Providence Medicare Advantage Plan enrollment forms & documents

Enrollment information

Please visit our how to enroll page and read the enrollment instructions (PDF coming soon) 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

• Multi-language insert (PDF)
• Summary of Benefits
• Plan Comparisons
• Evidence of Coverage
• Optional Supplemental Dental Benefits
• Plan star rating (PDF)
• Plan star rating (Spanish) (PDF)
• Plan star rating (Vietnamese) (PDF)
• Important contract information (PDF)
• How to appoint a representative (PDF)

Resources for enrollment

• How to enroll – Helpful information on when and where to enroll
• Premium payment options – Your choices for how to pay your monthly bill
• Premium assistance –You may qualify for extra help
• Medicare Service Area – Where our plans are offered