpage is current as of: 06/16/2021

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